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Jiménez-Sánchez C, la Cruz NBD, Lafuente-Ureta R, Francín-Gallego M, Calvo S, Fortún-Rabadán R, Pérez-Palomares S. Physical therapy interventions for people experiencing homelessness to improve pain and self-perceived health status. BMC Public Health 2024; 24:993. [PMID: 38594673 PMCID: PMC11003153 DOI: 10.1186/s12889-024-18453-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Homeless shelters have emerged as components of the social services network, playing an important role in providing health care to the homeless population. The aim of this study was to evaluate an individualized physical therapy intervention for people experiencing homelessness and to determine the relationship between self-perceived variables. METHODS Pre and post study, setting at the "Santa y Real Hermandad de Nuestra Señora del Refugio y Piedad" homeless shelter in Zaragoza, Spain. Participants were people experiencing homelessness with musculoskeletal disorders who attended a physical therapy service at shelter facilities. A physical therapy program was implemented including health education, exercise and manual therapy, electrotherapy, thermotherapy and bandaging. Demographic variables (age and gender), nationality, employment situation, educational level, pain location, number of painful areas, feeling of loneliness (3-Item Loneliness Scale; values from 3 to 9), pain intensity (Numerical Pain Rating Scale [NPRS]; from 0 to 10) and self-perceived health (Clinical Global Impression [CGI]; from 1 to 7). RESULTS Sixty-four homeless people (age of 46.4 ± 10.9 years) participated in the study. Musculoskeletal pain was reported by 98.4% of subjects, with moderate pain intensities (6.1), and 48.4% presenting with pain at multiple sites. Perceptions of loneliness were low (3.7 ± 2.5) and self-perceived health status was moderately ill (3.5 ± 1.7). Positive significant correlations were identified between pain intensity and self-perceived health. The average number of sessions was 1.5 (± 0.8), with manual therapy (35.6%) followed by health education (23.5%) being the most frequently used techniques. Both pain and self-perceived health improved after treatment, even following a brief intervention. CONCLUSIONS This study demonstrates the potentially negative impact of untreated pain on the self-perceived health of homeless individuals with musculoskeletal disorders that should be targeted for consideration. The findings suggest that a paradigm shift in pain management, including a physical therapy service in shelters, is needed to address the rehabilitation demands of these individuals in a real-life context. This study was approved by the Aragon Ethics Committee (PI19/438) and performed according to the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) statement.
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Affiliation(s)
- Carolina Jiménez-Sánchez
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
- IIS Aragón, Zaragoza, Spain
| | - Natalia Brandín-de la Cruz
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
- IIS Aragón, Zaragoza, Spain
| | - Raquel Lafuente-Ureta
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
| | - Marina Francín-Gallego
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
| | - Sandra Calvo
- IIS Aragón, Zaragoza, Spain.
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.
| | - Rocío Fortún-Rabadán
- Department of Physical Therapy, Faculty of Health Sciences, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
| | - Sara Pérez-Palomares
- IIS Aragón, Zaragoza, Spain
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
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Klaman SL, Godino JG, Northrup A, Lewis SV, Tam A, Carrillo C, Lewis R, Matthews E, Mendez B, Reyes L, Rojas S, Ramers C. Does a simplified algorithm and integrated HCV care model improve linkage to care, retention, and cure among people who inject drugs? A pragmatic quality improvement randomized controlled trial protocol. BMC Infect Dis 2024; 24:105. [PMID: 38238686 PMCID: PMC10797714 DOI: 10.1186/s12879-024-08982-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND As many as 2.4 million Americans are affected by chronic Hepatitis C Virus (HCV) in the United States.In 2018, the estimated number of adults with a history of HCV infection in San Diego County was 55,354 (95% CI: 25,411-93,329). This corresponded to a seroprevalence of 2.1% (95% CI: 2.1-3.4%). One-third of infections were among PWID. Published research has demonstrated that direct-acting antivirals (DAAs) have high efficacy and can now be used by primary care providers to treat HCV. In addition, limited evidence exists to support the effectiveness of simplified algorithms in clinical trial and real-world settings. Even with expanded access to HCV treatment in primary care settings, there