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.
injection drug users substance abuse emergency room health care utilization needle exchange HIV/AIDS mobile health care cost of care
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Secretary Shalala Backs Needle-Exchange Program. Wall Street Journal. April 21, 1998:A10.Google Scholar
Heimer R. Can syringe exchange serve as a conduit to substance abuse treatment? J Subst Abuse Treat. 1998;15:183–91.PubMedCrossRefGoogle Scholar
Watters J. Impact of HIV risk and infection and the role of prevention services. J Subst Abuse Treat. 1996;13:375–85.PubMedCrossRefGoogle Scholar
McGeary KA, French MT. Illicit drug use and emergency room utilization. Health Serv Res. 2000;35:153–69.PubMedGoogle Scholar
French MT, McGeary KA, Chitwood DD, McCoy CB. Chronic illicit drug use, health services utilization and the cost of medical care. Soc Sci Med. 2000;50:1703–13.PubMedCrossRefGoogle Scholar
Thompson AB, Blankenship KM, Selwyn PA, et al. Evaluation of an innovative program to address the health and social service needs of drug-using women with or at risk for HIV infection. J Community Health. 1998;23:419–40.PubMedCrossRefGoogle Scholar
Baker LC, Baker LS. Excess cost of emergency department visits for nonurgent care. Health Aff (Millwood). 1994;13:162–71.CrossRefGoogle Scholar
Markson LE, Houchens R, Fanning TR, Turner BJ. Repeated emergency department use by HIV-infected persons: effect of clinic accessibility and expertise in HIV care. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;17:35–41.PubMedGoogle Scholar
Padgett D, Brodsky B. Psychosocial factors influencing non-urgent use of the emergency room: a review of the literature and recommendations for research and improved service delivery. Soc Sci Med. 1992;35:1189–97.PubMedCrossRefGoogle Scholar
Malone RE. Whither the almshouse? Overutilization of the emergency department. J Health Polit Policy Law. 1998;23:795–832.PubMedGoogle Scholar
Padgett D, Struening E, Andrews H, Pittman J. Predictors of emergency room use by homeless adults in New York City: the influence of predisposing, enabling and need factors. Soc Sci Med. 1995;41:547–56.PubMedCrossRefGoogle Scholar
Padgett D, Struening E. Influence of substance abuse and mental disorders on emergency room use by homeless adults. Hosp Community Psychiatry. 1991;42:834–8.PubMedGoogle Scholar
Marx R, Chang S, Park M, Katz M. Reducing financial barriers to HIV-related medical care: does the Ryan White CARE Act make a difference. AIDS Care. 1998;10:611–6.PubMedCrossRefGoogle Scholar
Fleishman J, Hsia D, Hellinger F. Correlates of medical service utilization among people with HIV infection. Health Serv Res. 1994;29:523–5.Google Scholar
Mauskopf J, Turner BJ, Markson LE, Houchens RL, Fanning TR, McKee L. Patterns of ambulatory care for AIDS patients, and association with emergency room use. Health Serv Res. 1994;29:489–510.PubMedGoogle Scholar
Weissman JS, Gatsonis C, Epstein AM. Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland. JAMA. 1992;268:2388–94.PubMedCrossRefGoogle Scholar
Chitwood D, McBride D, French M, Comerford M. Health care need and utilization: a preliminary comparison of injection drug users, other illicit drug users, and nonusers. Subst Use Misuse. 1999;34:727–46.PubMedCrossRefGoogle Scholar
Friedland G, Selwyn P. Infections in drug users. In: Fauci A, Isselbacher K, eds. Harrison’s Principles of Internal Medicine. New York: McGraw Hill; 1998.Google Scholar
Levine D, Sobel J. Infections in Intravenous Drug Abusers. New York: Oxford University Press; 1991.Google Scholar
Kaplan EH, Soloshatz D. How many drug injectors are there in New Haven? Answers from AIDS data. Mathematical and Computer Modelling. 1993;17:109–15.CrossRefGoogle Scholar
Kaplan E, Heimer R. HIV prevalence among intravenous drug users: model-based estimates from New Haven’s legal needle exchange. J Acquir Immune Defic Syndr. 1994;5:163–9.Google Scholar
Heckathorn D. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl. 1997;44:174–99.Google Scholar
Heimer R, Kaplan EH, O’Keefe E, Khoshnood K, Altice F. Three years of needle exchange in New Haven. Aids Public Policy J. 1994;9:59–74.Google Scholar
Altice FK, Khoshnood K, Blankenship KM, Lamberti MP, Selwyn PA. Needle Exchange-Based Health Services as a Comprehensive Community Prevention Program. Presented at the International Conference on AIDS 1998.Google Scholar
Cameron AC, Trivedi PK. Regression Analysis of Count Data. Cambridge, UK: Cambridge University Press; 1998.Google Scholar
Stein MD, O’Sullivan PS, Ellis P, Perrin H, Wartenberg A. Utilization of medical services by drug abusers in detoxification. J Subst Abuse. 1993;5:187–93.PubMedCrossRefGoogle Scholar
Lambert E. The Collection and Interpretation of Data from Hidden Populations. NIDA Research Monograph. Rockville, Md: United States Department of Health and Human Services; 1990.Google Scholar
Currie J. Welfare and the Wellbeing of Children. Harwood Academic; 1995.Google Scholar
Reguero W, Crane M. Project MotherCare: one hospital’s response to the high pre-natal death rate in New Haven, CT. Public Health Rep. 1994;109:647–52.PubMedGoogle Scholar
Pollack H, Khoshnood K, Altice F. Health care delivery strategies for criminal offenders. J Health Care Finance. 1999;26:63–77.PubMedGoogle Scholar