1
|
Montgomery AE, DeRussy AJ, Richman JS, Lin C. Predictors of recurrent stroke and subsequent mortality among patients experiencing housing instability. J Stroke Cerebrovasc Dis 2024; 33:107896. [PMID: 39067657 PMCID: PMC11347088 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND The experience of homelessness has been linked with developing poor health outcomes. Little is known about the risk of recurrent stroke among these individuals. This study investigated the correlates of developing recurrent stroke and subsequent mortality among Veterans with housing instability. METHODS Using a national sample of Veterans from the U.S. Department of Veterans Affairs who had an indicator of housing instability between 2014-2018 (n=659,987), we identified 15,566 Veterans who experienced incident stroke. We compared characteristics of Veterans who experienced incident stroke and did and did not experience recurrent stroke and conducted logistic regressions using a discrete-time survival framework to assess two outcomes: recurrent stroke and all-cause mortality. RESULTS Among our cohort, 91.3% did not experience recurrent stroke while 8.7% did during the observation period. The receipt of any level of primary care outpatient visits was associated with a reduction in the odds of recurrent stroke. Several medical diagnoses were also associated with increased odds of recurrent stroke, including hypertension (aOR 1.35, 95% CI 1.15-1.59), diabetes (aOR 1.21, 95% CI 1.07-1.36), and renal disease (aOR 1.17, 95% CI 1.02, 1.35). Veterans who used any level of VA Homeless Programs had reduced odds of all-cause mortality (high level: aOR 0.65, 95% CI 0.60-0.71; low level: aOR 0.66, 95% CI 0.60-0.73). CONCLUSION Our study found several predictors of developing recurrent stroke and subsequent death in a population of Veterans experiencing housing instability. Implications include the need to monitor closely high-risk patients who have experienced incident stroke and have other co-occurring needs.
Collapse
Affiliation(s)
- Ann Elizabeth Montgomery
- Departments of Health Behavior, The University of Alabama at Birmingham, Birmingham, AL 35294, United States; Birmingham VA Medical Center, Birmingham, AL, United States
| | | | - Joshua S Richman
- Departments of Surgery, The University of Alabama at Birmingham, Birmingham, AL 35294, United States; Birmingham VA Medical Center, Birmingham, AL, United States
| | - Chen Lin
- Departments of Neurology, The University of Alabama at Birmingham, Birmingham, AL 35294, United States; Birmingham VA Medical Center, Birmingham, AL, United States.
| |
Collapse
|
2
|
Hodwitz K, Ginocchio GF, Fedorovsky T, Girdler H, Bossin B, Juando-Prats C, Dell E, Somers A, Hulme J. Healthcare workers' perspectives on a prescription phone program to meet the health equity needs of patients in the emergency department: a qualitative study. CAN J EMERG MED 2024; 26:570-581. [PMID: 38951473 PMCID: PMC11335851 DOI: 10.1007/s43678-024-00735-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/30/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES People experiencing homelessness and marginalization face considerable barriers to accessing healthcare services. Increased reliance on technology within healthcare has exacerbated these inequities. We evaluated a hospital-based prescription phone program aimed to reduce digital health inequities and improve access to services among marginalized patients in Emergency Departments. We examined the perceived outcomes of the program and the contextual barriers and facilitators affecting outcomes. METHODS We conducted a constructivist qualitative program evaluation at two urban, academic hospitals in Toronto, Ontario. We interviewed 12 healthcare workers about their perspectives on program implementation and outcomes and analyzed the interview data using reflexive thematic analysis. RESULTS Our analyses generated five interrelated program outcomes: building trust with patients, facilitating independence in healthcare, bridging sectors of care, enabling equitable care for marginalized populations, and mitigating moral distress among healthcare workers. Participants expressed that phone provision is critical for adequately serving patients who face barriers to accessing health and social services, and for supporting healthcare workers who often lack resources to adequately serve these patients. We identified key contextual enablers and challenges that may influence program outcomes and future implementation efforts. CONCLUSIONS Our findings suggest that providing phones to marginalized patient populations may address digital and social health inequities; however, building trusting relationships with patients, understanding the unique needs of these populations, and operating within a biopsychosocial model of health are key to program success.
Collapse
Affiliation(s)
- Kathryn Hodwitz
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Galo F Ginocchio
- Einstein Lab, Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Tali Fedorovsky
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hannah Girdler
- Centre for Global Equity in Emergency Medicine, University Health Network, Toronto, ON, Canada
| | - Brielle Bossin
- Emergency Department, St. Michael's Hospital, Toronto, ON, Canada
| | - Clara Juando-Prats
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Evelyn Dell
- Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Andrea Somers
- University Health Network, Toronto, ON, Canada
- Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer Hulme
- University Health Network, Toronto General Hospital, Toronto, ON, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
3
|
Moore H, Bablitz C, Santos Salas A, Morris H, Sinnarajah A, Watanabe SM. Describing the characteristics and symptom profile of a group of urban patients experiencing socioeconomic inequity and receiving palliative care: a descriptive exploratory analysis. Palliat Care Soc Pract 2024; 18:26323524241264880. [PMID: 39099621 PMCID: PMC11295232 DOI: 10.1177/26323524241264880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/11/2024] [Indexed: 08/06/2024] Open
Abstract
Background Individuals experiencing socioeconomic inequity have worse health outcomes and face barriers to palliative and end-of-life care. There is a need to develop palliative care programs tailored to this underserved population. Objectives To understand the characteristics and symptom profiles of a group of urban patients experiencing socioeconomic inequity and receiving palliative care. Design Descriptive exploratory analysis of a patient dataset. The patient dataset was generated through a pilot research study with patients experiencing socioeconomic inequity and life-limiting illness who received a community-based palliative care intervention. Methods The intervention took place over 1 year in the Palliative Care Outreach and Advocacy Team, a community-based urban palliative care clinic in Edmonton, Alberta, Canada, serving persons experiencing socioeconomic inequity. Participants had to be at least 18 years of age, be able to communicate in English, require palliative care for a life-limiting illness, and be able to consent to inclusion in the study. Results Twenty-five participants were enrolled. Participants predominantly identified as male and Indigenous, experienced poverty and housing instability, and had metastatic cancer. Our participants rated their pain, shortness of breath, and anxiety as more severe than the broader community-based palliative care population in the same city. Most patients died in inpatient hospices (73%). Conclusion Our analysis provides an in-depth picture of an understudied, underserved population requiring palliative care. Given the higher symptom severity experienced by participants, our analysis highlights the importance of person-centered palliative care. We suggest that socioeconomic inequity should be considered in patients with life-limiting illnesses. Further research is needed to explore palliative care delivery to those facing socioeconomic inequity.
Collapse
Affiliation(s)
- Harrison Moore
- Division of Palliative Care Medicine, Department of Oncology, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, 8440 112 Street NW, Edmonton, AB T6G 2B7, Canada
| | - Cara Bablitz
- Department of Family Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta
- Family Medicine, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Anna Santos Salas
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Heather Morris
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Aynharan Sinnarajah
- Division of Palliative Medicine, Department of Medicine, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Sharon M. Watanabe
- Department of Symptom Control and Palliative Care Cross Cancer Institute, Edmonton, AB, Canada
- Division of Palliative Care Medicine, Department of Oncology, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
4
|
Kent JT, Ritchie LMP, Klaiman M, Dell EM, Garnett M, Landes M, Ginocchio GF, Alsefaou A. Barriers and facilitators to the implementation of rapid HIV testing in Canadian Emergency Departments: a mixed methods study. CAN J EMERG MED 2024; 26:463-471. [PMID: 38960973 DOI: 10.1007/s43678-024-00716-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/27/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVES 1 in 7 Canadians with Human Immunodeficiency Virus (HIV) do not know their status. Patients at increased risk of HIV routinely access the emergency department (ED), yet few are tested, representing a missed opportunity for diagnosis and linkage-to-care. Rapid HIV testing provides reliable results within the same ED encounter but is not routinely implemented. The objective of this study was to identify barriers and facilitators to rapid HIV testing in Ontario EDs. METHODS We employed a mixed-methods, convergent, parallel design study including online surveys and semi-structured interviews of physicians, nurses, and allied health across four hospitals in Toronto and Thunder Bay, Ontario. Data were analyzed in equal priority using descriptive statistics for quantitative data and thematic analysis for qualitative data guided by the Theoretical Domains framework and Capability, Opportunity, Motivation Behaviour change model. RESULTS Among 187 survey respondents, 150 (80%) felt implementing rapid HIV testing would be helpful in the ED. Facilitators included availability of resources to link patients to care after testing (71%), testing early in patient encounters (41%), and having dedicated staff with lived experience support testing (34%). Motivation to offer testing included opportunities to support an underserved population (66%). Challenges to implementation included limited time during ED patient encounters (51%) and a lack of knowledge around HIV testing (42%) including stigma. Interview themes confirmed education, and integration of people with lived experience being essential to provide rapid HIV testing and linkage-to-care in the ED. CONCLUSIONS Implementation of rapid HIV testing in the ED is perceived to be important irrespective of practice location or profession. Intrinsic motivations to support underserved populations and providing linkage-to-care are novel insights to facilitate testing in the ED. Streamlined implementation, including clear testing guidelines and improved access to follow-up care, is felt to be necessary for implementation.
Collapse
Affiliation(s)
- Jessica T Kent
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Lisa M Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Emergency Medicine, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Michelle Klaiman
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Evelyn Marion Dell
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Emergency Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Meghan Garnett
- Emergency and Critical Care Services, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
- Division of Clinical Sciences, NOSM University, Thunder Bay, ON, Canada
| | - Megan Landes
- Department of Emergency Medicine, University Health Network, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Galo Fernando Ginocchio
- Emergency Department, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Psychology, Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada
| | | |
Collapse
|
5
|
Choudhury S, Choi SL, Lee Y, Manser SS. Examining the Role of Self-Harm in the Relationship between Emergency Department Service Utilization and Trauma-Induced Homelessness among Homeless Individuals in Texas. HEALTH & SOCIAL WORK 2024; 49:87-94. [PMID: 38478764 DOI: 10.1093/hsw/hlae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/17/2023] [Accepted: 09/08/2023] [Indexed: 04/30/2024]
Abstract
Homelessness is a complex public health problem in the United States. Current or ongoing history of trauma among individuals adds to the complexity and challenges of homelessness. Our study assessed the moderating role of self-harm in the association between emergency department (ED) service utilization and trauma-induced homelessness (TIH) among adults in Texas. Homeless adults (N = 282) who completed their baseline Vulnerability Index Service Prioritization Decision Assistance Prescreen Tool survey between February 2021 and February 2022 at a Local Mental Health Authority in Texas were selected. The outcome variable, TIH, was assessed by current period of homelessness due to experiencing trauma or abuse. The main independent variable was ED utilization, while self-harm in the past year was assessed as the moderating variable. A multivariate logistic regression with a moderation analysis was conducted while adjusting for the covariates. Individuals who utilized ED services and engaged in self-harm and risky behaviors had greater odds of experiencing current period of TIH. Male respondents were less likely to experience TIH. Finally, engaging in self-harm significantly moderated the association between ED service use and TIH. This study may help inform efforts to develop tailored interventions and promote resilience-based approaches to improve health outcomes among individuals experiencing homelessness due to TIH.
Collapse
Affiliation(s)
- Sumaita Choudhury
- MPH, is a doctoral candidate and research associate, Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, University of Texas at Austin, 1823 Red River Street, Austin, TX 78712, USA
| | - Sharon Lee Choi
- PhD, is a research associate, Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Yehyang Lee
- MS, is a graduate research assistant, Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Stacey Stevens Manser
- PhD, is a research scientist and associate director, Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| |
Collapse
|
6
|
Thambinathan V, Lena S, Ramnarine J, Chuang H, Ogbaselassie L, Dagher M, Goulbourne E, Wijayasinghe S, Bawden J, Kennedy L, Wright V. "Access to healthcare is a human right": a constructivist study exploring the impact and potential of a hospital-community partnered COVID-19 community response team for Toronto homeless services and congregate living settings. BMC Health Serv Res 2024; 24:526. [PMID: 38664700 PMCID: PMC11046903 DOI: 10.1186/s12913-023-10140-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 10/12/2023] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Individuals experiencing homelessness face unique physical and mental health challenges, increased morbidity, and premature mortality. COVID -19 creates a significant heightened risk for those living in congregate sheltering spaces. In March 2020, the COVID-19 Community Response Team formed at Women's College Hospital, to support Toronto shelters and congregate living sites to manage and prevent outbreaks of SARS-CoV-2 using a collaborative model of onsite mobile testing and infection prevention. From this, the Women's College COVID-19 vaccine program emerged, where 14 shelters were identified to co-design and support the administration of vaccine clinics within each shelter. This research seeks to evaluate the impact of this partnership model and its future potential in community-centered integrated care through three areas of inquiry: (1) vaccine program evaluation and lessons learned; (2) perceptions on hospital/community partnership; (3) opportunities to advance hospital-community partnerships. METHODS Constructivist grounded theory was used to explore perceptions and experiences of this partnership from the voices of shelter administrators. Semi-structured interviews were conducted with administrators from 10 shelters using maximum variation purposive sampling. A constructivist-interpretive paradigm was used to determine coding and formation of themes: initial, focused, and theoretical. RESULTS Data analysis revealed five main categories, 16 subcategories, and one core category. The core category "access to healthcare is a human right; understand our communities" emphasizes access to healthcare is a consistent barrier for the homeless population. The main categories revealed during a time of confusion, the hospital was seen as credible and trustworthy. However, the primary focus of many shelters lies in housing, and attention is often not placed on health resourcing, solidifying partnerships, accountability, and governance structures therein. Health advocacy, information sharing tables, formalized partnerships and educating health professionals were identified by shelter administrators as avenues to advance intersectoral relationship building. CONCLUSION Hospital-community programs can alleviate some of the ongoing health concerns faced by shelters - during a time of COVID-19 or not. In preparation for future pandemics, access to care and cohesion within the health system requires the continuous engagement in relationship-building between hospitals and communities to support co-creation of innovative models of care, to promote health for all.
