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From the Inner City Health Project, University of Ottawa, and the Department of Medicine, Ottawa Hospital (Podymow, Turnbull); the Clinical Epidemiology Program of the Ottawa Health Research Institute and the Department of Medicine, University of Ottawa (Coyle); the University of Ottawa (Yetisir); and the Department of Epidemiology and Community Medicine, University of Ottawa (Wells), Ottawa, Ont.
Correspondence to: Dr. Tiina Podymow, tpodymow{at}uottawa.ca and Dr. Jeff Turnbull, The Ottawa Hospital, 501 Smyth Rd., Rm. LM12, Ottawa ON K1H 8L6; fax 613 737-8851; turnbull{at}ottawahospital.on.ca
Background: People who are homeless and chronically alcoholic have increased health problems, use of emergency services and police contact, with a low likelihood of rehabilitation. Harm reduction is a policy to decrease the adverse consequences of substance use without requiring abstinence. The shelter-based Managed Alcohol Project (MAP) was created to deliver health care to homeless adults with alcoholism and to minimize harm; its effect upon consumption of alcohol and use of crisis services is described as proof of principle.
Methods: Subjects enrolled in MAP were dispensed alcohol on an hourly basis. Hospital charts were reviewed for all emergency department (ED) visits and admissions during the 3 years before and up to 2 years after program enrolment, and the police database was accessed for all encounters during the same periods. The results of blood tests were analyzed for trends. A questionnaire was administered to MAP participants and staff about alcohol use, health and activities of daily living before and during the program. Direct program costs were also recorded.
Results: Seventeen adults with an average age of 51 years and a mean duration of alcoholism of 35 years were enrolled in MAP for an average of 16 months. Their monthly mean group total of ED visits decreased from 13.5 to 8 (p = 0.004); police encounters, from 18.1 to 8.8 (p = 0.018). Changes in blood test findings were nonsignificant. All program participants reported less alcohol consumption during MAP, and subjects and staff alike reported improved hygiene, compliance with medical care and health.
Interpretation: A managed alcohol program for homeless people with chronic alcoholism can stabilize alcohol intake and significantly decrease ED visits and police encounters.
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