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Troyer L, Khaleel M, Cook JL, Rucinski K. Addressing social determinants of health in orthopaedics: A systematic review of strategies and solutions. Knee 2024; 49:241-248. [PMID: 39043019 DOI: 10.1016/j.knee.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 06/06/2024] [Accepted: 07/04/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Barriers stemming from Social Determinants of Health (SDOH) are known to contribute to higher rates of complications, poor patient adherence to treatment plans, and suboptimal outcomes following orthopaedic care. While SDOH's impact has been characterized, interventions to address SDOH-related inequities in orthopaedics have not yet been optimized. PURPOSE The objective of the present systematic review was to identify and synthesize current peer-reviewed literature focused interventions to address SDOH-related inequities to develop optimal mitigation strategies that improve outcomes for orthopaedic patients. METHODS A systematic search of PubMed, OVID, and CINAHL identified articles that referenced SDOH and an intervention to address inequities. RESULTS After screening 419 studies, 19 met inclusion criteria. Studies commonly looked at the impact of insurance policy change on the rate of the population with active insurance and associated use of elective surgery. Nine studies found that policy changes generally increased the rate of insured patients, though inequities remained for younger and racial minority patients. The relative paucity of literature in conjunction with methodological differences among studies highlights the need for further development and validation of effective interventions to address SDOH-related inequities in orthopaedics. CONCLUSIONS Insurance expansion was the focus of the majority of included articles, finding that expansion is associated with higher rates of insured patients undergoing elective and emergent procedures, however, gaps remain for young patients and racial minorities. Further research is needed to determine effective healthcare team, healthcare system, and policy-level interventions that overcome SDOH-related barriers to optimal care and outcomes for orthopaedic patients. LEVEL OF EVIDENCE Level-II.
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Affiliation(s)
- Luke Troyer
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, United States
| | - Mubinah Khaleel
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, United States
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, United States; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, United States
| | - Kylee Rucinski
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, United States; Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, United States.
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Kaufman RA, Mallick M, Louis JT, Williams M, Oriol N. The Role of Street Medicine and Mobile Clinics for Persons Experiencing Homelessness: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:760. [PMID: 38929006 PMCID: PMC11204218 DOI: 10.3390/ijerph21060760] [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: 05/08/2024] [Revised: 06/08/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION An estimated 5800 to 46,500 lives are lost due to homelessness each year. Experiencing homelessness and poor health are cyclically related, with one reinforcing the other. Mobile programs, which include vehicles that travel to deliver care, and street medicine, the act of bringing care to spaces where PEH live, may play a role in alleviating this burden by providing trusted, affordable, and accessible care to this community. METHODS We conducted a scoping review of peer-reviewed literature on the role of mobile clinics and street medicine in providing care for PEH by searching PubMed, Embase, and Web of Science on 10 August 2023. Articles from 2013 to 2023 specific to programs in the United States were included. The protocol was developed following the PRISMA-ScR guidelines. The primary outcome was the role of mobile programs for persons experiencing homelessness. RESULTS A total of 15 articles were included in this review. The descriptive findings emphasized that street medicine and mobile clinics provide primary care, behavioral health, and social services. The utilization findings indicate that street medicine programs positively impact the health system through their ability to defer emergency department and hospital visits, providing financial benefits. The comparative findings between mobile programs and office-based programs indicate current successes and areas for improvement. DISCUSSION Mobile clinics and street medicine programs that serve PEH provide a wide range of services. While more significant structural change is needed to address healthcare costs and housing policies in the United States, mobile clinics and street medicine teams can improve healthcare access and the healthcare system.
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Affiliation(s)
- Rebekah A. Kaufman
- Harvard Medical School, 200 Longwood Ave, Boston, MA 02115, USA; (R.A.K.); (J.T.L.); (N.O.)
| | - Mahwish Mallick
- Harvard Medical School, 200 Longwood Ave, Boston, MA 02115, USA; (R.A.K.); (J.T.L.); (N.O.)
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Jarvis Thanex Louis
- Harvard Medical School, 200 Longwood Ave, Boston, MA 02115, USA; (R.A.K.); (J.T.L.); (N.O.)
| | - Mollie Williams
- Harvard Medical School, 200 Longwood Ave, Boston, MA 02115, USA; (R.A.K.); (J.T.L.); (N.O.)
| | - Nancy Oriol
- Harvard Medical School, 200 Longwood Ave, Boston, MA 02115, USA; (R.A.K.); (J.T.L.); (N.O.)