Collapse
Affiliation(s)
| | - Suvendrini Lena
- Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada.
- Neurology and Psychiatry, University of Toronto, 27 King's College Cir, Toronto, ON, M5S 1A1, Canada.
| | - Jordan Ramnarine
- Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada
| | - Helen Chuang
- Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada
| | - Luwam Ogbaselassie
- Gattuso Centre for Social Medicine, UHN, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Marc Dagher
- Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada
- Department of Family and Community Medicine, University of Toronto, 27 King's College Cir, Toronto, ON, M5S 1A1, Canada
| | - Elaine Goulbourne
- Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada
| | | | - Jessica Bawden
- Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada
| | - Logan Kennedy
- Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada
| | - Vanessa Wright
- Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada
| |
Collapse
|
7
|
Coronado-Vázquez MDV, Gómez-Trenado R, Benito-Sánchez B, Barrio-Cortes J, Gil-Salmerón A, Amengual-Pliego M, Grabovac I. Cancer prevention in people experiencing homelessness: ethical considerations and experiences from the CANCERLESS project. Front Public Health 2024; 12:1371505. [PMID: 38655508 PMCID: PMC11036339 DOI: 10.3389/fpubh.2024.1371505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
The incidence of cancer in Europe has been increasing in recent years. Despite this, cancer prevention has remained a low priority in health policies. Cancer is one of the main causes of mortality among people experiencing homelessness, who continue to have difficulties accessing prevention programs. A strategy that has been tested to favor cancer prevention is the health navigator figure. The objective of CANCERLESS project is to implement this model among populations experiencing homelessness in four European countries to foster the prevention and early detection of cancer. In this perspective, a presentation of CANCERLESS project is made, and its ethical aspects are discussed according to the ethics of public health, the ethics of care, solidarity, relational autonomy, and the social recognition of the virtue of just generosity. The ethical foundations of CANCERLESS project are rooted in social justice and in equity in access to health systems in general and cancer screening programs in particular. The ethics of public health guided by utilitarianism are insufficient in serving the interests of the most disadvantaged groups of the population. Hence, it is necessary to resort to relational bioethics that includes the ethics of care and solidarity and that recognizes the moral identity of socially excluded persons, reaffirming their position of equality in society. Relational autonomy therefore provides a broader conception by including the influence of living conditions in decisions. For this reason, the CANCERLESS project opts for a dialogue with those affected to incorporate their preferences and values into decisions about cancer prevention.
Collapse
Affiliation(s)
- María del Valle Coronado-Vázquez
- Healthcare Center Las Cortes, Gerencia 1 Healthcare Center Las Cortes, Gerencia Asistencial de Atención Primaria, Madrid, Spain
- Facultad de Medicina, Francisco de Vitoria University, Madrid, Spain
- B21-20R Group, Instituto Aragonés de Investigaciones Sanitarias, Universidad de Zaragoza, Zaragoza, Spain
| | - Rosa Gómez-Trenado
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), Madrid, Spain
- Health Work Department, Complutense University of Madrid, Madrid, Spain
| | - Beatriz Benito-Sánchez
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), Madrid, Spain
| | - Jaime Barrio-Cortes
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), Madrid, Spain
- Faculty of Health, Camilo José Cela University, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion, Carlos III Health Institute, Madrid, Spain
| | - Alejandro Gil-Salmerón
- International Foundation for Integrated Care, Oxford, United Kingdom
- International University of Valencia, Valencia, Spain
- Complutense University of Madrid, Madrid, Spain
| | - Miguel Amengual-Pliego
- B21-20R Group, Instituto Aragonés de Investigaciones Sanitarias, Universidad de Zaragoza, Zaragoza, Spain
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
8
|
Stanford D, Dinh MM, Eastwood JG, Korczak V, Seimon RV, Moore C, Liu H, Bein KJ. Clinical and longitudinal patterns of frequent presenters to emergency departments: A multi-centre data linkage analysis. Emerg Med Australas 2024; 36:277-282. [PMID: 38172087 DOI: 10.1111/1742-6723.14349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/21/2023] [Accepted: 11/04/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To describe clinical characteristics and longitudinal patterns of representation in a cohort of patients who frequently present to EDs for care. METHODS A retrospective data analysis linking routinely collected ED data across three hospitals. The study population consisted of patients who presented to any ED on 10 or more occasions in any continuous 365-day period from 1 July 2015 to 30 June 2021. Presenting complaints were divided into those with any mental health, drug and alcohol, or social presentations (MHDAS group) and those without (non-MHDAS group). Outcomes of interest were number of presentations as well as temporal and facility clustering of presentations. A per patient regression analysis was performed to identify independent risk factors for increased presentations. RESULTS Presentations by 1640 frequent ED presenters in the study constituted 4.6% of total ED presentations. MHDAS study group were younger, predominantly English speaking, twice as likely to be married, had lower hospital admission rates and almost three times as many of them did not wait for treatment. Statistically significant differences were also found between these groups regarding presentation clustering, facility entropy, each of the four categories of the number of ED presentations, and Index of Relative Socio-Economic Advantage and Disadvantage. CONCLUSION Representations associated with MHDAS have a different trajectory of representation episodes compared to non-MHDAS group. Escalating number of presentations and clustering are important predictors of future representation numbers. Those 'did not waits' who appear to be representing would be the highest risk of ongoing and persistent representations in the future and should be the target of early interventions to ensure they are accessing appropriate care before this happens.
Collapse
Affiliation(s)
- Dorota Stanford
- Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Michael M Dinh
- Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
- RPA Green Light Institute for Emergency Care, Sydney Local Health District, Sydney, New South Wales, Australia
| | - John G Eastwood
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, Australia
| | - Viola Korczak
- Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Radhika V Seimon
- RPA Green Light Institute for Emergency Care, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Corey Moore
- Public Health Unit, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Hueiming Liu
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kendall J Bein
- Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
- RPA Green Light Institute for Emergency Care, Sydney Local Health District, Sydney, New South Wales, Australia
| |
Collapse
|
9
|
Pulaski M, Bittermann T, Taddei TH, Kaplan DE, Mahmud N. The Association Between Homelessness and Key Liver-Related Outcomes in Veterans With Cirrhosis. Am J Gastroenterol 2024; 119:297-305. [PMID: 37782293 DOI: 10.14309/ajg.0000000000002535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/06/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Homelessness adversely affects patient outcomes in broad cohort studies; however, its impact on key liver-related outcomes in patients with cirrhosis is understudied. We aimed to address this knowledge gap using data from the Veterans Health Administration, a cohort disproportionately affected by homelessness. METHODS This was a retrospective cohort study of the Veterans Health Administration patients with incident cirrhosis diagnosis between January 2008 and February 2022. Homeless status was classified at baseline and as time-updating variable during follow-up. Inverse probability treatment weighted Cox regression was performed to evaluate the association between homelessness and outcomes of all-cause mortality, cirrhosis decompensation, and hepatocellular carcinoma. RESULTS A total of 117,698 patients were included in the cohort, of whom 14,243 (12.1%) were homeless at baseline. In inverse probability treatment weighted Cox regression, homelessness was associated with a 24% higher hazard of all-cause mortality (hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.22-1.26, P < 0.001). However, in competing risk regression models, homelessness was associated with a reduced subhazard of decompensation (subhazard ratio 0.86, 95% CI 0.84-0.88, P < 0.001) and hepatocellular carcinoma (subhazard ratio 0.86, 95% CI 0.83-0.89, P < 0.001). In cause-specific mortality analysis, homeless patients had significantly increased non-liver-related and liver-related mortality; however, the magnitude of effect size was greater for non-liver-related mortality (csHR 1.38, 95% CI 1.35-1.40, P < 0.001). DISCUSSION Homelessness in veterans with cirrhosis is associated with increased all-cause mortality; however, this is likely mediated primarily through non-liver-related factors. Future studies are needed to explore drivers of mortality and improve mitigation strategies in these patients.
Collapse
Affiliation(s)
- Marya Pulaski
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Therese Bittermann
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tamar H Taddei
- Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - David E Kaplan
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Gastroenterology Section, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Nadim Mahmud
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Gastroenterology Section, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| |
Collapse
|
10
|
O'Neill M, Michalski C, Hayman K, Hulme J, Dube S, Diemert LM, Kornas K, Schoffel A, Rosella LC, Boozary A. "Whatever journey you want to take, I'll support you through": a mixed methods evaluation of a peer worker program in the hospital emergency department. BMC Health Serv Res 2024; 24:147. [PMID: 38287378 PMCID: PMC10826204 DOI: 10.1186/s12913-023-10532-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 12/27/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND People who are unhoused, use substances (drugs and/or alcohol), and who have mental health conditions experience barriers to care access and are frequently confronted with discrimination and stigma in health care settings. The role of Peer Workers in addressing these gaps in a hospital-based context is not well characterized. The aim of this evaluation was to 1) outline the role of Peer Workers in the care of a marginalized populations in the emergency department; 2) characterize the impact of Peer Workers on patient care, and 3) to describe how being employed as a Peer Worker impacts the Peer. METHODS Through a concurrent mixed methods evaluation, we explore the role of Peer Workers in the care of marginalized populations in the emergency department at two urban hospitals in Toronto, Ontario Canada. We describe the demographic characteristics of patients (n = 555) and the type of supports provided to patients collected through a survey between February and June 2022. Semi-structured, in-depth interviews were completed with Peer Workers (n = 7). Interviews were thematically analyzed using a deductive approach, complemented by an inductive approach to allow new themes to emerge from the data. RESULTS Support provided to patients primarily consisted of friendly conversations (91.4%), discharge planning (59.6%), tactics to help the patient navigate their emotions/mental wellbeing (57.8%) and sharing their lived experience (50.1%). In over one third (38.9%) of all patient interactions, Peer Workers shared new information about the patient with the health care team (e.g., obtaining patient identification). Five major themes emerged from our interviews with Peer Workers which include: (1) Establishing empathy and building trust between the patient and their care team through self-disclosure; (2) Facilitating a person-centered approach to patient care through trauma-informed listening and accessible language; (3) Support for patient preferences on harm reduction; (4) Peer worker role facilitating self-acceptance and self-defined recovery; and (5) Importance of supports and resources to help Peer Workers navigate the emotional intensity of the emergency department. CONCLUSIONS The findings add to the literature on Peer Worker programs and how such interventions are designed to best meet the needs of marginalized populations.
Collapse
Affiliation(s)
- Meghan O'Neill
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Camilla Michalski
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kate Hayman
- University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer Hulme
- University Health Network, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Sané Dube
- University Health Network, Toronto, ON, Canada
- Gattuso Centre for Social Medicine and Population Health, University Health Network, Toronto, ON, Canada
| | - Lori M Diemert
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kathy Kornas
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Alice Schoffel
- University Health Network, Toronto, ON, Canada
- Gattuso Centre for Social Medicine and Population Health, University Health Network, Toronto, ON, Canada
| | - Laura C Rosella
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Andrew Boozary
- University Health Network, Toronto, ON, Canada.
- Gattuso Centre for Social Medicine and Population Health, University Health Network, Toronto, ON, Canada.
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
11
|
Mistry N, Knoeckel J, McBeth L, Johnson A, Bredenberg E, Raffel K, Cunningham J, Sarcone E, Misky G, Stella SA. Prevalence of homelessness among hospitalized patients: A point-in-time survey. J Hosp Med 2024; 19:45-50. [PMID: 38058085 DOI: 10.1002/jhm.13241] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/24/2023] [Accepted: 11/04/2023] [Indexed: 12/08/2023]
Abstract
Although homelessness is associated with increased acute healthcare utilization and poorer health outcomes, the prevalence of homelessness and housing insecurity in hospitalized patients is poorly characterized. We conducted an in-person survey to determine the prevalence of housing insecurity and homelessness among hospitalized patients at two hospitals in metropolitan Denver in conjunction with the Housing and Urban Development point-in-time count on January 24, 2022. Of the 271 surveyed patients, 79 (29.2%) reported experiencing either housing insecurity (17.3%) or homelessness (11.8%). Of those experiencing housing insecurity or homelessness, 69.6% reported chronic health conditions, 55.7% reported multiple hospitalizations in the preceding year, 38% reported mental health concerns and 39.2% reported substance use. The prevalence of homelessness among a hospitalized patient population was over 20-fold higher than community prevalence estimates. Housing insecurity also impacted a substantial proportion of hospitalized patients and was associated with high rates of co-morbid conditions.
