Mental disorders and the use of primary health care services among homeless shelter users in the Helsinki metropolitan area, Finland

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http://hdl.handle.net/10138/201580

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Stenius-Ayoade , A , Haaramo , P , Erkkila , E , Marola , N , Nousiainen , K , Wahlbeck , K & Eriksson , J G 2017 , ' Mental disorders and the use of primary health care services among homeless shelter users in the Helsinki metropolitan area, Finland ' , BMC Health Services Research , vol. 17 , 428 . https://doi.org/10.1186/s12913-017-2372-3

Title: Mental disorders and the use of primary health care services among homeless shelter users in the Helsinki metropolitan area, Finland
Author: Stenius-Ayoade, Agnes; Haaramo, Peija; Erkkila, Elisabet; Marola, Niko; Nousiainen, Kirsi; Wahlbeck, Kristian; Eriksson, Johan G.
Contributor: University of Helsinki, Natl Inst Hlth & Welf
University of Helsinki, Natl Inst Hlth & Welf
University of Helsinki, Department of Social Research (2010-2017)
University of Helsinki, University of Helsinki
Date: 2017-06-21
Language: eng
Number of pages: 11
Belongs to series: BMC Health Services Research
ISSN: 1472-6963
URI: http://hdl.handle.net/10138/201580
Abstract: Background: Homelessness is associated with increased morbidity, mortality and health care use. The aim of this study was to examine the role of mental disorders in relation to the use of 1) daytime primary health care services and 2) after hours primary health care emergency room (PHER) services among homeless shelter users in the Helsinki Metropolitan Area, Finland. Methods: The study cohort consists of all 158 homeless persons using the four shelters operating in the study area during two selected nights. The health records were analyzed over a period of 3 years prior to the sample nights and data on morbidity and primary health care visits were gathered. We used negative binomial regression to estimate the association between mental disorders and daytime visits to primary health care and after hours visits to PHERs. Results: During the 3 years the 158 homeless persons in the cohort made 1410 visits to a physician in primary health care. The cohort exhibited high rates of mental disorders, including substance use disorders (SUDs); i.e. 141 persons (89%) had a mental disorder. We found dual diagnosis, defined as SUD concurring with other mental disorder, to be strongly associated with daytime primary health care utilization (IRR 11.0, 95% CI 5.9-20.6) when compared with those without any mental disorder diagnosis. The association was somewhat weaker for those with only SUDs (IRR 4.9, 95% CI 2.5-9.9) or with only other mental disorders (IRR 5.0, 95% CI 2.4-10.8). When focusing upon the after hours visits to PHERs we observed that both dual diagnosis (IRR 14.1, 95% CI 6.3-31.2) and SUDs (11.5, 95% CI 5.7-23.3) were strongly associated with utilization of PHERs compared to those without any mental disorder. In spite of a high numbers of visits, we found undertreatment of chronic conditions such as hypertension and diabetes. Conclusions: Dual diagnosis is particularly strongly associated with primary health care daytime visits among homeless persons staying in shelters, while after hours visits to primary health care level emergency rooms are strongly associated with both dual diagnosis and SUDs. Active treatment for SUDs could reduce the amount of emergency visits made by homeless shelter users.
Subject: Homeless
Primary health care use
Mental disorders
Register based cohort study
Shelter use
Dual diagnosis
REGISTER-BASED COHORT
UTILIZATION PATTERNS
GENERAL-POPULATION
PEOPLE
MORTALITY
ADULTS
BOSTON
NEEDS
DETOXIFICATION
COMORBIDITY
3121 General medicine, internal medicine and other clinical medicine
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