title: Health, access to health care, and health care use among homeless women with a history of intimate partner violence.
abstract: Among a sample of sheltered homeless women, we examined health, access to health care, and health care use overall and among the subgroup of participants with and without intimate partner violence (IPV). We recruited homeless women from a random sampling of shelters in New York City, and queried them on health, access to health care and health care use. Using multivariable logistic regression, we determined whether IPV was associated with past-year use of emergency, primary care and outpatient mental health services. Of the 329 participants, 31.6% reported one or more cardiovascular risk factors, 32.2% one or more sexually transmitted infections, and 32.2% any psychiatric condition. Three-fourths (73.5%) had health insurance. Health care use varied: 55.4% used emergency, 48.9% primary care, and 75.9% outpatient mental health services in the past year. Across all participants, 44.7% reported IPV. Participants with IPV compared to those without were more likely to report medical and psychiatric conditions, and be insured. Participants with IPV reported using emergency (64.4%) more than primary care (55.5%) services. History of IPV was independently associated with use of emergency (Adjusted odds ratio (AOR) 1.7, 95% CI 1.0-2.7), but not primary care (AOR 1.5, 95% CI 0.9-2.6) or outpatient mental health services (AOR 1.9, 95% CI 0.9-4.1). Across the whole sample and among the subgroup with IPV, participants used emergency more than primary care services despite being relatively highly insured. Identifying and eliminating non-financial barriers to primary care may increase reliance on primary care among this high-risk group.
authors.affiliation: Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, San Diego, CA 92093-0901, USA. mvijayaraghavan@ucsd.edu
authors.forename: Maya
authors.initials: M
authors.lastname: Vijayaraghavan
authors.forename: Ana
authors.initials: A
authors.lastname: Tochterman
authors.forename: Eustace
authors.initials: E
authors.lastname: Hsu
authors.forename: Karen
authors.initials: K
authors.lastname: Johnson
authors.forename: Sue
authors.initials: S
authors.lastname: Marcus
authors.forename: Carol L M
authors.initials: CL
authors.lastname: Caton
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006304:Health Status; D006703:Ill-Housed Persons / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City; D011320:Primary Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D013179:Spouse Abuse / Q000706:statistics & numerical data*