Collapse
Affiliation(s)
- Neelam Mistry
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Julie Knoeckel
- Division of Hospital Medicine, Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA
| | - Lauren McBeth
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amanda Johnson
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Erin Bredenberg
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Katie Raffel
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John Cunningham
- Division of Hospital Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Ellen Sarcone
- Division of Hospital Medicine, Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA
| | - Gregory Misky
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sarah A Stella
- Division of Hospital Medicine, Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA
| |
Collapse
|
12
|
Sauro KM, O'Rielly CM, Kersen J, Soo A, Bagshaw SM, Stelfox HT. Critical illness among patients experiencing homelessness: a retrospective cohort study. Crit Care 2023; 27:477. [PMID: 38053149 PMCID: PMC10699027 DOI: 10.1186/s13054-023-04753-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023] Open
Abstract
PURPOSE To understand the epidemiology and healthcare use of critically ill patients experiencing homelessness compared to critically ill patients with stable housing. METHODS This retrospective population-based cohort study included adults admitted to any ICU in Alberta, Canada, for a 3-year period. Administrative and clinical data from the hospital, ICU and emergency department were used to examine healthcare resource use (processes of care, ICU and hospital length of stay, hospital readmission and emergency room visits). Regression was used to quantify differences in healthcare use by housing status. RESULTS 2.3% (n = 1086) of patients admitted to the ICU were experiencing homelessness; these patients were younger, more commonly admitted for medical reasons and had fewer comorbidities compared to those with stable housing. Processes of care in the ICU were mostly similar, but healthcare use after ICU was different; patients experiencing homelessness who survived their index hospitalization were more than twice as likely to have a visit to the emergency department (OR = 2.3 times, 95% CI 2.0-2.6, < 0.001) or be readmitted to hospital (OR = 2.1, 95% CI 1.8-2.4, p < 0.001) within 30 days, and stayed 10.1 days longer in hospital (95% CI 8.6-11.6, p < 0.001), compared with those who have stable housing. CONCLUSIONS Patients experiencing homelessness have different characteristics at ICU admission and have similar processes of care in ICU, but their subsequent use of healthcare resources was higher than patients with stable housing. These findings can inform strategies to prepare patients experiencing homelessness for discharge from the ICU to reduce healthcare resource use after critical illness.
Collapse
Affiliation(s)
- K M Sauro
- Departments of Community Health Sciences, Surgery and Oncology, O'Brien Institute for Public Health and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr. NW, Room 3D41, Calgary, AB, T2N 4Z6, Canada.
| | | | - J Kersen
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - A Soo
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - S M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - H T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| |
Collapse
|
13
|
Weerasinghe SS, Campbell SG. Homelessness and Emergency Department Use: Wait Time Disparities Across Triage Acuity Levels. Cureus 2023; 15:e49520. [PMID: 38161888 PMCID: PMC10756006 DOI: 10.7759/cureus.49520] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Certain patient groups perceive specific barriers to accessing primary care, resulting in increased emergency department (ED) use for non-emergency conditions. There is evidence coming from other countries that homeless people are treated differently in accessing emergency services. Examination of ED wait time by demographic characteristics provides pertinent information to identify subgroups that are more subject to the consequences or causes of access block and delayed treatment. Methods We analyzed five years of Emergency Department Information System (EDIS) visit records of the largest tertiary care center in Atlantic Canada. The wait time from triage to seeing a physician was the outcome, housing status was the main exposure, and age and gender were the predictors. Quantile regressions were carried out to identify the influence of homeless visits in meeting the Canadian Association of Emergency Physicians (CAEP) wait time benchmarks for each Canadian Triage and Acuity Scale (CTAS) level. The classification and regression tree method was used to quantify and classify the demographic subgroups contributing to wait time disparities across CTAS levels. Results Homeless visit median wait times that exceeded the three-hour CAEP benchmark were significantly longer for urgent (by 40 minutes, CI: 25-55), semi-urgent (by 31 minutes, CI: 17-45), and non-urgent (by 57 minutes, CI: 25-89) than acuity level-matched domiciled visit wait times. At the 50th percentile, one-hour benchmark homeless triaged as semi-urgent waited (median=20 minutes, CI: 12-28) longer, and no other triage-level differences were found at this benchmark. Homeless emergent-level visits that exceeded the three-hour benchmark were 28 minutes, on average, shorter than domiciled patients of the same acuity level. Homeless females above 40 stayed the longest for non-urgent care (mean=173 minutes), 82 minutes longer (p=0.0001) than age-gender-acuity level-matched domiciled patients. Homelessness was the most prominent ED wait time classifier for non-urgent, ED visits. Overall, homeless patients triaged as CTAS-5 waited 30 minutes longer (p=0.0001) than domiciled patients triaged as CTAS-5. Homeless male 16-20-year-olds waited the shortest time of 72 minutes. Conclusion Homelessness-related wait time disparities exist in the low acuity non-urgent-level ED visits more than in the other levels, supporting the theory that lack of primary care access is a driver of ED use in this group. Our acuity level analysis supports that homeless people of a certain age (older) and gender groups (female) wait longer than their age-gender-matched domiciled patients to be seen by a physician in low acuity level presentations. Given the pattern of the homeless being seen earlier or statistically similar in emergent-level visits compared to matched domiciled patients and that 16-20-year-old homeless males were seen on average within 72 minutes (the shortest mean wait time reported for the triage level CTAS-5), we decline the notion of discrimination at the study site ED. If homeless patients' non-urgent needs were met elsewhere, pressure on the ED to meet benchmarks might be reduced.
Collapse
Affiliation(s)
- Swarna S Weerasinghe
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, CAN
| | - Samuel G Campbell
- Department of Emergency Medicine, Dalhousie University, Halifax, CAN
| |
Collapse
|
14
|
Loubiere S, Hafrad I, Monfardini E, Mosnier M, Bosetti T, Auquier P, Mosnier E, Tinland A. Morbidity and mortality in a prospective cohort of people who were homeless during the COVID-19 pandemic. Front Public Health 2023; 11:1233020. [PMID: 37780443 PMCID: PMC10536263 DOI: 10.3389/fpubh.2023.1233020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Certain living conditions, such as homelessness, increase health risks in epidemic situations. We conducted a prospective observational cohort study to investigate the impact of the COVID-19 pandemic on morbidity and mortality in adult people who were homeless. Methods The study population comprised around 40% of the entire population experiencing homelessness in Marseille. They were enrolled at 48 different locations during the first pandemic wave (June to August 2020) and were followed up 3 and 6 months later. Rapid serological screening for SARS-CoV-2 was performed by community outreach teams at each follow-up, who also conducted interviews. Death registers and hospital administrative databases were consulted. Results A total of 1,332 participants [mean age 40.1 years [SD 14.2], women 339 (29.9%)] were enrolled in the cohort. Of these, 192 (14.4%) participants were found positive for COVID-19 and were propensity score matched (1:3) and compared with 553 non-COVID-19 cases. Living in emergency shelters was associated with COVID-19 infection. While 56.3% of the COVID-19-infected cohort reported no symptoms, 25.0% were hospitalized due to the severity of the disease. Presence of three or more pre-existing comorbidities was associated with all-cause hospitalization. Among COVID-19 cases, only older age was associated with COVID-19 hospitalization. Three deaths occurred in the cohort, two of which were among the COVID-19 cases. Conclusion The study provides new evidence that the population experiencing homelessness faces higher risks of infection and hospitalization due to COVID-19 than the general population. Despite the efforts of public authorities, the health inequities experienced by people who are homeless remained major. More intensive and appropriate integrated care and earlier re-housing are needed.
Collapse
Affiliation(s)
- Sandrine Loubiere
- Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique – Hôpitaux de Marseille, Marseille, France
- CEReSS – Health Service Research and Quality of Life Center, EA 3279: CEReSS – Health Service Research and Quality of Life Center, School of medicine – La Timone Medical Campus, Aix-Marseille University, Marseille, France
| | - Ikrame Hafrad
- Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique – Hôpitaux de Marseille, Marseille, France
| | - Elisabetta Monfardini
- Department of Psychiatry, Assistance Publique – Hôpitaux de Marseille, Marseille, France
| | - Marine Mosnier
- Médecins du Monde – Doctors of the World, Marseille, France
| | - Thomas Bosetti
- Médecins du Monde – Doctors of the World, Marseille, France
| | - Pascal Auquier
- Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique – Hôpitaux de Marseille, Marseille, France
- CEReSS – Health Service Research and Quality of Life Center, EA 3279: CEReSS – Health Service Research and Quality of Life Center, School of medicine – La Timone Medical Campus, Aix-Marseille University, Marseille, France
| | - Emilie Mosnier
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Aix Marseille University, Marseille, France
| | - Aurélie Tinland
- CEReSS – Health Service Research and Quality of Life Center, EA 3279: CEReSS – Health Service Research and Quality of Life Center, School of medicine – La Timone Medical Campus, Aix-Marseille University, Marseille, France
- Department of Psychiatry, Assistance Publique – Hôpitaux de Marseille, Marseille, France
| |
Collapse
|
15
|
Jih J, Nguyen A, Cenzer I, Morrish J. Burden of unmet health-related social needs in an academic adult primary care practice in San Francisco California. BMC PRIMARY CARE 2023; 24:166. [PMID: 37626286 PMCID: PMC10463763 DOI: 10.1186/s12875-023-02125-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 08/15/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVES Unmet health-related social needs can influence health outcomes and increase healthcare utilization. There is growing interest in integrating social needs care into healthcare delivery. We conducted an assessment of health-related social needs in an academic adult primary care practice in San Francisco, California. METHODS We recruited a random convenience sample of adult English-, Chinese- or Spanish-speaking patients from clinic waiting rooms at the study sites to complete a self-administered, anonymous survey. We used the Accountable Health Communities Health-Related Social Needs Screening Tool for these domains: housing instability, food insecurity, transportation problems, utility help needs, interpersonal safety, financial strain, and family/community support. We conducted univariate and multivariate analyses adjusting for age, sex and survey language. RESULTS 679 patients completed the survey. Respondents were 57% female and mean age of 58 ± 18 years old. 54% of patients had at least one unmet health-related social need. The most prevalent health-related social needs were financial strain (35%), at least one issue with housing conditions (27%), and food insecurity (23%). Respondents completing the survey in Spanish had significantly higher odds of reporting food insecurity (AOR 3.97, 95%CI 1.86, 8.46), transportation problems (AOR 3.13, 95%CI 1.32, 7.43), and need for support with activities of daily living (AOR 4.58, 95%CI 2.04, 10.25) than respondents completing the survey in English. CONCLUSIONS The burden of unmet health-related social needs was considerable in this adult primary care practice. These findings can support a case for integrating health-related social need screening and social care in the delivery of primary care in the United States to advance health equity.
Collapse
Affiliation(s)
- Jane Jih
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, 490 Illinois St, San Francisco, CA, 94158, USA.
- Asian American Research Center on Health, 490 Illinois St, San Francisco, CA, 94158, USA.
- Multiethnic Health Equity Research Center, University of California San Francisco, 490 Illinois St, San Francisco, CA, 94158, USA.
| | - Antony Nguyen
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, 490 Illinois St, San Francisco, CA, 94158, USA
- Asian American Research Center on Health, 490 Illinois St, San Francisco, CA, 94158, USA
| | - Irena Cenzer
- Division of Geriatrics, Department of Medicine, University of California San Francisco, 4150 Clement St, San Francisco, CA, 94121, USA
| | - Jennifer Morrish
- University of California San Francisco Health, 1545 Divisadero St, San Francisco, CA, 94143, USA
| |
Collapse
|
16
|
Taylor SN, Munson D. Health Care of People Experiencing Homelessness: Part I. NEJM EVIDENCE 2023; 2:EVIDra2300123. [PMID: 38320148 DOI: 10.1056/evidra2300123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Homelessness and Health CarePeople who experience homelessness have high rates of medical illness. They struggle with conditions associated with living in crowded shelters, trauma, and exposure to extreme weather. Here, Taylor and Munson review the care of this vulnerable population.
Collapse
Affiliation(s)
| | - David Munson
- Massachusetts General Hospital, Boston
- Boston Health Care for the Homeless Program, Boston
| |
Collapse
|
17
|
Schiffler T, Carmichael C, Smith L, Doñate-Martínez A, Alhambra-Borrás T, Varadé MR, Barrio Cortes J, Kouvari M, Karnaki P, Moudatsou M, Tabaki I, Gil-Salmeron A, Grabovac I. Access to cancer preventive care and program considerations for people experiencing homelessness across four European countries: an exploratory qualitative study. EClinicalMedicine 2023; 62:102095. [PMID: 37533422 PMCID: PMC10393536 DOI: 10.1016/j.eclinm.2023.102095] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 08/04/2023] Open
Abstract
Background People experiencing homelessness (PEH) have a higher prevalence of adverse health outcomes and premature mortality compared to the non-homeless population. These include a higher burden of cancer and cancer-specific morbidity and mortality-outcomes that may be a consequence of significant barriers to accessing primary and secondary prevention and community health services. This study aimed to better comprehend the health needs and barriers to accessing preventive cancer care for PEH across four European countries as well as necessary considerations for developing interventions around cancer prevention for this population. Methods In this exploratory qualitative study, 69 semi-structured interviews were conducted across Austria, Greece, Spain, and the UK, with a sample comprising 15 professionals working in homelessness support services, 19 health professionals, and 35 PEH. Interviews took place between August 1 and October 31, 2021, and data were analysed inductively and iteratively following a thematic approach. Findings Findings were organised into two overarching themes: (1) Experiences and understanding of cancer prevention and treatment and (2) Considerations for program interventions. While cancer was a significant worry among PEH across all settings, they generally had minimal knowledge and understanding of cancer symptoms and prevention. Specific programs for cancer prevention for PEH were described as almost non-existent. Health professionals in some settings indicated that cancer in PEH was often missed in the early stages and instead diagnosed when the severity of symptoms intensified. Interpretation Overall, our findings indicate many commonalities in the health needs of PEH and the barriers they face when they seek access to cancer-specific healthcare services in the European context. Funding This study received funding from the European Union's Horizon 2020 Research and Innovation Programme under GA 965351.
