An application of hospital at home for precariously housed people who use drugs in a community-based harm reduction setting in Vancouver, Canada

Background People who use drugs (PWUD) interact with hospital and emergency departments at higher rates than the general population. PWUD have unique needs when receiving hospital-based care and often face challenges receiving care in hospital-based environments. Programs such as Hospital at Home provide the opportunity to deliver hospital-level care outside of traditional hospital-based environments through the use of in-person outreach and virtual care, however have traditionally faced challenges providing this care to people actively using substances and to those who are unhoused or unsafely housed. Case presentation In Vancouver, Canada a novel partnership was formed between Hospital at Home and a community-based, harm reduction site in order to provide hospital-level care for PWUD who are unhoused or precariously housed. Baseline demographic data as well as substance use disorder diagnoses, admitting diagnoses and admission outcome were collected. During the first 3 months of the program, 17 patients were admitted, with 94% ( n = 16) of patients admitted for an infectious disease. There was a high preponderance of opioid use disorder ( n = 15, 88%) and stimulant use disorder ( n = 14, 82%). There was 1 patient-initiated discharge and 2 patients required transfer back to hospital to receive a higher level of care. All other patients completed treatment and were discharged to community. Median length of stay was 31 days (standard deviation 26 days). Conclusions Early program findings suggest that providing hospital-level of care in a community based harm reduction setting may be an acceptable alternative to traditional hospital admission in appropriately selected patients who use drugs.