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

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.

journal_name

J Gen Intern Med

journal_title

Journal of general internal medicine

authors

Pollack HA,Khoshnood K,Blankenship KM,Altice FL

subject

Has Abstract

pub_date

2002-05-01 00:00:00

pages

341-8

issue

5

eissn

0884-8734

issn

1525-1497

pii

jgi10663

journal_volume

17

pub_type

杂志文章

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