are still groups, especially people who inject drugs (PWID) and people experiencing homelessness, who experience treatment disparities due to access and treatment barriers. The current study extends the simplified algorithm with a streetside 'one-stop-shop' approach with integrated care (including the offer of buprenorphine prescriptions and abscess care) using a mobile clinic situated adjacent to a syringe service program serving many homeless populations. Rates of HCV treatment initiation and retention will be compared between patients offered HCV care in a mobile clinic adjacent to a syringe services program (SSP) and homeless encampment versus those who are linked to a community clinic's current practice of usual care, which includes comprehensive patient navigation. METHODS A quasi-experimental, prospective, interventional, comparative effectiveness trial with allocation of approximately 200 patients who inject drugs and have chronic HCV to the "simplified care" pathway (intervention group) or the "usual care" pathway (control group). Block randomization will be performed with a 1:1 randomization. DISCUSSION Previous research has demonstrated acceptable outcomes for patients treated using simplified algorithms for DAAs and point-of-care testing in mobile medical clinics; however, there are opportunities to explore how these new, innovative systems of care impact treatment initiation rates or other HCV care cascade outcomes among PWID. TRIAL REGISTRATION We have registered our study with ClinicalTrials.gov, a resource of the United States National Library of Medicine. This database contains research studies from United States and other countries around the world. Our study has not been previously published. The ClinicalTrials.gov registration identifier is NCT04741750.
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Affiliation(s)
- Stacey L Klaman
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
| | - Job G Godino
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA.
| | - Adam Northrup
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
| | - Sydney V Lewis
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
| | - Aaron Tam
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
| | - Carolina Carrillo
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
| | - Robert Lewis
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
| | - Eva Matthews
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
| | - Blanca Mendez
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
| | - Letty Reyes
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
| | - Sarah Rojas
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
| | - Christian Ramers
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
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Henry T, Khachemoune A. Dermatologic conditions and risk factors in people experiencing homelessness (PEH): systematic review. Arch Dermatol Res 2023; 315:2795-2803. [PMID: 37833427 DOI: 10.1007/s00403-023-02722-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/02/2023] [Accepted: 09/06/2023] [Indexed: 10/15/2023]
Abstract
Limited data is present that characterizes dermatological conditions and their risk factors in people experiencing homelessness (PEH).We conducted a systematic review to investigate the types of dermatological conditions in PEH, their risk factors, and provide solutions when providing dermatological care to this patient population. We searched PubMed, EMBASE and Cochrane for articles written in English from 2012 to 2022. The last search was performed on December 27, 2022. Twelve studies met the inclusion criteria. Fifty-eight percent of the studies took place in the USA (n = 7) and 42% of studies took place in Canada (n = 5). Prevalent dermatological conditions included, skin cancer, cutaneous manifestations of malnutrition, cutaneous diphtheria, Group A Streptococcus infection (iGAS), lice, atopic dermatitis, acne, sexually transmitted infections (STIs), and Staphylococcus aureus infections. Risk factors included substance use disorder, skin trauma, not having access to sunscreen or hats, unstable housing, higher exposure to extreme weather, and higher mobility. Due to studies being conducted in the USA or Canada, results may not be generalizable. This systematic review strongly suggests that many dermatological conditions prevalent in PEH can be contributed to poor skin integrity. Better measures can significantly reduce certain dermatological conditions by improving access to dermatological care.
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Affiliation(s)
- Tanya Henry
- College of Medicine, University of Illinois, 1853 W Polk St, Chicago, IL, 60612, USA
| | - Amor Khachemoune
- Veterans Affairs Medical Center, 800 Poly Pl, Brooklyn, NY, USA.
- Department of Dermatology, SUNY Downstate, Brooklyn, NY, USA.