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
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Ali F, Law J, Russell C, Crépault JF, Goulão JCB, Lock K, Rehm J. Navigating the nexus between British Columbia's public consumption and decriminalization policies of illegal drugs. Health Res Policy Syst 2024; 22:60. [PMID: 38783308 PMCID: PMC11112927 DOI: 10.1186/s12961-024-01150-6] [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: 01/08/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
In January 2023, the province of British Columbia (BC) decriminalized the possession of certain illegal drugs for personal use. The province's primary intent was to reduce the stigma associated with drug use, as well as barriers for people who use drugs (PWUD) to access treatment and supports. However, less than ten months into the decriminalization policy, due to growing concerns about public safety voiced by municipal governments and communities, the provincial government made amendments to the policy to ban the public consumption of illicit drugs in additional locations, and subsequently introduced additional legislation, Bill 34, aimed at regulating public consumption of drugs in public spaces. Some communities have also implemented local bylaws similarly regulating public drug use. Bill 34 and local bylaws may serve as tools to promote community health and safety and minimize direct and indirect harms associated with public drug use. However, such legislation may re-criminalize PWUD and reinforce negative perceptions surrounding drug use, especially if these policies are not paired with strategies to expand the availability and accessibility of critical harm reduction and housing services. Without ample access to these services, limitations on public drug use can potentially displace individuals to areas where they are more likely to use alone, further exposing them to substance use-related harms, and undermining the goals of decriminalization. The potential effects of these restrictions may also disproportionately impact marginalized populations. As of April 2024, Bill 34 remains on hold. Moving forward, it will be important to monitor this bill, as well as other public consumption bylaws and legislation, and their impact on BC's overall decriminalization initiative. Decision-makers are urged to increase engagement with PWUD and relevant stakeholders in the design and implementation of policies pertaining to public consumption to ensure that they effectively address the evolving needs and realities of PWUD, and align with decriminalization goals.
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Affiliation(s)
- Farihah Ali
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St., Toronto, ON, M5S 2S1, Canada.
- Ontario CRISM Node Team (OCRINT), Canadian Research Initiative in Substance Misuse (CRISM), Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Justine Law
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St., Toronto, ON, M5S 2S1, Canada
- Ontario CRISM Node Team (OCRINT), Canadian Research Initiative in Substance Misuse (CRISM), Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Cayley Russell
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St., Toronto, ON, M5S 2S1, Canada
- Ontario CRISM Node Team (OCRINT), Canadian Research Initiative in Substance Misuse (CRISM), Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Jean-Francois Crépault
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Communications and Partnerships, CAMH, Toronto, Canada
| | | | - Kurt Lock
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St., Toronto, ON, M5S 2S1, Canada
- Ontario CRISM Node Team (OCRINT), Canadian Research Initiative in Substance Misuse (CRISM), Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- PAHO/WHO Collaborating Centre, CAMH, Toronto, Canada
- WHO European Region Collaborating Centre at Public Health Institute of Catalonia, Barcelona, Spain
- Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg (ZIS), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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MacKinnon L, Kerman N, Socías ME, Brar R, Bardwell G. Primary care embedded within permanent supportive housing for people who use substances: A qualitative study examining healthcare access in Vancouver, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5062-e5073. [PMID: 35852403 PMCID: PMC9970158 DOI: 10.1111/hsc.13921] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/09/2022] [Accepted: 07/08/2022] [Indexed: 05/11/2023]
Abstract
Marginally housed people who use drugs and alcohol (PWUD/A) face barriers in accessing healthcare services, which may be improved by providing healthcare in housing settings. This case study examines the experiences of healthcare access amongst PWUD/A who live in a permanent supportive housing model in Vancouver, Canada. This model has an embedded multidisciplinary clinic providing in-reach services. Thirty participants were recruited via posters placed throughout the building and semi-structured qualitative interviews were conducted remotely. Interviews were conducted with participants who accessed onsite care regularly (n = 15) and those who do not (n = 15). Data were analysed to identify both a priori and emerging themes. Participants who accessed the onsite clinic reported benefiting from stigma-free care. Close proximity and convenience of drop-in appointments enabled participants to engage with healthcare services more consistently, though hours of operation and privacy concerns were barriers for others. Participants who did not use the onsite clinic highlighted the importance of continuity of care with their pre-existing primary care team, particularly if their clinic was in close geographic proximity. However, they also described utilising these services for urgent health needs or as an occasional alternative source of care. Shared perspectives across all participants emphasised the importance of low-barrier services, including medication delivery, convenience and positive therapeutic relationships. Our findings suggest that embedding access to primary care within supportive housing benefits PWUD/A who have previously encountered barriers to healthcare access. This model could be implemented to prevent utilisation of acute healthcare resources and improve health outcomes amongst PWUD/A.
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Affiliation(s)
- Laura MacKinnon
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Kerman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - M. Eugenia Socías
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Rupinder Brar
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Geoff Bardwell
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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