Collapse
Affiliation(s)
- Tobias Schiffler
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria
| | - Christina Carmichael
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | | | | | - Miguel Rico Varadé
- General Directorate of Social Services, Council of Family, Youth and Social Policy, Community of Madrid, Madrid, Spain
| | - Jaime Barrio Cortes
- Foundation for Biosanitary Research and Innovation in Primary Care, Madrid, Spain
| | - Matina Kouvari
- Institute of Preventive Medicine, Environmental and Occupational Health Prolepsis, Athens, Greece
| | - Pania Karnaki
- Institute of Preventive Medicine, Environmental and Occupational Health Prolepsis, Athens, Greece
| | - Maria Moudatsou
- PRAKSIS – Programs of Development, Social Support and Medical Cooperation, Athens, Greece
| | - Ioanna Tabaki
- PRAKSIS – Programs of Development, Social Support and Medical Cooperation, Athens, Greece
| | | | - Igor Grabovac
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
18
|
Russolillo A, Moniruzzaman A, Carter M, Raudzus J, Somers JM. Association of homelessness and psychiatric hospital readmission-a retrospective cohort study 2016-2020. BMC Psychiatry 2023; 23:459. [PMID: 37353747 PMCID: PMC10288711 DOI: 10.1186/s12888-023-04945-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/09/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND A large proportion of adult psychiatric inpatients experience homelessness and are often discharged to unstable accommodation or the street. It is unclear whether homelessness impacts psychiatric hospital readmission. Our primary objective was to examine the association between homelessness and risk for 30-day and 90-day readmission following discharge from a psychiatric unit at a single urban hospital. METHODS A retrospective cohort study involving health administrative data among individuals (n = 3907) in Vancouver, Canada with an acute psychiatric admission between January 2016 and December 2020. Participants were followed from the date of index admission until censoring (December 30, 2020). Homelessness was measured at index admission and treated as a time-varying exposure. Adjusted Hazard Ratios (aHRs) of acute readmission (30-day and 90-day) for psychiatric and substance use disorders were estimated using multivariable Cox proportional hazards regression. RESULTS The cohort comprised 3907 individuals who were predominantly male (61.89%) with a severe mental illness (70.92%), substance use disorder (20.45%) and mean age of 40.66 (SD, 14.33). A total of 686 (17.56%) individuals were homeless at their index hospitalization averaging 19.13 (21.53) days in hospital. After adjusting for covariates, patients experiencing homelessness had a 2.04 (1.65, 2.51) increased rate of 30-day readmission and 1.65 (1.24, 2.19) increased rate of 90-day readmission during the observation period. CONCLUSIONS Homelessness was significantly associated with increased 30-day and 90-day readmission rates in a large comprehensive sample of adults with mental illness and substance use disorders. Interventions to reduce homelessness are urgently needed. QUESTION Is homelessness associated with risk for 30-day and 90-day psychiatric hospital readmission? FINDINGS In this retrospective cohort study of 3907 individuals, homelessness at discharge was associated with increased 30-day and 90-day psychiatric readmission. MEANING Housing status is an important risk factor for hospital readmission. High-quality interventions focused on housing supports have the potential to reduce psychiatric readmission.
Collapse
Affiliation(s)
- Angela Russolillo
- Department of Psychiatry, St. Paul's Hospital, Providence Health Care, 1081 Burrard Street, BC, V6Z 1Y6, Vancouver, Canada.
- Faculty of Health Sciences, Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, 515 West Hastings Street, BC, V6B 5K3, Vancouver, Canada.
| | - Akm Moniruzzaman
- Faculty of Health Sciences, Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, 515 West Hastings Street, BC, V6B 5K3, Vancouver, Canada
| | - Michelle Carter
- Department of Psychiatry, St. Paul's Hospital, Providence Health Care, 1081 Burrard Street, BC, V6Z 1Y6, Vancouver, Canada
| | - Julia Raudzus
- Department of Psychiatry, St. Paul's Hospital, Providence Health Care, 1081 Burrard Street, BC, V6Z 1Y6, Vancouver, Canada
| | - Julian M Somers
- Faculty of Health Sciences, Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, 515 West Hastings Street, BC, V6B 5K3, Vancouver, Canada
| |
Collapse
|
19
|
Rogers JH, Hawes SE, Wolf CR, Hughes JP, Englund JA, Starita LM, Chu HY. Care-seeking correlates of acute respiratory illness among sheltered adults experiencing homelessness in Seattle, WA, 2019: a community-based cross-sectional study. Front Public Health 2023; 11:1090148. [PMID: 37408748 PMCID: PMC10319010 DOI: 10.3389/fpubh.2023.1090148] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/15/2023] [Indexed: 07/07/2023] Open
Abstract
Objective Multifarious barriers to accessing healthcare services among people experiencing homelessness (PEH) lead to delays in seeking care for acute infections, including those caused by respiratory viruses. PEH are at high risk of acute respiratory illness (ARI)-related complications, especially in shelter settings that may facilitate virus spread, yet data characterizing healthcare utilization for ARI episodes among sheltered PEH remained limited. Methods We conducted a cross-sectional study of viral respiratory infection among adult residents at two homeless shelters in Seattle, Washington between January and May 2019. We assessed factors associated with seeking medical care for ARI via self-report. We collected illness questionnaires and nasal swabs were tested for respiratory viruses by reverse transcription quantitative real-time PCR (RT-qPCR). Results We observed 825 encounters from 649 unique participants; 241 (29.2%) encounters reported seeking healthcare for their ARI episode. Seasonal influenza vaccine receipt (adjusted prevalence ratio [aPR] 1.39, 95% CI 1.02-1.88), having health insurance (aPR 2.77, 95% CI 1.27-6.02), chronic lung conditions (aPR 1.55, 95% CI 1.12-2.15), and experiencing influenza-like-illness symptoms (aPR 1.63, 95% CI 1.20 - 2.20) were associated with increased likelihood of seeking care. Smoking (aPR 0.65, 95% CI 0.45-0.92) was associated with decreased likelihood of seeking care. Discussion Findings suggest that care seeking for viral respiratory illness among PEH may be supported by prior engagement with primary healthcare services. Strategies to increase healthcare utilization may lead to earlier detection of respiratory viruses.
Collapse
Affiliation(s)
- Julia H. Rogers
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Stephen E. Hawes
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Caitlin R. Wolf
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States
| | - James P. Hughes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Janet A. Englund
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Seattle Children’s Research Institute, University of Washington, Seattle, WA, United States
| | - Lea M. Starita
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
- Department of Genome Sciences, University of Washington, Seattle, WA, United States
| | - Helen Y. Chu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States
| |
Collapse
|
20
|
Ingram C, Buggy C, Elabbasy D, Perrotta C. Homelessness and health-related outcomes in the Republic of Ireland: a systematic review, meta-analysis and evidence map. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023:1-22. [PMID: 37361314 PMCID: PMC10233198 DOI: 10.1007/s10389-023-01934-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/03/2023] [Indexed: 06/28/2023]
Abstract
Aim To map existing research on homelessness and health in the Republic of Ireland, and to synthesize the evidence on housing-related disparities in health. Methods Peer-reviewed articles and conference abstracts published in English between 2012-2022 were retrieved from 11 bibliographic databases if they contained empirical data on homelessness and health in Ireland, and - in a subsequent screening stage - at least one measure of health disparity between the homeless and general populations. Reviewers extracted relative risks (RR), 95% confidence intervals (CI), and calculated pooled RR of comparable health disparities using pairwise random-effects meta-analyses. Results One hundred four articles contained empirical data on the health of homeless individuals residing in Ireland, addressing primarily substance use, addiction and mental health. Homelessness was associated with increased risk of illicit drug use (RR 7.33 [95% CI 4.2, 12.9]), reduced access to a general practitioner (GP) (RR 0.73 [CI 95% 0.71, 0.75]), frequent emergency department (ED) presentation (pooled RR 27.8 [95% CI 4.1, 189.8]), repeat presentation for self-harm (pooled RR 1.6 [95% CI 1.2, 2.0]) and premature departure from hospital (pooled RR 2.65 [95% CI 1.27, 5.53]). Conclusions Homelessness in Ireland is associated with reduced access to primary care and overreliance on acute care. Chronic conditions amongst homeless individuals are understudied. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-023-01934-0.
Collapse
Affiliation(s)
- Carolyn Ingram
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Conor Buggy
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
- Centre for Safety and Health at Work, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Darin Elabbasy
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Carla Perrotta
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| |
Collapse
|
21
|
Anastas TM, Stewart JC, Rand KL, Hirsh AT. Pain in People Experiencing Homelessness: A Scoping Review. Ann Behav Med 2023; 57:288-300. [PMID: 36745022 PMCID: PMC10094969 DOI: 10.1093/abm/kaac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Prior work suggests that people experiencing homelessness (PEH) are at heightened risk for developing pain and have a uniquely burdensome pain experience. PURPOSE The aim of this scoping review was to map the current peer-reviewed, published literature on the pain experience of PEH. METHODS In accordance with the US Annual Homeless Assessment Report, we defined homelessness as lacking shelter or a fixed address within the last year. We conceptualized the pain experience via a modified version of the Social Communication Model of Pain, which considers patient, provider, and contextual factors. Published articles were identified with CINHAL, Embase, PubMed, PsycINFO, and Web of Science databases. RESULTS Sixty-nine studies met inclusion criteria. Studies revealed that PEH have high rates of pain and experience high levels of pain intensity and interference. Substantially fewer studies examined other factors relevant to the pain experience, such as self-management, treatment-seeking behaviors, and pain management within healthcare settings. Nonetheless, initial evidence suggests that pain is undermanaged in PEH. CONCLUSIONS Future research directions to understand pain and homelessness are discussed, including factors contributing to the under-management of pain. This scoping review may inform future work to develop interventions to address the specific pain care needs of PEH.
Collapse
Affiliation(s)
- Tracy M Anastas
- Department of Psychology, Indiana University – Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University – Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University – Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University – Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| |
Collapse
|
22
|
Nemeth JM, Glasser AM, Hinton A, Macisco JM, Wermert A, Smith R, Kemble H, Sasser G. Brain Injury Is Prevalent and Precedes Tobacco Use among Youth and Young Adults Experiencing Homelessness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5169. [PMID: 36982077 PMCID: PMC10049052 DOI: 10.3390/ijerph20065169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
70%+ of youth and young adults experiencing homelessness (YYEH; 14-24 years old) smoke combustible tobacco. Little is known about the prevalence of acquired brain injury (ABI) among youth and young adult smokers experiencing homelessness (YYSEH) and its impact on tobacco use progression-the aim of our study. Through an interviewer-administered survey, YYSEH were asked about timing of tobacco use; exposure to causes of ABI; including brain oxygen deprivation (BOD; strangulation; accidental; choking games) and blunt force head trauma (BFHT; intentional; shaken violently; accidental); and perpetrators of intentional assault. Participants (n = 96) were on average 22 years old and from populations who experience structural disparities; including those minoritized by race (84.4%) and gender/sexual orientation (26.0%). In total, 87% of participants reported at least one exposure to BFHT and 65% to BOD. Intentional injury was more common than accidental. Furthermore, 60.4% of participants (n = 59) were classified as having ABI using the Brain Injury Severity Assessment. A significant proportion of YYSEH living with ABI were exposed to both BFHT and BOD prior to trying (68.5%, p = 0.002) and to first regular use (82.8%, p < 0.001) of tobacco. Among YYSEH with ABI; injury exposure occurred a median of 1 and 5 years before age of first regular tobacco use, dependent on injury mechanism. ABI from intentional violence is prevalent and precedes tobacco use among YYSEH.
Collapse
Affiliation(s)
- Julianna M. Nemeth
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Allison M. Glasser
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Joseph M. Macisco
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Amy Wermert
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Raya Smith
- College of Arts and Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Hannah Kemble
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
- Division of Health Services, Management, and Policy, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Georgia Sasser
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| |
Collapse
|
23
|
Kopanitsa V, McWilliams S, Leung R, Schischa B, Sarela S, Perelmuter S, Sheeran E, d'Algue LM, Tan GC, Rosenthal DM. A systematic scoping review of primary health care service outreach for homeless populations. Fam Pract 2023; 40:138-151. [PMID: 35809035 DOI: 10.1093/fampra/cmac075] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Homeless populations (HPs) have difficulties obtaining necessary medical care, and primary health care service outreach (PHSO) might be useful to bridge this gap. OBJECTIVE Using the Centre for Evidence-Based Management Critically Appraised Topics framework, to provide systematic evidence of the usefulness of PHSO interventions for HPs. METHODS A systematic search was conducted in 4 electronic databases: PubMed, Web of Science, CINAHL, and Cochrane (publication dates between January 1980 and November 2020). In total, 2,872 articles were identified. Primary research about PHSO for HPs in high-income countries were included. Data were extracted from eligible studies, summarized, and collated into a narrative account. RESULTS Twenty-four studies that described and evaluated PHSO interventions for adults experiencing homelessness were selected in the final synthesis. Most studies had a nonrandomized design. PHSO was found to successfully address some barriers to health care access for HPs through flexible appointments in convenient locations, fostering an understanding relationship between doctor and patients, and provision of additional basic necessities and referrals. Outreach was provided for a range of health care concerns, and several solutions to engage more HPs in primary care, improve continuity of care and to decrease the running costs were identified. Outreach also helped to implement preventative measures and reduced emergency service admissions. CONCLUSION Our review adds to the evidence that PHSO likely improves health care access for HPs. Further studies over longer time periods, involving collaborations with experts with lived experience of homelessness, and utilizing randomized study designs are needed to test outreach efficacy.