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Filardo TD, Prasad N, Waddell CJ, Persad N, Pellegrini GJ, Borne D, Janssen J, Bejarano A, Marx GE, Mosites E. Mpox vaccine acceptability among people experiencing homelessness in San Francisco - October-November 2022. Vaccine 2023; 41:5673-5677. [PMID: 37591706 DOI: 10.1016/j.vaccine.2023.07.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/19/2023]
Abstract
Mpox has affected many communities in the United States (U.S.), including people experiencing homelessness (PEH). Mpox vaccination has been an important tool to disrupt transmission and protect communities at risk of infection. To better understand mpox vaccine knowledge and attitudes, we surveyed 273 PEH and people accessing homeless service sites in San Francisco. Among 64 participants previously offered mpox vaccination, 38 (59 %) had received the vaccine. Among 209 participants not previously offered mpox vaccination, 108 (52 %) reported they would receive the vaccine. Vaccine acceptance was higher among transgender female participants and among male participants who reported male sex partner preference (MSM). Half of participants who declined vaccination identified that perception of personal risk and vaccine education may increase their likelihood of receiving an mpox vaccine. Leveraging trusted information sources to provide risk communication and vaccine education may increase vaccine uptake among PEH.
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Affiliation(s)
- Thomas D Filardo
- 2022 Multi-National Mpox Outbreak Response, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, CDC, Atlanta, GA, USA.
| | - Namrata Prasad
- 2022 Multi-National Mpox Outbreak Response, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, CDC, Atlanta, GA, USA
| | - Caroline J Waddell
- 2022 Multi-National Mpox Outbreak Response, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, CDC, Atlanta, GA, USA
| | - Neela Persad
- 2022 Multi-National Mpox Outbreak Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gerald J Pellegrini
- 2022 Multi-National Mpox Outbreak Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Deborah Borne
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Julia Janssen
- San Francisco Department of Public Health, San Francisco, CA, USA
| | | | - Grace E Marx
- 2022 Multi-National Mpox Outbreak Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily Mosites
- 2022 Multi-National Mpox Outbreak Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Swartz N, Odayappan S, Chatterjee A, Cutler D. Impact of Medicaid expansion on inclusion of medications for opioid use disorder in homeless adults' treatment plans. J Subst Use Addict Treat 2023; 152:209059. [PMID: 37207834 DOI: 10.1016/j.josat.2023.209059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/22/2023] [Accepted: 05/01/2023] [Indexed: 05/21/2023]
Abstract
INTRODUCTION People experiencing homelessness (PEH) bear disproportionate opioid mortality. This article aims to determine how state Medicaid expansion under the Affordable Care Act impacted the inclusion of medications for opioid use disorder (MOUD) in treatment plans for housed versus homeless individuals. METHODS The Treatment Episodes Data Set (TEDS) provided data on 6,878,044 U.S. treatment admissions between 2006 and 2019. Difference-in-differences analysis compared MOUD treatment plans and Medicaid enrollment for housed versus homeless clients in states that did and did not expand Medicaid. RESULTS Medicaid expansion was associated with a 35.2 (95 % CI, 11.9 to 58.4) percentage point increase in Medicaid enrollment and an 8.51 (95 % CI, 1.13 to 15.9) percentage point increase in MOUD-inclusive treatment plans for housed and homeless clients alike. Yet the pre-existing MOUD disparity persisted, with PEH being 11.8 (95 % CI, -18.6 to -5.07) percentage points less likely to have MOUD-inclusive treatment plans. CONCLUSIONS Medicaid expansion may be an effective tool for increasing MOUD treatment plans for PEH in the 11 states that have not yet implemented the policy, but additional efforts to increase MOUD initiation for PEH will be necessary for closing their treatment gap.
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Affiliation(s)
- Natalie Swartz
- Harvard College, 1 Harvard Yard, Cambridge, MA 02138, USA
| | | | - Avik Chatterjee
- Boston Health Care for the Homeless Program, 780 Albany St, Boston, MA 02118, USA; Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - David Cutler
- Department of Economics, Harvard University, 1805 Cambridge Street, Cambridge, MA 02138, USA
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Tobin KE, Winiker A, Moran M, Felsher M, Owczarzak J. No one runs alone: Combining community-based program evaluation with photo elicitation interviewing among people experiencing homelessness. Eval Program Plann 2023; 97:102206. [PMID: 36621203 DOI: 10.1016/j.evalprogplan.2022.102206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/11/2022] [Accepted: 12/18/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Homelessness is associated with poor physical and mental health, but social support may reduce negative health outcomes. A community-academic partnership with Back on My Feet (BoMF), an organization in Baltimore, MD serving people experiencing homelessness, used photo elicitation interviews (PEI) to explore how social interactions within program activities improved mental health among participants. METHODS Between October 2018 and June 2019, 29 BoMF participants were recruited. Participants were provided digital cameras and photographed what BoMF meant to them. Participants presented photographs in meetings that were audio recorded and transcribed. Thirty-three themes and 44 photographs were generated. Findings were presented at a public photo exhibit. The partnership used content analysis of transcripts to build upon participant-generated themes for peer-review publication. RESULTS Social interaction among BoMF participants and volunteers helped participants form new positive social networks, often for the first time, which made participants feel valued by their peers. This led to increased self-worth, a greater sense of social support and social connectedness, and confidence that participants could overcome future challenges. CONCLUSIONS Combining community-based research with PEI provided a nuanced understanding of the mechanisms through with BoMF's activities facilitated positive mental health among participants and was a feasible approach to program evaluation.
