Use of Medical Services By Homeless Persons With Psychiatric and Co-Occurring Disorders
Methods: This study was a secondary analysis of the national ACCESS participant database that involved 6,398 participants who completed a 12-month follow-up interview with the project. The ACCESS project provided assertive outreach and case management services to homeless persons with psychiatric and co-occurring disorders in eighteen sites in nine states across the United States from 1993-1999. Multinomial logistic regression analysis was used to examine factors that predicted the use of emergency and outpatient medical services at 12-months after involvement in the project.
Results: When compared with use of outpatient medical services, higher alcohol severity scores predicted higher use of emergency medical services (OR = 3.00; CI = 2.03-4.42, p = 0.016). Also, participants with higher psychiatric symptom scores used more emergency medical services than outpatient medical services (OR = 2.22, CI = 1.515-3.25, p < 0.001). Participants who reported having a case manager were more likely to use outpatient medical services rather than emergency medical services (OR = 1.32; 1.14-1.52, p < 0.001), and those who stayed were in a shelter for 60 consecutive nights were more likely receive outpatient medical services than emergency medical services (OR = 1.22; CI = 1.06-1.39, p = 0.005).
Implications: This follow-up study of participants in the federal ACCESS initiative provides empirical evidence that alcohol use and psychiatric symptom severity predicts use of emergency medical services. Receipt of case management services and use of shelters were found to enhance participants’ use of outpatient medical services. These findings illustrate the value of providing assertive outreach and case management services to homeless persons who have psychiatric disorders. These programs can help link homeless people with psychiatric and co-occurring disorders with medical services that they need and help to further reduce the costly use of emergency medical services. Implications of these findings for social work research, practice and policy are explored.