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Journal of General Internal Medicine

, Volume 17, Issue 5, pp 341–348 | Cite as

The impact of needle exchange-based health services on emergency department use

  • Harold A. PollackEmail author
  • Kaveh Khoshnood
  • Kim M. Blankenship
  • Frederick L. Altice
Original Articles

Abstract

OBJECTIVE: To examine the impact of the New Haven Community Health Care Van (CHCV), a mobile needle exchange-based health care delivery system, in reducing emergency department (ED) use among out-of-treatment injection drug users (IDUs) between January 1, 1996 and December 31, 1998.

DESIGN: A pre-post comparison of ED utilization was performed using linked medical records from New Haven’s only two emergency departments. Fixed-effect negative binomial regression analysis was used to explore the impact of the CHCV on ED use within a longitudinal cohort.

SETTING: Mobile health clinic in New Haven, Conn.

PARTICIPANTS: Out-of-treatment IDUs.

INTERVENTION: Acute care, linkages to medical, drug treatment, and social services.

MEASUREMENTS AND MAIN RESULTS: Among 373 IDUs, 117 (31%) were CHCV clients, and 256 had not used CHCV services. At baseline, CHCV users were more frequent users of ED services (P<.001). After full-scale implementation, mean ED utilization declined among CHCV clients and increased within the non-CHCV group. CHCV use is associated with statistically significant reductions in ED use, with an incidence rate ratio (IRR) of 0.79 (95% confidence interval [95% CI], 0.66 to 0.95). Subgroup analyses demonstrated significant IRR reductions, notably among Hispanics (0.65; 95% CI, 0.47 to 0.90), men (0.79; 95% CI, 0.64 to 0.98), HIV-negative IDUs (0.79; 95% CI, 0.63 to 0.98), and those with mental illness (0.75; 95% CI, 0.60 to 0.94).

CONCLUSION: Needle exchange-based health care services can reduce ED utilization among high-risk injection drug users. Such services may have an important role within communities with high rates of drug use and HIV/AIDS.

Key Words

injection drug users substance abuse emergency room health care utilization needle exchange HIV/AIDS mobile health care cost of care 

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Copyright information

© Society of General Internal Medicine 2002

Authors and Affiliations

  • Harold A. Pollack
    • 1
    Email author
  • Kaveh Khoshnood
    • 2
  • Kim M. Blankenship
    • 2
  • Frederick L. Altice
    • 3
  1. 1.University of Michigan School of Public Health, SPH IIAnn Arbor
  2. 2.the Department of Epidemiology and Public HealthYale UniversityUSA
  3. 3.the AIDS ProgramYale University School of MedicineNew Haven

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