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Affiliation(s)
- Karin E Tobin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, USA.
| | - Abigail Winiker
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, USA
| | | | - Marisa Felsher
- College of Population Health, Thomas Jefferson University, USA
| | - Jill Owczarzak
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, USA
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Miller J, Cuby J, Hall SM, Stitzer M, Kushel M, Appiah D, Vijayaraghavan M. Tobacco use behaviors and views on engaging in clinical trials for tobacco cessation among individuals who experience homelessness. Contemp Clin Trials Commun 2023; 32:101094. [PMID: 36852099 PMCID: PMC9958417 DOI: 10.1016/j.conctc.2023.101094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/31/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Background Clinical trials that include contingency management for smoking cessation have shown promising results for short-term quitting, but none have explored this approach for long-term abstinence in people experiencing homelessness. We designed a clinical trial of an extended contingency management intervention for smoking cessation for people experiencing homelessness. This study has two aims: (1) to explore tobacco use behaviors, and views toward smoking cessation, and (2) to explore factors influencing acceptability of engaging in such a trial in a sample of adult smokers experiencing homelessness. Methods We administered a questionnaire to obtain information on tobacco use behaviors and conducted in-depth, semi-structured interviews with 26 patients who had experienced homelessness and were patients at a safety net health clinic in San Francisco, California, where we planned to pilot the intervention. We obtained information on triggers for tobacco use, prior cessation experiences, attitudes toward cessation, attitudes toward engaging in a clinical trial for cessation, and factors that might influence participation in our proposed contingency management clinical trial. We analyzed transcripts using content analysis. Results Participants described the normative experiences of smoking, co-occurring substance use, and the use of tobacco to relieve stress as barriers to quitting. Despite these barriers, most participants had attempted to quit smoking and most were interested in engaging in a clinical trial as a method to quit smoking. Participants noted that desirable features of the trial include: receiving financial incentives to quit smoking, having a flexible visit schedule, having the study site be easily accessible, and having navigators with lived experiences of homelessness. Conclusion A patient-centric clinical trial design that includes incentives, flexible visits and navigators from the community may increase feasibility of engaging in clinical trials among individuals experiencing homelessness.
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Affiliation(s)
- Joshua Miller
- Center for Tobacco Control Research and Education, University of California, San Francisco, USA
| | - Jordan Cuby
- Division of General Internal Medicine, University of California, San Francisco, USA
| | - Sharon M. Hall
- Department of Psychiatry, And Weill Institute for Neurosciences, University of California, San Francisco, USA
| | | | - Margot Kushel
- Center for Vulnerable Populations, University of California, San Francisco, USA
| | - Donna Appiah
- School of Medicine, University of California, San Francisco, USA
| | - Maya Vijayaraghavan
- Center for Tobacco Control Research and Education, University of California, San Francisco, USA,Division of General Internal Medicine, University of California, San Francisco, USA,Center for Vulnerable Populations, University of California, San Francisco, USA,Corresponding author. Division of General Internal Medicine/San Francisco General Hospital, 1001 Potrero Avenue Box 1394, San Francisco, CA, 94110, USA.
