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Housing Homeless Alcoholics Cuts Public Costs, Alcohol Use

Permanent housing for homeless patients with ongoing drinking problems can help reduce medical and social costs and lower alcohol consumption, researchers here said.

In one year, the so-called “Housing First” program cut costs from about $8 million to $4 million across the study sample, Mary E. Larimer, Ph.D., of the University of Washington, and colleagues reported in the April 1 issue of the Journal of the American Medical Association.

“The findings support the basic premise of Housing First: providing housing to individuals who remain actively addicted to alcohol . . . can reduce the public burden associated with overuse of crisis services and reduce alcohol consumption,” the researchers said.

Homeless patients with severe alcohol problems often have medical and psychiatric problems, the researchers said, and they tend to overburden costly health and criminal justice services.

The “Housing First” model provides housing for homeless patients with alcohol addiction, but removes requirements for sobriety, treatment attendance, and other barriers to entrance.

The lack of preconditions has made this type of program controversial, so the researchers evaluated one program in Seattle — known as 1811 Eastlake.

There are no treatment requirements for residents, but on-site case managers talk to them about substance use and life goals. Meals and on-site healthcare services are also offered. The cost: about $1,120 per person each month.

The researchers evaluated healthcare use and costs of the program by comparing 95 housed participants with 39 wait-listed controls between November 2005 and March 2007. A total of 16 of the 39 controls eventually moved into the home after six months.

The researchers also collected administrative data from justice service centers and claims submitted to Medicaid.

In the year prior to the study, housed participants accrued a median of $4,066 per month per patient in use costs, totaling $8,175,922 for all 95 participants.

By six months into the program, median monthly costs per patient had dropped to $1,492, and then to $958 by one year. Total costs for the housed group one year after enrollment were $4,094,291.

“The program demonstrated significant cost savings . . . for housed individuals over the course of the first year,” the researchers said.

Wait-listed controls accrued median costs of $3,318 per month per individual in the year prior to the study, and that figure dropped to $1,932 at six months.

The researchers said the difference between groups at six months is significant, with participants accruing about 53% less costs than controls (RR 0.47, 95% CI 0.25 to 0.88).

They also found that participants cut down on drinking by 2% each month (RR 0.98, 95% CI 0.96 to 0.99).

“The HF intervention was associated with substantial declines in drinking, despite no requirement to abstain from or reduce drinking to remain housed,” the researchers said.

The study was limited in that it relied on archival data to evaluate use and costs of services. It also included only one hospital in its medical records search, although it was the most commonly used center for that population in the area.

In addition, the authors noted that “participants were not randomly assigned to condition, and there were differences between groups in costs of services used prior to enrollment.”

They also pointed out that “the current sample was also drawn from a population with extremely high use of publicly funded services, and it is likely that cost offsets would be attenuated in a less severe sample.”

Despite the limitations, the researchers said, the study “adds to the body of literature in support of ‘Housing First.’ Reductions in healthcare and criminal justice system use and costs and alcohol consumption support expansion and replication of this low-threshold approach.”

source: MedPage Today

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