Needle Exchange-Based Health Services Reduce Emergency Department Use

Providing active drug users with health services during their visits to needle exchange programs serves the dual purpose of cutting the death rate among this group and reducing the burden on hospital emergency rooms by as much as 41 percent, Yale researchers report in a new study.

“Our study is the first to demonstrate that providing health care to active drug users results in a positive health benefit by reducing reliance on and inappropriate use of emergency room services, in addition to reducing HIV incidence among drug users,” said senior author Frederick L. Altice, M.D., associate professor of medicine (AIDS Program) at the Yale University School of Medicine.

Published in the May issue of Journal of General Internal Medicine, the study, funded by the National Institute on Drug Abuse (NIDA) was comprised of 375 high-risk injecting drug users (IDUs). Researchers compared drug users who used needle exchange-based health services with those who didn’t use the services. IDUs using these services were provided acute, episodic and some primary care during their visits to the New Haven Community Healthcare Van (CHCV), instead of at often overwhelmed hospital emergency rooms. Between 1996 and 1998, the researchers linked the medical records of those people who used the CHCV and those who did not and compared the two samples. Altice and his team that included first author Harold A. Pollack, found that CHCV services reduced emergency department use by 41 percent; the reduction in ER use was even more impressive for those IDU’s with co-morbid mental illness

The drug users were treated on the CHCV for illnesses such as pneumonia, common infections associated with HIV infection and active drug injection. They also received vaccinations against pneumoccocal pneumonia and influenza. The CHCV staff was also able to treat the drug users for many chronic illnesses.

“Finding ways to provide health services to active and out-of-treatment drug users that is acceptable to them and that they’re willing to use, can have a profound impact on reducing morbidity in a population that already has a high rate of medical diseases and complications,” said Altice, who is also principal investigator of the CHCV project. “Though the CHCV was the first mobile needle exchange-based health service developed in the U.S., several other programs around the country have begun to adopt similar services, however the array and delivery of services varies by location.”

The original 18-foot CHCV began in January 1993 and provided services such as acute medical care, HIV counseling and testing and social work referrals one day a week and then expanding to two days a week in 1994. It was the first mobile health program linked to needle exchange. The current 36-foot CHCV has two exam rooms and one counseling room. In addition to medical and HIV services, a case manager, a drug treatment coordinator, and an outreach worker were added to the program. Services were then expanded to three and a half days a week and the CHCV currently operates five days a week.

Altice said the CHCV is not designed or specifically intended to reduce emergency room use, but the staff does provide many services that most emergency departments consider being inappropriate use.

Other authors on the study include Harold Pollack, a former Yale postdoctoral fellow and now assistant professor of Health Management Policy at the University of Michigan; Kaveh Khoshnood, assistant professor in the Department of Epidemiology and Public Health (EPH) at Yale University School of Medicine; and Kim Blankenship, associate research scientist in EPH.