Collapse
Affiliation(s)
- Valeriya Kopanitsa
- Faculty of Medical Sciences, University College London Medical School, London, UK
| | - Stephen McWilliams
- Faculty of Medical Sciences, University College London Medical School, London, UK
| | - Richard Leung
- Faculty of Medical Sciences, University College London Medical School, London, UK
| | | | - Shazia Sarela
- Faculty of Medical Sciences, University College London Medical School, London, UK
| | - Sara Perelmuter
- Faculty of Life Sciences, University College London, London, UK
| | - Emma Sheeran
- Health Humanities Centre, University College London, London, UK
| | | | - Guan Chwen Tan
- Arts and Sciences Department, University College London, London, UK
| | - Diana Margot Rosenthal
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK.,UCL Collaborative Centre for Inclusion Health, University College London, London, UK
| |
Collapse
|
24
|
Bonacci RA, Moorman AC, Bixler D, Penley M, Wilson S, Hudson A, McClung RP. Prevention and Care Opportunities for People Who Inject Drugs in an HIV Outbreak - Kanawha County, West Virginia, 2019-2021. J Gen Intern Med 2023; 38:828-831. [PMID: 36323825 PMCID: PMC9971525 DOI: 10.1007/s11606-022-07875-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Robert A Bonacci
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- United States Public Health Service, Rockville, MD, USA.
| | - Anne C Moorman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Danae Bixler
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - McKenna Penley
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Suzanne Wilson
- Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, WV, USA
| | - Alana Hudson
- Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, WV, USA
| | - R Paul McClung
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
- United States Public Health Service, Rockville, MD, USA
| |
Collapse
|
25
|
Lenta M, Panadero S, Cabrera A, Vázquez JJ. Health situation and perceived health status among women experiencing homelessness: A longitudinal study in Spain. Public Health Nurs 2023; 40:9-16. [PMID: 36029140 PMCID: PMC10086823 DOI: 10.1111/phn.13130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/05/2022] [Accepted: 08/12/2022] [Indexed: 01/14/2023]
Abstract
The paper analyses the health situation and the perceived health status of a sample of women experiencing homelessness (n = 138) in Madrid, Spain. All participants were adults, and the night before the baseline interview, they had slept on the street, at a shelter or any facility provided to care for people living homeless. The information was collected using structured interviews, repeated twice a year for a 3-year follow-up period. The findings of this study show that women experiencing homelessness presented poor health, particularly in comparison with the general Spanish population. Over half of the women questioned claimed to have a diagnosed serious or chronic illness, with a correlation between these conditions and the age, time spent homeless or high levels of drug use. There was a positive correlation found between women's perceived health status and being younger and having access to independent accommodation, while having suffered a number of stressful life events and having spent long periods of time living homeless presented a negative correlation with a good perceived health status.
Collapse
Affiliation(s)
- Malena Lenta
- Department of Preventive Psychology, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Sonia Panadero
- Department of Clinical Psychology, Universidad de Complutense de Madrid, Madrid, Spain
| | - Adrian Cabrera
- Department of Economy, Universidad de Alcalá, Alcalá de Henares (Madrid), Spain
| | - José Juan Vázquez
- Department of Social Psychology, Universidad de Alcalá, Alcalá de Henares (Madrid), Spain
| |
Collapse
|
26
|
Coleman HLS, Levy-Philipp L, Balt E, Zuiderent-Jerak T, Mander H, Bunders J, Syurina E. Addressing health needs of the homeless in Delhi: Standardising on the issues of Street Medicine practice. Glob Public Health 2022; 17:2991-3004. [PMID: 35019812 DOI: 10.1080/17441692.2021.2023605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Due to barriers in accessing and using healthcare services, a large proportion of the care homeless populations receive comes from informal providers. In Delhi, one such informal programme, called Street Medicine, provides healthcare outreach to homeless communities. Clinical practice guidelines are set to be developed for Street Medicine teams in India and form the object of this research. This study uses a social-ecological model to understand the barriers facing Street Medicine teams and the homeless as they attempt to address the latter's healthcare needs; coupling it with an analytical approach which situates these barriers as the issues within practice through which standardisation can take place. A qualitative inquiry, comprising three months of observations of Street Medicine outreach and interviews with over 30 key informants, was conducted between April and July 2018. The analysis identified novel barriers to addressing the needs of homeless individuals, which bely a deficit between the design of health and social care systems and the agency homeless individuals possess within this system to influence their health outcomes. These barriers - which include user-dependent technological inscriptions, collaborating with untargeted providers and the distinct health needs of homeless individuals - are the entry points for standardising, or opening up, Street Medicine practices .
Collapse
Affiliation(s)
| | - Liam Levy-Philipp
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Elias Balt
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Teun Zuiderent-Jerak
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Joske Bunders
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Elena Syurina
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
27
|
Wiens K, Rosella LC, Kurdyak P, Chen S, Aubry T, Stergiopoulos V, Hwang SW. Determinants of Hospital Use and Physician Services Among Adults With a History of Homelessness. Health Serv Insights 2022; 15:11786329221127150. [PMID: 36325379 PMCID: PMC9618755 DOI: 10.1177/11786329221127150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 09/01/2022] [Indexed: 11/07/2022] Open
Abstract
Background: People experiencing homelessness have diverse patterns of healthcare use. This study examined the distribution and determinants of healthcare encounters among adults with a history of homelessness. Methods: Administrative healthcare records were linked with survey data for a general cohort of adults with a history of homelessness and a cohort of homeless adults with mental illness. Binary and count models were used to identify factors associated with hospital admissions, emergency department visits and physician visits for comparison across the 2 cohorts. Results: During the 1-year follow-up period, a higher proportion of people in the cohort with a mental illness used any inpatient (27% vs 14%), emergency (63% vs 53%), or physician services (90% vs 76%) compared to the general homeless cohort. People from racialized groups were less likely use nearly all health services, most notably physician services. Other factors, such as reporting of a regular source of care, poor perceived general health, and diagnosed chronic conditions were associated with higher use of all health services except psychiatric inpatient care Conclusion: When implementing interventions for patients with the greatest health needs, we must consider the unique factors that contribute to higher healthcare use, as well as the barriers to healthcare access.
Collapse
Affiliation(s)
- Kathryn Wiens
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Kathryn Wiens, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada.
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Tim Aubry
- School of Psychology & Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, ON, Canada
| | | | - Stephen W Hwang
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON, Canada
| |
Collapse
|
28
|
Cox SN, Rogers JH, Thuo NB, Meehan A, Link AC, Lo NK, Manns BJ, Chow EJ, Al Achkar M, Hughes JP, Rolfes MA, Mosites E, Chu HY. Trends and factors associated with change in COVID-19 vaccination intent among residents and staff in six Seattle homeless shelters, March 2020 to August 2021. Vaccine X 2022; 12:100232. [PMID: 36276877 PMCID: PMC9578969 DOI: 10.1016/j.jvacx.2022.100232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 09/30/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Achieving high COVID-19 vaccination coverage in homeless shelters is critical in preventing morbidity, mortality, and outbreaks, however, vaccination coverage remains lower among people experiencing homelessness (PEH) than the general population. Methods We conducted a cross-sectional study to retrospectively describe attitudes and identify factors associated with change in COVID-19 vaccination intent among shelter residents and staff during March 2020 - August 2021. To identify factors associated with change in COVID-19 vaccine intent becoming more positive overall compared to other attitudes, we utilized a Poisson model to calculate Risk Ratios with robust standard errors, adjusting for confounding by shelter site and demographic variables determined a priori. Results From July 12 - August 2, 2021, 97 residents and 20 staff participated in surveys across six shelters in Seattle King County, Washington. Intent to be vaccinated against COVID-19 increased from 45.3 % (n = 53) when recalling attitudes in March 2020 to 74.4 % (n = 87) as of August 2021, and was similar among residents and staff. Many participants (43.6 %, n = 51) indicated feeling increasingly accepting about receiving a COVID-19 vaccine since March 2020, while 13.7 % (n = 16) changed back and forth, 10.3 % (n = 12) became more hesitant, and 32.5 % (n = 38) had no change in intent. In the model examining the relationship between becoming more positive about receiving a COVID-19 vaccine compared to all other attitudes (n = 116), we found a 57.2 % increase in vaccine acceptability (RR 1.57; 95 % CI: 1.01, 2.45) among those who reported worsening mental health since the start of the pandemic. Conclusions Findings highlight opportunities to improve communication with residents and staff about COVID-19 vaccination and support a need for continued dialogue and a person-centered approach to understanding the sociocultural complexities and dynamism of vaccine attitudes at shelters.Clinical Trial Registry Number: NCT04141917.
Collapse
Affiliation(s)
- Sarah N. Cox
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA,Department of Epidemiology, University of Washington, Seattle, WA, USA,Corresponding author at: UW Medicine Box 358061, Chu Lab Room E630, 750 Republican Street, Seattle, WA, 98109, USA.
| | - Julia H. Rogers
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Nicholas B. Thuo
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Ashley Meehan
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy C. Link
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Natalie K. Lo
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Brian J. Manns
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eric J. Chow
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - James P. Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Emily Mosites
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Helen Y. Chu
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| |
Collapse
|
29
|
Cole ES, Hollander MAG, Ennis M, Donohue JM, James AE, Roberts ET. Do Medicaid Expenditures Increase After Adults Exit Permanent Supportive Housing? HOUSING POLICY DEBATE 2022; 34:148-155. [PMID: 38616891 PMCID: PMC11008701 DOI: 10.1080/10511482.2022.2112609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/04/2022] [Indexed: 04/16/2024]
Abstract
The effects of homelessness and permanent supportive housing (PSH) on health care utilization have been well documented. Prior research on the association between PSH entry and Medicaid expenditures have indicated that such housing support could result in savings to Medicaid programs; however, whether changes occur in health care use and expenditures after individuals exit PSH is unknown. If efficiency gains from PSH persist after the individual leaves PSH, the savings to payers such as Medicaid may continue even after the costs to provide housing for a PSH recipient have ended. We used linked Medicaid and housing data from Pennsylvania to examine changes in the level and composition of Medicaid expenditures for 580 adult enrollees during the 12 months before and after exit from PSH adjusting for relevant covariates. In adjusted analyses, we estimated that monthly spending declined by $200.32 (95% CI: $323.50, $75.15) in the first quarter post-exit and by $267.63 (95% CI: $406.10, $127.10) in the third quarter. Our findings suggest that PSH may have sustained budgetary benefits to state Medicaid agencies even for beneficiaries exiting the program. However, more research is needed to understand if these reductions in expenditures last beyond 12 months and do not reflect under-use of care that may be important for managing health over the long-term.
Collapse
Affiliation(s)
- Evan S. Cole
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mara A. G. Hollander
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Molly Ennis
- Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Julie M. Donohue
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - A. Everette James
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eric T. Roberts
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
30
|
Developing and evaluating a SAFER model to screen for diabetes complications among people experiencing homelessness: a pilot study protocol. Pilot Feasibility Stud 2022; 8:211. [PMID: 36114586 PMCID: PMC9479401 DOI: 10.1186/s40814-022-01165-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Diabetes management combined with housing instability intersects, forcing individuals to triage competing needs and critical stressors, such as safety and shelter, with fundamental diabetes self-management tasks like attending healthcare appointments to screen for the complications of diabetes, leaving individuals overwhelmed and overburdened. We aim to address this disjuncture found within our current healthcare delivery system by providing point-of-care screening opportunities in a more patient-centered approach.
Method
We describe a pilot study of a novel clinical intervention which provides timely, comprehensive, and accessible screening for diabetes complications to people experiencing homelessness. We will assess the reach, effectiveness, adoption, implementation, and maintenance, as per the RE-AIM framework, of a SAFER model of care (i.e., screening for A1C, feet, eyes, and renal function). A trained nurse will provide this screening within a homeless shelter. During these encounters, eligible participants will be screened for microvascular complications (neuropathy, nephropathy, retinopathy) and have their A1C measured, all at the point of care, using bedside tools and novel technology. Effectiveness, our primary objective, will be evaluated using a pre-post design, by comparing the rate of completion of full microvascular screening during the study period with individuals’ own historical screening in the 2-year period prior to enrollment. The other domains of the RE-AIM framework will be assessed using process data, chart reviews, patient surveys, and qualitative semi-structured interviews with service providers and participants. This study will be conducted in a large inner-city homeless shelter within a major urban Canadian city (Calgary, Canada).
Discussion
Currently, screening for diabetes complications is often inaccessible for individuals experiencing homelessness, which places heavy burdens on individuals and, ultimately, on already strained emergency and acute care services when complications go undetected at earlier stages. The SAFER intervention will modify the current standard of care for this population in a way that is less fragmented, more person-focused, and timely, with the goal of ultimately improving the rate of screening in an acceptable fashion to identify those requiring specialist referral at earlier stages.