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Ramirez J, Petruzzi LJ, Mercer T, Gulbas LE, Sebastian KR, Jacobs EA. Understanding the primary health care experiences of individuals who are homeless in non-traditional clinic settings. BMC Prim Care 2022; 23:338. [PMID: 36572847 PMCID: PMC9792313 DOI: 10.1186/s12875-022-01932-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/28/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Despite the widespread implementation of Health Care for the Homeless programs that focus on comprehensive, integrated delivery systems of health care for people experiencing homelessness, engaging and retaining people experiencing homelessness in primary care remains a challenge. Few studies have looked at the primary care delivery model in non-traditional health care settings to understand the facilitators and barriers to engagement in care. The objective of our study was to explore the clinic encounters of individuals experiencing homelessness receiving care at two different sites served under a single Health Care for the Homeless program. METHODS Semi-structured interviews were conducted with people experiencing homelessness for an explorative qualitative study. We used convenience sampling to recruit participants who were engaged in primary care at one of two sites: a shelter clinic, n = 16, and a mobile clinic located in a church, n = 15. We then used an iterative, thematic approach to identify emergent themes and further mapped these onto the Capability-Opportunity-Motivation model. RESULTS Care accessibility, quality and integration were themes that were often identified by participants as being important facilitators to care. Psychological capability and capacity became important barriers to care in instances when patients had issues with memory or difficulty with perceiving psychological safety in healthcare settings. Motivation for engaging and continuing in care often came from a team of health care providers using shared decision-making with the patient to facilitate change. CONCLUSION To optimize health care for people experiencing homelessness, clinical interventions should: (1) utilize shared-decision making during the visit, (2) foster a sense of trust, compassion, and acceptance, (3) emphasize continuity of care, including consistent providers and staff, and (4) integrate social services into Health Care for the Homeless sites.
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Affiliation(s)
- Jahanett Ramirez
- grid.89336.370000 0004 1936 9924The Steve Hicks School of Social Work at the University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712 USA
| | - Liana J. Petruzzi
- grid.89336.370000 0004 1936 9924Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX USA
| | - Timothy Mercer
- grid.89336.370000 0004 1936 9924Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX USA ,grid.89336.370000 0004 1936 9924Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX USA ,CommUnityCare Health Centers, Austin, TX USA
| | - Lauren E. Gulbas
- grid.89336.370000 0004 1936 9924The Steve Hicks School of Social Work at the University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712 USA
| | - Katherine R. Sebastian
- grid.89336.370000 0004 1936 9924Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX USA
| | - Elizabeth A. Jacobs
- grid.89336.370000 0004 1936 9924Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX USA ,grid.416311.00000 0004 0433 3945Maine Medical Center Research Institute, MaineHealth Institute for Research, Scarborough, ME USA
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Hartman-Filson M, Chen J, Lee P, Phan M, Apollonio DE, Kroon L, Donald F, Vijayaraghavan M. A community-based tobacco cessation program for individuals experiencing homelessness. Addict Behav 2022; 129:107282. [PMID: 35184003 DOI: 10.1016/j.addbeh.2022.107282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/26/2022] [Accepted: 02/12/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Tobacco use is common among persons experiencing homelessness (PEH), and interventions are needed. We conducted a community-based, single-arm uncontrolled trial of a pharmacy-linked intervention for smoking cessation for PEH. METHODS The intervention took place between September 2019 and June 2021 in homeless shelters in San Francisco, CA. We trained shelter staff on how to provide brief cessation counseling, then tested a program among PEH in two shelters that included one-time pharmacist-delivered cessation counseling and nicotine replacement therapy (NRT) for 3 months. We examined factors associated with cigarette consumption and quit attempts. RESULTS We trained 69 staff from 8 shelters and selected 2 of those shelters as pilot sites for the program. Of the 52 participants, 71% were male and 49% were Black. The majority of participants reported making a quit attempt (70%) and using NRT (84%). Having an encounter with staff in the past week was associated with a 40% reduction in weekly consumption (Incidence rate ratio (IRR) 0.61, 95% CI 0.57-0.67) and using medications in the past week was associated with a 23% reduction in weekly consumption (IRR 0.78, 95% CI 0.75-0.81). Using medications in the past week increased the odds of a quit attempt 2.89 times compared to not using medications (Adjusted odds ratio (AOR), 2.89, 95% CI 1.45-5.77). CONCLUSIONS Our findings highlight a role for leveraging community-based pharmacists to expand smoking cessation services in homeless shelters to reduce tobacco use among PEH.
