Using the Gelberg-Andersen Behavioral Model for Vulnerable Populations To Predict Health Services’ Utilization Among Homeless Adults by Hepatitis B or C Serostatus
Lillian Gelberg1, M. Robertson2, R.M. Andersen3, J. Stein4, L. Arangua1. 1Department of Family Medicine, University of California, Los Angeles (UCLA), United States; 2Alcohol Research Group, Public Health Institute, United States; 3School of Public Health, UCLA, United States; 4Department of Psychology, UCLA, United States
Background: Homeless people have high rates of illness and death, including hepatitis B and C virus (HBV and HCV). Health care is essential to identify persons with hepatitis. Using the Gelberg-Andersen Model and structural equation modeling, we sought to understand healthcare access among this high-risk group and to assess whether HBV or HCV disproportionately affected access. Models identified predictors of HBV or HCV and associations between these infections and healthcare utilization.
Methods: A population-based probability sample of 534 homeless adults in 41 shelters and meal programs in Los Angeles was interviewed and tested for HBV and HCV. Structural models assessed the impact of predisposing, enabling, and need variables on utilization in the past 12 months (emergency department [ED], hospitals, and ambulatory visits).
Results: HBV or HCV positivity (43%) was positively associated with injection drug use, competing needs, older age, less education, and jail or prison history. ED use was predicted by regular source of care, insurance, younger age, alcohol abuse, perceived bad health, fewer competing needs, and more medical conditions; ED use was less likely among HBV- or HCV-positive adults. Hospitalizations were predicted by female gender, more medical conditions, and greater percentage of life homeless; hospitalizations were less likely among African Americans. Ambulatory office visits were predicted by regular source of care, case management, more education, and perceived bad health; number of visits was lower among HBV- or HCV-positive adults than others (
Conclusions: Homelessness severity and alcohol abuse place homeless adults at risk for needing ED care. Having a medical home and a supportive relationship are key facilitators of access. HBV- or HCV-positive adults used ambulatory services less despite their need. Ambulatory services targeting HBV- and HCV-positive homeless adults are needed.
Financial Support: National Institute on Drug Abuse (NIDA) DA14294, NIDA DA01070-35, and Centers for Disease Control and Prevention.