Disclosures: Stewart and Doran report no relevant financial disclosures. Please see the study and commentary for all authors’ relevant financial disclosures.
March 25, 2021
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Primary care visits may lower nonemergent ED visits in unhoused women

Disclosures: Stewart and Doran report no relevant financial disclosures. Please see the study and commentary for all authors’ relevant financial disclosures.
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Receiving care at a primary care clinic appears to lower nonemergent ED visits among women experiencing homelessness, according to research published in JAMA Network Open.

Jenell Stewart, DO, MPH, acting assistant professor in the departments of global health and medicine in the division of allergy and infectious diseases at the University of Washington, and colleagues wrote that “this study’s findings suggest that use of collocated clinic services may be associated with reduced nonemergent ED visits among unhoused women in Seattle, indicating the need for walk-in harm-reduction services.”

Nonemergent ED visits in group of women experiencing homelessness who visited primary care clinic
Reference: Stewart J, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2021.3134.

Stewart and colleagues collected information from surveys completed by 76 adult women at a drop-in community center in Seattle, 41 of whom sought care at the Safe, Health, Empowered (SHE) Clinic, which provides care to unhoused women 4 hours per week.

The researchers compared the prevalence of ED visits among women who had at least one visit to the SHE Clinic prior to February 2, 2019, with those who did not. They evaluated electronic health records from February 2018 to August 2019 to identify the dates of any ED visits in the 10 facilities in the Seattle area and patients’ chief concerns at these visits.

Among the participants, 88% visited an ED during the study period and 61% had more than three ED visits.

The researchers determined that, of the total 388 ED visits among respondents, 43% were for emergent concerns and 57% were for nonemergent concerns.

Among the 41 women who received care at the SHE Clinic, the frequency of ED visits for nonemergent concerns decreased from 37 visits in the pre-intervention period (mean = 0.5 visits per 100 woman-days; 95% CI, 0.32-0.68) to 22 visits in the 6 months after (mean = 0.3; visits per 100 woman-days; 95% CI, 0.15-0.45).

They did not identify a change in the frequency of nonemergent ED visits among the 35 women who did not use the clinic.

In an invited commentary published alongside the study, Kelly M. Doran, MD, MHS, assistant professor in the Ronald O. Perelman Department of Emergency Medicine at NYU Grossman School of Medicine, and colleagues wrote that additional research is needed on outcomes other than ED visits, such as housing status improvement, increased physical and mental well-being, medication management, HIV prophylaxis, continuity of care and overdose risk reduction.

“We have often observed studies examining the effects of interventions on ED use, but have rarely seen reports of programmatic changes when such interventions fail to demonstrate the desired effects, which raises questions regarding how critical reduced ED use really is to a program’s goals,” they wrote. “Humanistic care addressing the health and social needs of people experiencing homelessness is essential, regardless of whether it results in a few less visits to an ED.”

References:

Doran KM, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2021.3837.

Stewart J, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2021.3134.