Homeless adults tend to go to hospital emergency rooms more often for chronic conditions such as high blood pressure, diabetes, and heart disease, but providing housing and other services reduces those visits, researchers in the U.S. have found.

In Wednesday's issue of JAMA, internist Dr. Laura Sadowski of Stroger Hospital of Cook County, Chicago, and her colleagues compared 405 homeless adults in Chicago with chronic medical illness who were randomly assigned to usual hospital discharge care from hospital social workers or extra assistance, including:

• Temporary and then long-term housing.
• Follow-up from case managers who coordinated housing placement, medical care, substance abuse and mental health care as needed.

Even basic recommendations like "take a pill twice a day with meals" are difficult for the homeless, who might not be able to get the medication or eat two meals every day, Sadowski noted.

After 18 months, 73 per cent of participants had at least one hospitalization or emergency department visit.

Reducing burden

Those receiving extra help had a relative reduction of 29 per cent in hospitalizations and 24 per cent in emergency department visits, after adjusting for factors like age, race and gender, the researchers reported.

"Homelessness is a burden not only on the individuals, but also on the communities in which the individuals live and this kind of research can show that we can impact the healthcare for the homeless with chronic medical illnesses in a positive way for both the individual and for the communities in which they live," study author Dr. Romina Kee of Stroger Hospital said in a release.

During the study period, there were 583 hospitalizations in the intervention group compared with 743 in the usual care group.

The findings mean that for every 100 homeless people who received the intervention every year, there would be 49 fewer hospitalizations and 116 fewer visits to emergency, the researchers said.

Saving cities money

Case managers co-ordinated services across hospitals, respite care and community housing, tailored housing the needs of participants, and included the efforts of doctors, social workers, housing and other advocacy groups — factors that could account for the success of the program, the study's authors proposed.

"These results provide a rationale and a blueprint for programs that address the needs of this vulnerable population," the researchers concluded in the study.

Sadowski's findings and those of an earlier study in Seattle add to "the increasing evidence that at least some large U.S. cities cannot afford not to house some who live on their streets," Dr. Stefan Kertesz of the University of Alabama at Birmingham and Dr. Saul Weiner of the University of Illinois at Chicago, said in a journal commentary accompanying the study.

The editorial estimated annual savings from fewer emergency and hospital says from such programs ranged from $12,000 to $16,000 US, depending on what level of social services are offered in different cities.

"These studies demonstrate that for the most frequent users of costly public services, service use substantially abates when individuals have stable housing."

The next step is to determine which homeless people are most likely to benefit from such programs, Kertesz and Weiner added.

In a 2007 study of more than 360 people on the streets and in shelters in Toronto, more than half said they used hospital emergency departments for medical care.