The impact of needle exchange-based health services on emergency department use
The impact of needle exchange-based health services on emergency department use
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DOI：
10.1007/s11606-002-0037-2
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发表时间：
2002-05-01
影响因子：
5.7
通讯作者：
Altice, FL
中科院分区：
文献类型：
--
作者：
Pollock, HA;Khoshnood, K;Altice, FL
目的：考察1996年1月1日至1998年12月31日期间，以移动针头交换为基础的纽黑文社区卫生保健车（CHCV）在减少治疗外注射吸毒者（IDUs）使用急诊科（ED）方面的影响。设计：利用纽黑文仅有的两个急诊科的相关医疗记录，对急诊科的利用情况进行前后比较。采用固定效应负二项回归分析在纵向队列中探讨CHCV对ED使用的影响。地点：康涅狄格州纽黑文的移动医疗诊所。参与者：未接受治疗的注射吸毒者。干预措施：紧急护理、与医疗、药物治疗和社会服务的联系。测量和主要结果：在373名IDUs中，117名（31%）是CHCV客户，256名未使用CHCV服务。在基线时，CHCV患者更频繁地使用ED服务（P < 0.001）。全面实施后，CHCV患者的平均ED使用率下降，而非CHCV患者的平均ED使用率上升。CHCV的使用与ED使用的统计学显著减少相关，其发病率比（IRR）为0.79（95%可信区间[95% CI]， 0.66至0.95）。亚组分析显示，IRR显著降低，特别是在西班牙裔（0.65;95% CI， 0.47至0.90）、男性（0.79;95% CI， 0.64至0.98）、hiv阴性注射吸毒者（0.79;95% CI， 0.63至0.98）和精神疾病患者（0.75;95% CI， 0.60至0.94）。结论：以针头交换为基础的卫生保健服务可降低高危注射吸毒者的ED使用率。这种服务可能在吸毒和艾滋病毒/艾滋病高发的社区中发挥重要作用。
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.