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.
Key Words injection drug users - substance abuse - emergency room - health care utilization - needle exchange - HIV/AIDS - mobile health care - cost of care
This research was funded by the National Institute on Drug Abuse (R01-DA10186, Principal Investigator Frederick L. Altice).