Health care service utilization of individuals in permanent supportive housing in Seattle, WA accessing care through Public Health - Seattle and King County's Health Care for the Homeless Network

Abstract

Introduction: Permanent supportive housing (PSH) programs combine non-time limited housing with optional supportive services, including case management and health care, and are designed for those facing barriers to housing stability. Prior studies suggest that PSH can reduce emergency room visits and health care expenditures for an individual while improving their housing stability and well-being. However, research also suggests that not all groups utilize the same services or at the same rate. Methods: In a retrospective longitudinal study of PSH residents in Seattle, WA utilizing health care between 2015 and 2019, we examined health care service utilization across age, sex, race and ethnicity, education, and veteran status. We fit Generalized Estimating Equations (GEE) models specifying a Poisson distribution to compare annual service utilization rates. We also compared proportions of visits pertaining to respiratory diagnoses or symptoms, mental and behavioral health concerns, and injury. Results: Older groups utilized health care services at a higher rate than younger groups. Relative to non-Hispanic white groups, non-Hispanic Black or African American and non-Hispanic Asian, Pacific Islander, or Native Hawaiian groups exhibited lower annual service utilization rates. Veterans exhibited significantly lower annual service utilization rates than non-veterans. We did not identify significant associations between sex or education and annual utilization frequency. Discussion: This study provides insight to health care programs offering services to those in permanent supportive housing by identifying differential utilization of health care services by age, sex, race/ethnicity, education, and veteran status. Future studies should examine utilization across other sociodemographic characteristics and additional health care visit types.