Profiles of persons with current or previous experience of homelessness using emergency departments

Abstract

A typology for emergency department (ED) use was developed among persons with current or previous experience of homelessness in Quebec (Canada) (n = 455). Cluster analysis identified four profiles: (1) Low or high ED users in permanent housing: high use of primary care services; (2) High ED users in temporary housing or emergency shelters: complex health problems, frequent hospitalizations, without case managers; (3) Low or non-ED users in temporary housing: middle-aged, low quality of life, few chronic physical illnesses, little service use; and (4) Non-ED users in permanent housing: high quality of life, few affected by stigma, infrequent service use. Needs factors mainly accounted for ED use, but use of diversified health services and professionals reduced ED use. Results also suggested that improving access to health services may reduce stigma. Living in permanent housing and having a case manager were related to lower ED use, fewer hospitalizations, and greater satisfaction with services.

Keywords:

• Emergency department
• persons experiencing homelessness
• typologies
• cluster analysis
• type of housing
• healthcare service use

Acknowledgement

We are grateful for the support of the Social Sciences and Humanities Research Council of Canada (SSHRC). We thank the individuals who participated in the study and the research steering committee. We are also grateful to Judith Sabetti for her assistance.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes on contributors

Marie Josée Fleury is a professor in the Department of psychiatry at McGill University, and researcher at the Douglas Mental Health University Institue in Montreal, Canada. Her fields of expertise are health care system organization, mental health services evaluation, and outcomes studies. Her research interests focus on inter-organizational exchange, continuity and adequacy of care, implementation of innovative programs, needs assessments, service pathways in mental health, homelessness and addiction, and integration strategies at the community level.

Guy Grenier is an associate researcher at the Douglas Mental Health University Institute in Montreal, Canada. His research interests are history of medicine and psychiatry, as well as needs assessments, continuity and adequacy of care, and implementation of innovative programs in mental health, homelessness and addiction, and integration strategies at the community level.

Zhirong Cao is an experienced biostatician at the Douglas Mental Health University Institute Research Centre with broad research interests in population health, especially focussing on mental healht and homeless people.

Nadia L’Espérance is a staff researcher at the CIUSSS de la Mauricie-et-du-Centre-du-Québec and associate professor in the Psychosocial department at the Université du Québec à Trois-Rivières (Canada). Her research interests focus on improving services for clients with addiction (youth, adults, patients with traumatic brain injury, people under court order, and those in social distress.

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Additional information

Funding

This article is based on research funded by the Social Sciences and Humanities Research Council of Canada (SSHRC), (435-2016-0761).