Collapse
|
31
|
Ku-gaa-gii pimitizi-win, the COVID-19 cohort study of people experiencing homelessness in Toronto, Canada: a study protocol. BMJ Open 2022. [PMCID: PMC9361747 DOI: 10.1136/bmjopen-2022-063234] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
IntroductionInitial reports suggest people experiencing homelessness (PEH) are at high risk for SARS-CoV-2 infection and associated morbidity and mortality. However, there have been few longitudinal evaluations of the spread and impact of COVID-19 among PEH. This study will estimate the prevalence and incidence of COVID-19 infections in a cohort of PEH followed prospectively in Toronto, Canada. It will also examine associations between individual-level and shelter-level characteristics with COVID-19 infection, adverse health outcomes related to infection and vaccination. Finally, the data will be used to develop and parameterise a mathematical model to characterise SARS-CoV-2 transmission dynamics, and the transmission impact of interventions serving PEH.Design, methods and analysisKu-gaa-gii pimitizi-win will follow a random sample of PEH from across Toronto (Canada) for 12 months. 736 participants were enrolled between June and September 2021, and will be followed up at 3-month intervals. At each interval, specimens (saliva, capillary blood) will be collected to determine active SARS-CoV-2 infection and serologic evidence of past infection and/or vaccination, and a detailed survey will gather self-reported information, including a detailed housing history. To examine the association between individual-level and shelter-level characteristics on COVID-19-related infection, adverse outcomes, and vaccination, shelter and healthcare administrative data will be linked to participant study data. Healthcare administrative data will also be used to examine long-term (up to 5 years) COVID-19-related outcomes among participants.Ethics and disseminationEthical approval was obtained from the Unity Health Toronto and University of Toronto Health Sciences Research Ethics Boards (# 20-272). Ku-gaa-gii pimitizi-win was designed in collaboration with community and service provider partners and people having lived experience of homelessness. Findings will be reported to groups supporting Ku-gaa-gii pimitizi-win, Indigenous and other community partners and service providers, funding bodies, public health agencies and all levels of government to inform policy and public health programs.
Collapse
|
32
|
Khan BM, Reid N, Stergiopoulos V. Advancing recovery education for people experiencing housing instability: A qualitative analysis of service user and provider perspectives in Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1541-1549. [PMID: 34309106 DOI: 10.1111/hsc.13484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 05/14/2021] [Accepted: 05/29/2021] [Indexed: 06/13/2023]
Abstract
The recovery paradigm is increasingly being adopted within mental health services internationally, to support a process of personal change for affected individuals, with the aim of living a satisfying, hopeful, contributing life within the limitations of mental illness. In efforts to assist the process of recovery, Recovery Education Centres (REC), offering recovery supports through education rather than traditional service models, have been widely implemented; there is limited evidence to date with respect to the experiences and outcomes of disadvantaged populations, such as people experiencing homelessness, with recovery education. This study used qualitative methods to explore the perspectives and experiences of service users and providers of the Supporting Transitions and Recovery (STAR) Learning Centre in Toronto, Canada, focused on supporting the process of recovery for individuals with histories of homelessness. Between July 2017 and June 2018, semistructured interviews with 20 service users, one key informant, and a focus group comprising eight current and former REC staff and volunteers were conducted to explore opportunities to better tailor the curriculum, and key programmatic features, to the needs of the population. Interviews were analysed using inductive thematic analysis. Most participants described favourable experiences with the REC and suggested adding more challenging course content (n = 10) and increasing delivery options (n = 8), highlighting the diversity of participant needs. Others described the importance of improving accessibility through geographic expansion, offering transit subsidies, and using innovative media. In addition, the importance of delivering more courses in partnership with community partners, to maximise reach and impact, was also highlighted (n = 15). This study underscores the importance of engaging service users and providers, including peers, in ongoing adaptations to best serve the target populations. The expertise and lived experience of these key stakeholders offer a unique lens, supporting the process of recovery, through co-production of curriculum content and joint program planning and improvements. Findings can inform REC development for disadvantaged populations and potentially enhance recovery outcomes for those experiencing multiple barriers to recovery.
Collapse
Affiliation(s)
- Bushra M Khan
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nadine Reid
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
33
|
Fleming MD, Evans JL, Graham-Squire D, Cawley C, Kanzaria HK, Kushel MB, Raven MC. Association of Shelter-in-Place Hotels With Health Services Use Among People Experiencing Homelessness During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2223891. [PMID: 35895061 PMCID: PMC9331083 DOI: 10.1001/jamanetworkopen.2022.23891] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/18/2022] [Indexed: 01/28/2023] Open
Abstract
Importance Some jurisdictions used hotels to provide emergency noncongregate shelter and support services to reduce the risk of COVID-19 infection among people experiencing homelessness (PEH). A subset of these shelter-in-place (SIP) hotel guests were high users of acute health services, and the association of hotel placement with their service use remains unknown. Objective To evaluate the association of SIP hotel placements with health services use among a subset of PEH with prior high acute health service use. Design, Setting, and Participants This study used a matched retrospective cohort design comparing health services use between PEH with prior high service use who did and did not receive a SIP hotel placement, from April 2020 to April 2021. The setting was 25 SIP hotels in San Francisco, California, with a daily capacity of 2500 people. Participants included PEH who were among the top 10% high users of acute medical, mental health, and substance use services and who had 3 or more emergency department (ED) visits in the 9 months before the implementation of the SIP hotel program. Data analysis for this study was performed from February 2021 to May 2022. Exposures SIP hotel placement with on-site supportive services. Main Outcomes and Measures The primary outcomes were ED visits, hospitalizations and bed days, psychiatric emergency visits, psychiatric hospitalizations, outpatient mental health and substance use visits, and outpatient medical visits. Results Of 2524 SIP guests with a minimum of 90-day stays, 343 (13.6%) met criteria for high service use. Of 686 participants with high service use (343 SIP group; 343 control), the median (IQR) age was 54 (43-61) years, 485 (70.7%) were male, 283 (41.3%) were Black, and 337 (49.1%) were homeless for more than 10 years. The mean number of ED visits decreased significantly in the high-user SIP group (1.84 visits [95% CI, 1.52-2.17 visits] in the 90 days before SIP placement to 0.82 visits [95% CI, 0.66-0.99 visits] in the 90 days after SIP placement) compared with high-user controls (decrease from 1.33 visits [95% CI, 1.39-1.58 visits] to 1.00 visits [95% CI, 0.80-1.20 visits]) (incidence rate ratio [IRR], 0.60; 95% CI, 0.47-0.75; P < .001). The mean number of hospitalizations decreased significantly from 0.41 (95% CI, 0.30-0.51) to 0.14 (95% CI, 0.09-0.19) for SIP guests vs 0.27 (95% CI, 0.19-0.34) to 0.22 (95% CI, 0.15-0.29) for controls (IRR, 0.41; 95% CI, 0.27-063; P < .001). Inpatient hospital days decreased significantly from a mean of 4.00 (95% CI, 2.44-5.56) to 0.81 (95% CI, 0.40-1.23) for SIP guests vs 2.27 (95% CI, 1.27-3.27) to 1.85 (95% CI, 1.06-2.65) for controls (IRR, 0.25; 95% CI, 0.12-0.54; P < .001), as did psychiatric emergency visits, from a mean of 0.03 (95% CI, 0.01-0.05) to 0.01 (95% CI, 0.00-0.01) visits for SIP guests vs no change in the control group (IRR, 0.25; 95% CI, 0.11-0.51; P < .001). Conclusions and Relevance These findings suggest that in a population of PEH with high use of acute health services, SIP hotel placement was associated with significantly reduced acute care use compared with high users without a placement.
Collapse
Affiliation(s)
| | - Jennifer L. Evans
- Benioff Homelessness and Housing Initiative, University of California, San Francisco
- Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco
| | - Dave Graham-Squire
- Benioff Homelessness and Housing Initiative, University of California, San Francisco
- Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco
| | - Caroline Cawley
- Benioff Homelessness and Housing Initiative, University of California, San Francisco
- Department of Emergency Medicine, University of California, San Francisco
| | - Hemal K. Kanzaria
- Benioff Homelessness and Housing Initiative, University of California, San Francisco
- Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco
- Department of Emergency Medicine, University of California, San Francisco
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Margot B. Kushel
- Benioff Homelessness and Housing Initiative, University of California, San Francisco
- Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco
| | - Maria C. Raven
- Benioff Homelessness and Housing Initiative, University of California, San Francisco
- Department of Emergency Medicine, University of California, San Francisco
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| |
Collapse
|
34
|
Del Buono BC, Salhi BA, Kimmel AE, Santen SA, Jarrell KL, White MH, Brown CK, Moll JL. Prioritizing homelessness in emergency medicine education: A concept paper. AEM EDUCATION AND TRAINING 2022; 6:S85-S92. [PMID: 35774356 PMCID: PMC9222893 DOI: 10.1002/aet2.10753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/03/2022] [Accepted: 03/25/2022] [Indexed: 06/15/2023]
Abstract
Patients experiencing homelessness visit the emergency department (ED) often and have worse clinical outcomes. Caring for this patient population is complex, challenging, and resource-intensive. Emergency medicine (EM) education is lacking in formal curricula on the topic of homelessness, despite benefits for resident morale and patient care. Our goals were to identify a gap in EM education and training of the intersection of housing and health and propose educational topics and teaching methods to be included in residency curricula. Methodology was based on the development of a didactic session at the 2021 SAEM Annual Meeting. A needs assessment was performed through a review of medical education literature, a national survey of EM residency curricula, the individual curricula utilized by respective team members, and perspective from the team's own individual experiences with teaching about homelessness. Topics presented were chosen through discussion between the authors and determined to be common and relevant and cover a broad spectrum of content. The four presented topics included the intersection of COVID-19 and housing, the impact of LGBTQIA+ status on homelessness, housing status related to health system utilization and health outcomes, and housing inequity as a means of perpetuating structural racism. Suggestions for education of these topics included case-based learning, journal clubs, simulation, collaboration with social work, quality improvement projects, and engagement with community leaders. The ED is uniquely positioned to encounter the impacts of homelessness on health. Emergency physicians should be prepared to effectively care for these patients with complex social needs. Structured learning on this topic would benefit EM resident growth and lead to better patient care through improved screening, recognition of risk factors, and use of social resources.
Collapse
Affiliation(s)
- Benedict C. Del Buono
- Department of Emergency MedicineVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
| | - Bisan A. Salhi
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Alexis E. Kimmel
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Sally A. Santen
- Virginia Commonwealth University School of MedicineProfessor, Emergency Medicine and Medical EducationUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Kelli L. Jarrell
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Melissa H. White
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Christopher K. Brown
- Department of Emergency MedicineVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
| | - Joel L. Moll
- Department of Emergency MedicineVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
| |
Collapse
|
35
|
Total Joint Arthroplasty in Homeless Patients at an Urban Safety Net Hospital. J Am Acad Orthop Surg 2022; 30:523-527. [PMID: 35294408 DOI: 10.5435/jaaos-d-21-00651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 02/01/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Homelessness is a key social determinant of health, and the patient population has grown to over 580,000. Total joint arthroplasty (TJA) is an effective treatment of symptomatic end-stage osteoarthritis of the hip and knee and has been shown to improve health-related quality of life in the general population. However, the literature on the outcomes of TJA among homeless patients is limited. METHODS We retrospectively reviewed 442 patients who underwent primary, unilateral TJA between June 1, 2016, and August 31, 2017, at an urban, tertiary, academic safety net hospital. Based on self-reported living status, we classified 28 homeless patients and 414 control nonhomeless patients. Fisher exact tests, Student t-tests, and multivariate logistic regression were used to compare the demographics, preoperative conditions, and surgical outcomes between the two groups. RESULTS The homeless group were younger, more often male, and smokers; had alcohol use disorder; and used illicit drugs. After controlling for age, sex, and preoperative medical and social conditions, homeless patients were 15.83 times more likely to have an emergency department visit (adjusted odds ratio, 15.83; 95% confidence interval, 5.05 to 49.59; P < 0.0001) within 90 days but had similar rates of readmission (P = 0.25), revision surgery (P = 0.38), and prosthetic joint infection (P = 0.25) when compared with nonhomeless patients. DISCUSSION Although homeless patients did not have higher rates of readmission or revision surgery, homelessness still presents unique challenges for the TJA patients and providers. With careful preoperative optimization and collaborative support, however, the benefits of TJA may outweigh the risk of poor outcomes for these patients.
Collapse
|
36
|
Liu M, Richard L, Campitelli MA, Nisenbaum R, Dhalla IA, Wadhera RK, Shariff SZ, Hwang SW. Hospitalizations During the COVID-19 Pandemic Among Recently Homeless Individuals: a Retrospective Population-Based Matched Cohort Study. J Gen Intern Med 2022; 37:2016-2025. [PMID: 35396658 PMCID: PMC8992790 DOI: 10.1007/s11606-022-07506-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hospitalizations fell precipitously among the general population during the COVID-19 pandemic. It remains unclear whether individuals experiencing homelessness experienced similar reductions. OBJECTIVE To examine how overall and cause-specific hospitalizations changed among individuals with a recent history of homelessness (IRHH) and their housed counterparts during the first wave of the COVID-19 pandemic, using corresponding weeks in 2019 as a historical control. DESIGN Population-based cohort study conducted in Ontario, Canada, between September 30, 2018, and September 26, 2020. PARTICIPANTS In total, 38,617 IRHH, 15,022,368 housed individuals, and 186,858 low-income housed individuals matched on age, sex, rurality, and comorbidity burden. MAIN MEASURES Primary outcomes included medical-surgical, non-elective (overall and cause-specific), elective surgical, and psychiatric hospital admissions. KEY RESULTS Average rates of medical-surgical (rate ratio: 3.8, 95% CI: 3.7-3.8), non-elective (10.3, 95% CI: 10.1-10.4), and psychiatric admissions (128.1, 95% CI: 126.1-130.1) between January and September 2020 were substantially higher among IRHH compared to housed individuals. During the peak period (March 17 to June 16, 2020), rates of medical-surgical (0.47, 95% CI: 0.47-0.47), non-elective (0.80, 95% CI: 0.79-0.80), and psychiatric admissions (0.86, 95% CI: 0.84-0.88) were significantly lower among housed individuals relative to equivalent weeks in 2019. No significant changes were observed among IRHH. During the re-opening period (June 17-September 26, 2020), rates of non-elective hospitalizations for liver disease (1.41, 95% CI: 1.23-1.69), kidney disease (1.29, 95% CI: 1.14-1.47), and trauma (1.19, 95% CI: 1.07-1.32) increased substantially among IRHH but not housed individuals. Distinct hospitalization patterns were observed among IRHH even in comparison with more medically and socially vulnerable matched housed individuals. CONCLUSIONS Persistence in overall hospital admissions and increases in non-elective hospitalizations for liver disease, kidney disease, and trauma indicate that the COVID-19 pandemic presented unique challenges for recently homeless individuals. Health systems must better address the needs of this population during public health crises.
