Health service utilization of heroin abusers: a retrospective cohort study.
OBJECTIVE
This study aimed to determine the patterns of medical service utilization among heroin users and to identify the factors associated with the frequency of utilization.


METHODS
We conducted a retrospective/prospective cohort study of 789 heroin-using adults in a catchment area, collecting data on their usage of medical care, including inpatient care, emergency visits, and outpatient care, in a 2-year observation period. We interviewed and reviewed the medical records of 789 heroin users in a methadone clinic of a general hospital in a rural area of Taiwan. The demographic data, records of service use, diagnoses, and information on viral infection status from Jan. 1, 2007 to Dec. 31, 2008 were collected. Most patients were middle-aged and unemployed, had a basic educational level, and began their first heroin use in their twenties.


RESULTS
The health service utilization of heroin users was mostly for infectious diseases, orthopedic conditions, and gastroenterological disorders mainly due to blood-borne or local infections and traumatic injury. Heroin users utilize fewer outpatient or inpatient services, but more emergency care than the general public. The major correlates of inpatient and emergency service utilization were HIV status and education level.


CONCLUSIONS
Our findings suggest that integrated outpatient services may help to enhance medical service accessibility and adherence, and also imply the necessity of putting more effort into promoting health management and safe behaviors in heroin users, particularly the lower-educated addicts.
Department of Psychiatry, National Taiwan University Hospital, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan.
I-Ming
IM
Chen
Department of Psychiatry, Chi Mei Medical Center, Taiwan; Department of Social Worker, Chia Nan University of Pharmacy and Science, Taiwan.
Charles Lung-Cheng
CL
Huang
(e)Department of Psychiatry, National Taiwan University Hospital Yun-Lin Branch, Taiwan.
Bao-Juan
BJ
Yeh
Department of Psychiatry, National Taiwan University Hospital, Taiwan; (f)Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taiwan. Electronic address: ylchien@hotmail.com.
Yi-Ling
YL
Chien
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D015331:Cohort Studies; D015897:Comorbidity; D004522:Educational Status; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006296:Health Services / Q000706:statistics & numerical data; D006525:Hepatitis, Viral, Human / Q000453:epidemiology; D006556:Heroin Dependence / Q000453:epidemiology* / Q000534:rehabilitation; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007239:Infections / Q000453:epidemiology; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000706:statistics & numerical data; D011446:Prospective Studies; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology; D055815:Young Adult
D009294:Narcotics; D008691:Methadone
Heroin abuse; Human immunodeficiency virus; Medical utilization; Somatic diseases; Viral hepatitis