Health service use and predictors of high health service use among adults experiencing homelessness: a retrospective cohort study.

OBJECTIVE: To describe the characteristics and cost of health service use of a cohort of 2,140 people attending homeless hostel clinics, and identify predictors of high health service use and time to readmission. METHOD: A retrospective cohort study of 2,140 adults who attended a homeless hostel clinic and were hospitalised in New South Wales (NSW) using linked clinic, health and mortality data from 1 July 2008 to 30 June 2021. Multivariable logistic regression examined predictors of high health service users. RESULTS: There were 27,466 hospital admissions, with a median cost of A$81,481 per person, and a total cost of A$548.2 million. Twenty per cent of the cohort were readmitted within 28 days and 27.4% were classified as high users of health services. Factors associated with high use were age ≥45 years, female (AOR: 1.52; 95%CI 1.05-2.22), the presence of a mental disorder, substance use disorder (AOR: 1.36; 95%CI: 1.03-1.82), or if the person had been homeless for >1 year (AOR: 1.31; 95%CI: 1.06-1.62). Conclusions and implications for public health: The high health costs generated by homeless adults confirm the need to develop models of supported housing with a focus on integrated care, improved referral pathways and better coordination with community-based support agencies.

Overdose Risk and Client Characteristics Associated With the Injection of Buprenorphine at a Medically Supervised Injecting Center in Sydney, Australia.

Background: Buprenorphine and buprenorphine/naloxone (BNX) were developed to improve the safety profile of opioid substitution treatment (OST) and reduce diversion and injection, yet continue to be injected, despite the risk of harm. Previous studies examining injection of these substances have relied on self-reported injection and overdose. Using data from the Uniting Medically Supervised Injecting Center (MSIC) in Sydney, this study aimed to assess the overdose risk associated with the use of buprenorphine and BNX and identify factors associated with injecting. Methods: Client data routinely collected from MSIC, a drug consumption room where clients can legally inject drugs under supervision, was used. Odds ratios (OR) to assess the risk of overdose and their associated 95% confidence intervals (95%CI) were calculated and compared to other substances. Univariate analysis using χ-square and multivariate logistic regressions were used to determine characteristics associated with buprenorphine and BNX injection. Results: Data from 1,020,782 injections by 15,832 individuals were analyzed. Risk of overdose was low for buprenorphine compared to other substances (OR 0.16; 95%CI: 0.07-0.19) and no overdoses occurred when BNX was injected. Injection of both buprenorphine and BNX was associated with male gender, homelessness, no income/reliance upon government payments, and prior imprisonment. Conclusions: Buprenorphine and BNX continue to be injected, albeit in small numbers. This is the first study to report on injection and overdose risk using direct observation, and has confirmed the lower overdose risk. MSIC clients who inject buprenorphine and BNX tend to be marginalized and may benefit from targeted harm reduction measures.

An audit of assessment and outcome of intervention at a quit smoking clinic in a homeless hostel.

OBJECTIVE: We aim to report on smoking history, mental and physical health, and the results of interventions provided by a Quit Smoking Clinic (QSC) at a Sydney homeless men's shelter. METHODS: We undertook an audit of questionnaires administered during the first QSC visit and a review of outcomes of QSC clients who attended the clinic more than once. RESULTS: A total of 144 men were assessed at the QSC, with mean age 45.2 years (22-71) and mean smoking duration of 29 years. About half were receiving treatment for psychotic illness, and there were high rates of other psychiatric disorders, physical illness and substance use disorder. Carbon monoxide (CO) readings were significantly higher for those smoking discarded cigarette butts. Among the subset of clients who attended the clinic more than once (n=56), only four quit for more than a month and one for a year. However, the reported number of cigarettes smoked per day was significantly lower (p=0.001), with a significant reduction in CO (p<0.008). CONCLUSIONS: This study confirms the difficulty that homeless men experience in quitting smoking, but demonstrates the potential to reduce the physical and financial harm of smoking through cessation support interventions in this setting.

Accuracy of a hybrid finite-element method for solving a scattering Schrödinger equation.

This hybrid method [finite-element discrete variable representation (FE-DVR)], introduced by Resigno and McCurdy [Phys. Rev. A 62, 032706 (2000)], uses Lagrange polynomials in each partition, rather than "hat" functions or Gaussian functions. These polynomials are discrete variable representation functions, and they are orthogonal under the Gauss-Lobatto quadrature discretization approximation. Accuracy analyses of this method are performed for the case of a one-dimensional Schrödinger equation with various types of local and nonlocal potentials for scattering boundary conditions. The accuracy is ascertained by a comparison with a spectral Chebyshev integral equation method, accurate to 1:10⁻¹¹. For an accuracy of the phase shift of 1:10⁻8, the FE-DVR method is found to be 100 times faster than a sixth-order finite-difference method (Numerov), it is easy to program, and it can routinely achieve an accuracy of better than 1:10⁻8 for the numerical examples studied.