Collapse
Affiliation(s)
- Michael Liu
- Harvard Medical School, Boston, MA, USA.
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
- ICES Central, Toronto, Ontario, Canada.
| | | | | | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Irfan A Dhalla
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
37
|
Xie EC, Chan K, Khangura JK, Koh JJK, Orkin AM, Sheikh H, Hayman K, Gupta S, Kumar T, Hulme J, Mrochuk M, Dong K. CAEP position statement on improving emergency care for persons experiencing homelessness: executive summary. CAN J EMERG MED 2022; 24:369-375. [PMID: 35389188 PMCID: PMC8988109 DOI: 10.1007/s43678-022-00303-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Edward C Xie
- Department of Family & Community Medicine, Division of Emergency Medicine, University Health Network, Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada. .,Emergency Department, RFE Building, Toronto General Hospital, Toronto, ON, Canada.
| | - Kathryn Chan
- Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Jaspreet K Khangura
- Department of Emergency Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, AB, Canada.,Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Justin Jek-Kahn Koh
- Department of Emergency Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Aaron M Orkin
- Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Emergency Medicine, St Joseph's Health Centre, Unity Health Toronto, Inner City Health Associates, Toronto, ON, Canada
| | - Hasan Sheikh
- Division of Emergency Medicine, University Health Network, Toronto, ON, Canada.,Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Kate Hayman
- Division of Emergency Medicine, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sahil Gupta
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Thara Kumar
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada.,Medical Officer of Health, Central Zone, Alberta, Canada.,Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer Hulme
- Department of Family and Community Medicine, University Health Network, Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital, 200 Elizabeth Street, R. Fraser Elliott Building, Ground Floor, Room 480, Toronto, ON, M5G 2C4, Canada
| | - May Mrochuk
- Department of Emergency Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, AB, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada.,B804 Women's Centre, Royal Alexandra Hospital, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada
| |
Collapse
|
38
|
Shariff SZ, Richard L, Hwang SW, Kwong JC, Forchuk C, Dosani N, Booth R. COVID-19 vaccine coverage and factors associated with vaccine uptake among 23 247 adults with a recent history of homelessness in Ontario, Canada: a population-based cohort study. Lancet Public Health 2022; 7:e366-e377. [PMID: 35278362 PMCID: PMC8906815 DOI: 10.1016/s2468-2667(22)00037-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND People experiencing homelessness face a high risk of SARS-CoV-2 infection and transmission, as well as health complications and death due to COVID-19. Despite being prioritised for receiving the COVID-19 vaccine in many regions, little data are available on vaccine uptake in this vulnerable population. Using population-based health-care administrative data from Ontario, Canada-a region with a universal, publicly funded health system-we aimed to describe COVID-19 vaccine coverage (ie, the estimated percentage of people who have received a vaccine) and determinants of vaccine receipt among individuals with a recent history of homelessness. METHODS We conducted a retrospective, population-based cohort study of adults (aged ≥18 years) with a recent experience of homelessness, inadequate housing, or shelter use as recorded in routinely collected health-care databases between June 14, 2020, and June 14, 2021 (a period within 6 months of Dec 14, 2020, when COVID-19 vaccine administration was initiated in Ontario). Participants were followed up from Dec 14, 2020, to Sept 30, 2021, for the receipt of one or two doses of a COVID-19 vaccine using the province's real-time centralised vaccine information system. We described COVID-19 vaccine coverage overall and within predefined subgroups. Using modified Poisson regression, we further identified sociodemographic factors, health-care usage, and clinical factors associated with receipt of at least one dose of a COVID-19 vaccine. FINDINGS 23 247 individuals with a recent history of homelessness were included in this study. Participants were predominantly male (14 752 [63·5%] of 23 247); nearly half were younger than 40 years (11 521 [49·6%]) and lived in large metropolitan regions (12 123 [52·2%]); and the majority (18 226 [78·4%]) visited a general practitioner for an in-person consultation during the observation period. By Sept 30, 2021, 14 271 (61·4%; 95% CI 60·8-62·0) individuals with a recent history of homelessness had received at least one dose of a COVID-19 vaccine and 11 082 (47·7%; 47·0-48·3) had received two doses; in comparison, over the same period, 86·6% of adults in the total Ontario population had received a first dose and 81·6% had received a second dose. In multivariable analysis, factors positively associated with COVID-19 uptake were one or more outpatient visits to a general practitioner (adjusted risk ratio [aRR] 1·37 [95% CI 1·31-1·42]), older age (50-59 years vs 18-29 years: 1·18 [1·14-1·22], ≥60 years vs 18-29 years: 1·27 [1·22-1·31]), receipt of an influenza vaccine in either of the two previous influenza seasons (1·25 [1·23-1·28]), being identified as homeless via a visit to a community health centre versus exclusively a hospital-based encounter (1·13 [1·10-1·15]), receipt of one or more SARS-CoV-2 tests between March 1, 2020, and Sept 30, 2021 (1·23 [1·20-1·26]), and the presence of chronic health conditions (one condition: 1·05 [1·03-1·08]; two or more conditions: 1·11 [1·08-1·14]). By contrast, living in a smaller metropolitan region (aRR 0·92 [95% CI 0·90-0·94]) or rural location (0·93 [0·90-0·97]) versus large metropolitan regions were associated with lower uptake. INTERPRETATION In Ontario, COVID-19 vaccine coverage among adults with a recent history of homelessness has lagged and, as of Sept 30, 2021, was 25 percentage points lower than that of the general adult population in Ontario for a first dose and 34 percentage points lower for a second dose. With high usage of outpatient health services among individuals with a recent history of homelessness, better utilisation of outpatient primary care structures might offer an opportunity to increase vaccine coverage in this population. Our findings underscore the importance of leveraging existing health and service organisations that are accessed and trusted by people who experience homelessness for targeted vaccine delivery. FUNDING The Public Health Agency of Canada. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Salimah Z Shariff
- ICES (formerly the Institute for Clinical Evaluative Sciences), London, ON, Canada; Lawson Health Research Institute, London, ON, Canada; Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.
| | - Lucie Richard
- ICES (formerly the Institute for Clinical Evaluative Sciences), London, ON, Canada,MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | - Stephen W Hwang
- ICES (formerly the Institute for Clinical Evaluative Sciences), London, ON, Canada,MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jeffrey C Kwong
- ICES (formerly the Institute for Clinical Evaluative Sciences), London, ON, Canada,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Public Health Ontario, Toronto, ON, Canada,University Health Network, Toronto, ON, Canada
| | - Cheryl Forchuk
- Lawson Health Research Institute, London, ON, Canada,Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Naheed Dosani
- Division of Palliative Care, Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Richard Booth
- ICES (formerly the Institute for Clinical Evaluative Sciences), London, ON, Canada,Lawson Health Research Institute, London, ON, Canada,Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| |
Collapse
|
39
|
Strobel S, Shanjer M, Faragalla K, Liu A(Y, Hossain R. A Population-Based Susceptible, Infected, Recovered Simulation Model of the Spread of Influenza-Like-Illness in the Homeless versus Non-Homeless Population. Ann Epidemiol 2022; 70:68-73. [DOI: 10.1016/j.annepidem.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/31/2022] [Accepted: 04/11/2022] [Indexed: 11/01/2022]
|
40
|
I R Jenkinson J, Strike C, Hwang SW, Di Ruggiero E. Legal, geographic and organizational contexts that shape knowledge sharing in the hospital discharge process for people experiencing homelessness in Toronto, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e377-e387. [PMID: 33105525 DOI: 10.1111/hsc.13206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 06/11/2023]
Abstract
People experiencing homelessness use acute healthcare at higher rates than the general population, yet hospitals frequently discharge them to the streets or emergency shelters. Available literature on the hospital discharge process for people experiencing homelessness identifies knowledge sharing as an important and challenging part of the discharge process; however, it does little to explain what generates these challenges or what might support knowledge sharing. In this study, we explain under which contexts certain mechanisms are triggered to facilitate knowledge sharing between hospitals and shelters during the discharge process. Between September 2018 and April 2019, we interviewed 33 participants: hospital workers on general medicine wards across three hospitals; shelter workers; researchers, policy advisors or advocates working at the intersection of homelessness and healthcare in Toronto. We find that within the legal context of health information protection, the concept of "circle of care" has created barriers to knowledge sharing between hospitals and shelters by excluding shelter workers from discharge planning. We note, however, that the degree to which hospital workers have navigated these barriers and brought shelter workers into the discharge process varies across hospitals. We explore this variation and find that certain geographic and organisational contexts have activated the development of institutional- and individual-level relationships between hospitals and shelters or their workers, respectively. We suggest that these relationships generate increased trust and communication and have led to knowledge sharing between hospitals and shelters. These findings are applicable in most urban centres with hospitals and where people experiencing homelessness live. Understanding the role of context is imperative for developing appropriate and effective interventions to improve hospital discharge processes. The development and implementation of more effective discharge processes can contribute to improved post-discharge care and recovery for this patient population and contribute to addressing health equity.
Collapse
Affiliation(s)
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| |
Collapse
|
41
|
Kaltsidis G, Grenier G, Cao Z, Bertrand K, Fleury MJ. Predictors of change in housing status over 12 months among individuals using emergency shelters, temporary housing or permanent housing in Quebec, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:631-643. [PMID: 32985755 DOI: 10.1111/hsc.13168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/16/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
Homelessness is an ongoing societal and public health problem in Canada and other countries. Housing services help homeless individuals along the transition towards stable housing, yet few studies have assessed factors that predict change in individual housing trajectories. This study identified predictors of change in housing status over 12 months for a sample of 270 currently or formerly homeless individuals using emergency shelters, temporary housing (TH) or permanent housing (PH) resources in Quebec. Participants recruited from 27 community or public organisations were interviewed between January and September 2017, and again 12 months later. Sociodemographic variables, housing history, health conditions, service use and client satisfaction were measured. Directors and programme coordinators from the selected organisations also completed a baseline questionnaire measuring strictness in residential codes of living/conduct, interorganisational collaboration and overall budget. Independent variables were organised into predisposing, enabling and needs factors, based on the Gelberg-Andersen Behavioral Model. Multilevel logistic regressions were used to test associations with the dependent variable: change in housing status over 12 months, whether positive (e.g. shelter to TH) or negative (e.g. PH to shelter). Predictors of positive change in housing status were as follows: residing in PH, being female, having children (predisposing factors); having consulted a psychologist, higher frequency in use of public ambulatory services (enabling factors); and not having physical illnesses (needs factor). The findings support strategies for helping this clientele obtain and maintain stable housing. They include deploying case managers to promote access to public ambulatory services, mainly among men or individuals without children who are less likely to seek help; greater use of primary care mental health teams; the establishment of more suitable housing for accommodating physical health problems; and reinforcing access to subsidised PH programmes.
Collapse
Affiliation(s)
- Gesthika Kaltsidis
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Zhirong Cao
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Karine Bertrand
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Longueuil, QC, Canada
- Institut Universitaire sur les Dépendances, Montréal, QC, Canada
| | - Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
- Institut Universitaire sur les Dépendances, Montréal, QC, Canada
| |
Collapse
|
42
|
Winnett R. The experiences of hospital social workers who care for homeless patients: an interpretive phenomenological analysis. SOCIAL WORK IN HEALTH CARE 2022; 61:52-68. [PMID: 35098903 DOI: 10.1080/00981389.2022.2033379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 01/07/2022] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
Unique challenges exist for hospital social workers tasked with the care of patients experiencing homelessness. These challenges affect patient care, impact social work practice, and emphasize the need to better understand the experience of providing services to this vulnerable population. Research is limited and focuses upon the experiences of unhoused patients and of medical management, not upon the experiences of the social workers positioned to meaningfully impact care. To address this gap, the current study utilized Interpretive Phenomenological Analysis (IPA) to examine the lived experiences of hospital social workers providing services to homeless patients. Respondents identified fulfilling aspects of this work but also emphasized the deeply personal and professional challenges it engendered. Recommendations were offered for supporting hospital social workers' self-care, incorporating effective practice perspectives, and providing meaningful patient support. Alignment of respondent experiences with literature on compassion satisfaction, compassion fatigue, work life conditions, and burnout was considered.
