Lillian Gelberg

Researchers investigate the relationship of predisposing, enabling, need, and immigration-related factors to tele-mental health services utilization among California adults. They conducted a secondary analysis of two waves of the California Health Interview Survey (CHIS) collected between 2015 and 2018.

A series of logistic regression models were conducted to examine correlates and predictors to tele-mental health services use.

Findings: Approximately 1.3% reported the use of tele-mental health services. Overall, health insurance status, severe psychological distress, perceived need for mental health services, and identifying as Asian, remained strong predictors for tele-mental health service use. When accounting for all factors, authors found that being a noncitizen was associated with lower odds of tele-mental health service use. These findings suggest that citizenship, resources to access, and perceived need for mental health care collectively are the most significant factors driving the use of tele-mental health services. There is a need to address inequitable access to tele-mental health services among immigrants who do not qualify for health care coverage due to citizenship status.
 

Despite the changing legal status of cannabis and the potential impact on health, few health systems routinely screen for cannabis use. Data on the epidemiology of cannabis use, and especially medical cannabis use among primary care patients, are limited.

Researchers study the prevalence of, factors associated with, and reasons for past–3 month cannabis use reported by primary care patients. This study used electronic health record data from patients aged 18 years and older who had an annual wellness visit between January 2021 and May 2023 from a primary care clinic within a university-based health system in Los Angeles, California. Cannabis use was assessed using the Alcohol Substance Involvement Screening Test (ASSIST). Patients were also asked about reasons for use, symptoms for which they used cannabis, and mode of use.

Findings: Among the 175,734 patients screened, the median (range) age was 47 years; 58.0% were female; 15.7% were Asian, 13.7% were Hispanic, and 31.7% were white. Cannabis use was reported by 17.0% with 34.7% having ASSIST scores indicative of moderate to high risk for cannabis use disorder (CUD). Prevalence of cannabis use was higher among male patients than female patients and younger patients (18-29 years), and lower among those who lived in the most disadvantaged neighborhoods. The most common modes of use included edibles, smoking, and vaporizing. While 4,375 patients who reported using cannabis (15.6%) did so for medical reasons only, 75.7% of patients reported using cannabis to manage symptoms including pain (31.7%), stress (50.2%), and sleep (56.0%). 

In this study, cannabis use and risk of CUD were common, and more than three-quarters of patients who reported any cannabis use reported doing so to manage a health-related symptom. These findings suggest that integration of information regarding cannabis use for symptom management could help provide a crucial point-of-care opportunity for clinicians to understand their patients’ risk for CUD.
 

​Summary: Using multi-state discharge data, to identify predictors of frequent emergency department (ED) use among the homeless patients seen in emergent care, and to compare frequent versus less frequent homeless ED users for their risk of serious health services utilization outcomes.

Based on the State Emergency Department Database and the State Inpatient Database, authors analyzed data for homeless individuals (n = 88,541) who made at least one ED visit in four states (Florida, Maryland, Massachusetts, and New York) in 2014. In this retrospective cross-sectional analysis, patient-level demographic and clinical factors were assessed as predictors for increased ED use. Risks of opioid overdose, opioid-related hospital admission/ED visit, in-hospital mortality, mechanical ventilation, and number of hospitalizations were compared between individuals with 4 or more vs. 2-3 vs. 1 ED visit(s), adjusting for potential confounders including hospital fixed effects (allowing for within hospital comparisons).

Findings: Higher rates of ED use were associated with Medicare coverage; primary diagnosis of alcohol abuse, asthma, or abdominal pain; and co-morbidity of alcohol abuse, psychoses, or chronic pulmonary disease. Individuals with ≥4 visits had significantly higher adjusted risk of opioid overdose (3.7% vs. 1.2% vs. 1.0%), opioid-related hospitalizations/ED visits (17.9% vs. 8.5% vs. 6.6%), mechanical ventilation (9.8% vs. 7.0% vs. 4.7%), and greater # of hospitalizations (3.2 vs. 1.3 vs. 0.8) compared to individuals with 2-3 or 1 ED visit. Individuals with ≥4 and 2-3 ED visits had similar but increased risks of in-hospital mortality compared to individuals with 1 ED visit.

Homeless patients who were high ED users were more likely to be hospitalized and have other adverse outcomes. These findings encourage targeted interventions (i.e. housing) for the high-utilizer homeless population to reduce the burden of serious outcomes and costs for the patient and society.

Read the Publication:

• Journal Article: Frequent Emergency Department Use Among Homeless Individuals Seen in Emergent Care: High Risks of Opioid-Related Diagnoses and Adverse Health Services Utilization Outcomes

​This report describes a needs assessment of VA programs for homeless Veterans in Southern California and Nevada, the geographic region with the most homeless Veterans in the nation. The assessment was formulated through key informant interviews. Current service provisions are discussed, along with salient unmet needs for this vulnerable population.

• Sonya Gabrielian
• Anita Yuan
• Lisa Rubenstein
• Ronald M. Andersen, Ph.D.
• Lillian Gelberg, MD, MSPH