title: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  Mobile health clinic in New Haven, Conn.
  
  
  METHODS
  Out-of-treatment IDUs.
  
  
  METHODS
  Acute care, linkages to medical, drug treatment, and social services.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Public Health, University of Michigan, Ann Arbor 48109-2029, USA. haroldp@sph.umich.edu
authors.forename: Harold A
authors.initials: HA
authors.lastname: Pollack
authors.forename: Kaveh
authors.initials: K
authors.lastname: Khoshnood
authors.forename: Kim M
authors.initials: KM
authors.lastname: Blankenship
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
mesh_terms: D003237:Connecticut; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D008297:Male; D008952:Mobile Health Units / Q000706:statistics & numerical data*; D018671:Needle-Exchange Programs; D015819:Substance Abuse, Intravenous / Q000150:complications; D013997:Time Factors