Collapse
Affiliation(s)
- Ren Winnett
- Doctorate of Social Work Program, School of Social Work, Rutgers the State University of New Jersey, USA
| |
Collapse
|
43
|
Pidgeon H, McKinney D, Tan-Creevy J, Shah M, Ansari S, Gottlieb M. Thinking Beyond the Emergency Department: Addressing Homelessness in Residency Education. Ann Emerg Med 2021; 79:397-403. [PMID: 34607743 DOI: 10.1016/j.annemergmed.2021.07.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Harrison Pidgeon
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL.
| | - Dennis McKinney
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Jeny Tan-Creevy
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Meeta Shah
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Sobia Ansari
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| |
Collapse
|
44
|
Milaney K, Passi J, Zaretsky L, Liu T, O'Gorman CM, Hill L, Dutton D. Drug use, homelessness and health: responding to the opioid overdose crisis with housing and harm reduction services. Harm Reduct J 2021; 18:92. [PMID: 34446034 PMCID: PMC8394031 DOI: 10.1186/s12954-021-00539-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Canada is in the midst of an opioid overdose crisis and Alberta has one of the highest opioid use rates across the country. Populations made vulnerable through structural inequities who also use opioids, such as those who are unstably housed, are at an increased risk of experiencing harms associated with opioid use. The main purpose of this study was to explore if there was an association between unstable housing and hospital use for people who use opioids. Methods Analysis utilized self-reported data from the Alberta Health and Drug Use Survey which surveyed 813 Albertans in three cities. Hospital use was modeled using a logistic regression with our primary variable of interest being housing unstable status. Chi square tests were conducted between hospital use and variables associated with demographics, characteristics of drug use, health characteristics, and experiences of receiving services to establish model inclusion. Results Results revealed a significant association between housing instability and hospital use with unstably housed individuals twice as likely torequire hospital care. Conclusions Results highlight the importance of concurrently addressing housing instability alongside the provision of harm reduction services such as safe supply and supervised consumption sites. These findings have significant implications for policy and policymakers during the opioid overdose epidemic, and provide a foundation for future areas of research.
Collapse
Affiliation(s)
- Katrina Milaney
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW 3rd Floor
- 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
| | - Jenna Passi
- School of Public Policy, University of Calgary, Calgary, Canada
| | - Lisa Zaretsky
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW 3rd Floor
- 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Tong Liu
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | | | | | - Daniel Dutton
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| |
Collapse
|
45
|
Jenkinson JIR, Strike C, Hwang SW, Di Ruggiero E. Nowhere to go: exploring the social and economic influences on discharging people experiencing homelessness to appropriate destinations in Toronto, Canada. Canadian Journal of Public Health 2021; 112:992-1001. [PMID: 34448129 DOI: 10.17269/s41997-021-00561-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/02/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES A main component of discharging patients from hospital is identifying an appropriate destination to meet their post-hospitalization needs. In Canada, meeting this goal is challenged when discharging people experiencing homelessness, who are frequently discharged to the streets or shelters. This study aimed to understand why and how the ability of hospital workers to find appropriate discharge destinations for homeless patients is influenced by dynamic social and economic contexts. METHODS Guided by critical realism, we conducted semi-structured, in-depth interviews with 33 participants: hospital workers on general medicine wards at three urban hospitals; shelter workers; and researchers, policy advisors, and advocates working at the intersection of homelessness and healthcare. RESULTS Historical and contemporary social and economic contexts (e.g., shrinking financial resources) have triggered the adoption of efficiency and accountability measures in hospitals, and exclusion criteria and rules in shelters, both conceptualized as mechanisms in this article. Hospitals are pressured to move patients out as soon as they are medically stable, but they struggle to discharge patients to shelters: to prevent inappropriate discharges, shelters have adopted exclusion and eligibility rules and criteria. These mechanisms contribute to an explanation of why identifying an appropriate discharge destination for people experiencing homelessness is challenging. CONCLUSION Our results point to a systems gap in this discharge pathway where there is nowhere for people experiencing homelessness to go who no longer need acute care, but whose needs are too complex for shelters. Systemic changes are needed to better support hospital and shelter frontline workers to improve discharge processes.
Collapse
Affiliation(s)
- Jesse I R Jenkinson
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. .,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health, 30 Bond Street, Toronto, M5B 1W8, ON, Canada.
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health, 30 Bond Street, Toronto, M5B 1W8, ON, Canada.,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
46
|
Lachaud J, Mejia-Lancheros C, Durbin A, Nisenbaum R, Wang R, O'Campo P, Stergiopoulos V, Hwang SW. The Effect of a Housing First Intervention on Acute Health Care Utilization among Homeless Adults with Mental Illness: Long-term Outcomes of the At Home/Chez-Soi Randomized Pragmatic Trial. J Urban Health 2021; 98:505-515. [PMID: 34181180 PMCID: PMC8382791 DOI: 10.1007/s11524-021-00550-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/28/2022]
Abstract
We assessed the effects of the Toronto Site Housing First (HF) intervention on hospitalizations and emergency department (ED) visits among homeless adults with mental illness over 7 years of follow-up. The Toronto Site is part of an unblinded multi-site randomized pragmatic trial of HF for homeless adults with mental illness in Canada, which followed participants up to 7 years. Five hundred seventy-five participants were recruited and classified as having high (HN) or moderate need (MN) for mental health support services. Each group was randomized into intervention (HF) and treatment as usual groups, and 567 (98.6%) consented to link their data to health administrative databases. HF participants received a monthly rent supplement of $600 (Canadian) and assertive community treatment (ACT) support or intensive care management (ICM) support based on need level. Treatment as usual (TAU) participants had access to social, housing, and health services generally available in the community. Outcomes included all-cause and mental health-specific hospitalization, number of days in hospital, and ED visit. We used GEE models to estimate ratio of rate ratios (RRR). The results showed HF with ACT had no significant effect on hospitalization rates among HN participants, but reduced the number of days in hospital (RRR = 0.32, 95% CI 0.16-0.63) and number of ED visits (RRR = 0.57, 95% CI 0.34-0.95). HF with ICM resulted in an increase in the number of hospitalizations (RRR = 1.69, 95% CI 1.09-2.60) and ED visit rates (RRR = 1.42, 95% CI 1.01-2.01) but had no effect in days in hospital for MN participants. Addressing the health needs of this population and reducing acute care utilization remain system priorities. Trial registration: http://www.isrctn.com/identifier: ISRCTN42520374.
Collapse
Affiliation(s)
- James Lachaud
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada.
| | - Cilia Mejia-Lancheros
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Anna Durbin
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Ri Wang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Patricia O'Campo
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
47
|
Typology of Currently or Formerly Homeless Individuals Based on Their Use of Health and Social Services. Community Ment Health J 2021; 57:948-959. [PMID: 32734310 DOI: 10.1007/s10597-020-00693-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
This study identified profiles among 455 currently or formerly homeless individuals in Quebec (Canada), based on health and social service use. Using latent class analysis, four profiles were identified that grouped individuals with: (1) few health problems, and using few case managers and family doctors, but with high frequency of psychiatric consultations, emergency department (ED) visits and hospitalizations; (2) chronic physical illnesses, having case managers and family doctors, but low frequency of ED visits and hospitalizations; (3) moderate health problems and little service use; and (4) multiple and complex health problems and high frequency of service use. These profiles suggest the following recommendations to more adequately meet patient needs: regarding Class 1, improved outreach services, more ED liaison nurses and peer navigation; Class 2: more family doctors and case managers; Class 3: higher family doctors; and Class 4: more assertive or intensive case management, harm reduction and permanent housing resources.
Collapse
|
48
|
Factors associated with higher healthcare costs in a cohort of homeless adults with a mental illness and a general cohort of adults with a history of homelessness. BMC Health Serv Res 2021; 21:555. [PMID: 34090425 PMCID: PMC8180071 DOI: 10.1186/s12913-021-06562-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/17/2021] [Indexed: 11/28/2022] Open
Abstract
Background Healthcare costs are disproportionately incurred by a relatively small group of people often described as high-cost users. Understanding the factors associated with high-cost use of health services among people experiencing homelessness could help guide service planning. Methods Survey data from a general cohort of adults with a history of homelessness and a cohort of homeless adults with mental illness were linked with administrative healthcare records in Ontario, Canada. Total costs were calculated using a validated costing algorithm and categorized based on population cut points for the top 5%, top 6–10%, top 11–50% and bottom 50% of users in Ontario. Multinomial logistic regression was used to identify the predisposing, enabling, and need factors associated with higher healthcare costs (with bottom 50% as the reference). Results Sixteen percent of the general homeless cohort and 30% percent of the cohort with a mental illness were in the top 5% of healthcare users in Ontario. Most healthcare costs for the top 5% of users were attributed to emergency department and inpatient service costs, while the costs from other strata were mostly for physician services, hospital outpatient clinics, and medications. The odds of being within the top 5% of users were higher for people who reported female gender, a regular medical doctor, past year acute service use, poor perceived general health and two or more diagnosed chronic conditions, and were lower for Black participants and other racialized groups. Older age was not consistently associated with higher cost use; the odds of being in the top 5% were highest for 35-to-49-year year age group in the cohort with a mental illness and similar for the 35–49 and ≥ 50-year age groups in the general homeless cohort. Conclusions This study combines survey and administrative data from two cohorts of homeless adults to describe the distribution of healthcare costs and identify factors associated with higher cost use. These findings can inform the development of targeted interventions to improve healthcare delivery and support for people experiencing homelessness. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06562-6.
Collapse
|
49
|
Nelson RE, Montgomery AE, Suo Y, Cook J, Pettey W, Gundlapalli A, Greene T, Evans W, Gelberg L, Kertesz SG, Tsai J, Byrne TH. Temporary Financial Assistance Decreased Health Care Costs For Veterans Experiencing Housing Instability. Health Aff (Millwood) 2021; 40:820-828. [PMID: 33939508 DOI: 10.1377/hlthaff.2020.01796] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Compared with housed people, those experiencing homelessness have longer and more expensive inpatient stays as well as more frequent emergency department visits. Efforts to provide stable housing situations for people experiencing homelessness could reduce health care costs. Through the Supportive Services for Veteran Families program, the Department of Veterans Affairs partners with community organizations to provide temporary financial assistance to veterans who are currently homeless or at imminent risk of becoming homeless. We examined the impact of temporary financial assistance on health care costs for veterans in the Supportive Services for Veteran Families program and found that, on average, people receiving the assistance incurred $352 lower health care costs per quarter than those who did not receive the assistance. These results can inform national policy debates regarding the proper solution to housing instability.
Collapse
Affiliation(s)
- Richard E Nelson
- Richard E. Nelson is a core investigator at the Veterans Affairs (VA) Salt Lake City's Informatics, Decision-Enhancement, and Analytic Sciences Center and a research associate professor in the Division of Epidemiology, University of Utah, both in Salt Lake City, Utah
| | - Ann Elizabeth Montgomery
- Ann Elizabeth Montgomery is an investigator at the Birmingham VA Medical Center and an assistant professor in the School of Public Health, University of Alabama at Birmingham, in Birmingham, Alabama
| | - Ying Suo
- Ying Suo is a data manager in the Division of Epidemiology, University of Utah
| | - James Cook
- James Cook is a data manager in the Division of Epidemiology, University of Utah
| | - Warren Pettey
- Warren Pettey is a data scientist in the Division of Epidemiology, University of Utah
| | - Adi Gundlapalli
- Adi Gundlapalli is an adjunct professor in the Division of Epidemiology, University of Utah
| | - Tom Greene
- Tom Greene is a professor in the Division of Epidemiology and Department of Population Health Sciences, University of Utah
| | - William Evans
- William Evans is a professor in the Department of Economics, University of Notre Dame, in South Bend, Indiana
| | - Lillian Gelberg
- Lillian Gelberg is an investigator at the VA Greater Los Angeles Healthcare System and a professor in the Department of Family Medicine, University of California Los Angeles, in Los Angeles, California
| | - Stefan G Kertesz
- Stefan G. Kertesz is an investigator at the Birmingham VA Medical Center and a professor in the Division of Preventive Medicine, University of Alabama at Birmingham
| | - Jack Tsai
- Jack Tsai is the director of research at the National Center on Homelessness among Veterans, in Tampa, Florida, and a professor in the School of Public Health, University of Texas Health Sciences Center, in San Antonio, Texas
| | - Thomas H Byrne
- Thomas H. Byrne is an investigator at the Bedford VA Medical Center and an assistant professor in the School of Social Work, Boston University, in Bedford, Massachusetts
| |
Collapse
|
50
|
Martin C, Andrés P, Bullón A, Villegas JL, de la Iglesia-Larrad JI, Bote B, Prieto N, Roncero C. COVID pandemic as an opportunity for improving mental health treatments of the homeless people. Int J Soc Psychiatry 2021; 67:335-343. [PMID: 32820986 PMCID: PMC7443578 DOI: 10.1177/0020764020950770] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Homeless population has been severely affected by the COVID-19 pandemic. Their living conditions, comorbidity with different pathologies and a greater frequency of mental disorders, make this population vulnerable. METHOD We implemented a program of serial visits in a hostel for confined homeless of the city council social services, for the monitoring and treatment of mental disorders and substance abuse problems. Accompanied by serial phone and email contacts. RESULTS A highly significant percentage (63%) had mental disorders or substance abuse, requiring pharmacological intervention, and 37% began follow-up in resources of the Mental Health and Addiction network of the Psychiatric Service at the end of the program. Hospital emergency service visits were drastically reduced. None of them were infected with COVID-19. An individualized Social plan was drawn up in order to reintegrate them with support in the community. CONCLUSIONS The Results have been really positive, meeting all the objectives and opening up developing new programs in the future, in the pandemic outbreak and out of it.
Collapse
Affiliation(s)
- Carmen Martin
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Pilar Andrés
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Alberto Bullón
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain
| | - José Luis Villegas
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Javier Ignacio de la Iglesia-Larrad
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Berta Bote
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Nieves Prieto
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain.,Psychiatric Unit, School of Medicine, University of Salamanca, Spain
| | - Carlos Roncero
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain.,Psychiatric Unit, School of Medicine, University of Salamanca, Spain
| |
Collapse
|