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Seaman A, King CA, Kaser T, Geduldig A, Ronan W, Cook R, Chan B, Levander XA, Priest KC, Korthuis PT. A hepatitis C elimination model in healthcare for the homeless organization: A novel reflexive laboratory algorithm and equity assessment. Int J Drug Policy 2021; 96:103359. [PMID: 34325969 PMCID: PMC8720290 DOI: 10.1016/j.drugpo.2021.103359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Reaching World Health Organization hepatitis C (HCV) elimination targets requires diagnosis and treatment of people who use drugs (PWUD) with direct acting antivirals (DAAs). PWUD experience challenges engaging in HCV treatment, including needing multiple provider and laboratory appointments. Women, minoritized racial communities, and homeless individuals are less likely to complete treatment. METHODS We implemented a streamlined opt-out HCV screening and linkage-to-care program in two healthcare for the homeless clinics and a medically supported withdrawal center. Front-line staff initiated a single-order reflex laboratory bundle combining screening, confirmation, and pre-treatment laboratory evaluation from a single blood draw. Multinomial logistic regression models identified characteristics influencing movement through each stage of the HCV treatment cascade. Multiple logistic regression models identified patient characteristics associated with HCV care cascade progression and Cox proportional hazards models assessed time to initiation of DAAs. RESULTS Of 11,035 clients engaged in services between May 2017 and March 2020, 3,607 (32.7%) were screened. Of those screened, 1,020 (28.3%) were HCV PCR positive. Of those with detectable RNA, 712 (69.8%) initiated treatment and 670 (94.1%) completed treatment. Of those initiating treatment, 407 (57.2%) achieved SVR12. There were eight treatment failures and six reinfections. In the unadjusted model, the bundle intervention was associated with increased care cascade progression, and in the survival analysis, decreased time to initiation; these differences were attenuated in the adjusted model. Women were less likely to complete treatment and SVR12 labs than men. Homelessness increased likelihood of screening and diagnosis but was negatively associated with completing SVR12 labs. Presence of opioid and stimulant use disorder diagnoses predicted increased care cascade progression. CONCLUSIONS The laboratory bundle and referral pathways improved treatment initiation, time to initiation, and movement across the cascade. Despite overall population improvements, women and homeless individuals experienced important gaps across the HCV care cascade.
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Affiliation(s)
- A Seaman
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, Oregon, United States; Hepatitis C Elimination Program, Central City Concern, Portland, Oregon, United States.
| | - C A King
- Dept. of Biomedical Engineering, School of Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | - T Kaser
- Hepatitis C Elimination Program, Central City Concern, Portland, Oregon, United States
| | - A Geduldig
- Hepatitis C Elimination Program, Central City Concern, Portland, Oregon, United States
| | - W Ronan
- Hepatitis C Elimination Program, Central City Concern, Portland, Oregon, United States
| | - R Cook
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | - B Chan
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, Oregon, United States; Hepatitis C Elimination Program, Central City Concern, Portland, Oregon, United States
| | - X A Levander
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, Oregon, United States
| | - K C Priest
- School of Medicine, MD/PhD Program, Oregon Health & Science University, Portland, Oregon, United States
| | - P T Korthuis
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, Oregon, United States
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Clark E, Player E, Gillam T, Hanson S, Steel N. Evaluating a specialist primary care service for patients experiencing homelessness: a qualitative study. BJGP Open 2020; 4:bjgpopen20X101049. [PMID: 32636203 DOI: 10.3399/bjgpopen20X101049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND People experiencing homelessness (PEH) often experience poor health, multimorbidity, and early mortality and experience barriers to accessing high quality health care. Little is known about how best to provide specialist primary care for these patients. AIM To evaluate the health care provided to patients experiencing homelessness who were seen in a specialist primary care service. DESIGN & SETTING A qualitative evaluation of a city centre primary healthcare service for excluded and vulnerable people, such as rough sleepers, who find it difficult to visit mainstream GP services. METHOD Data on patient characteristics and service use were extracted from primary care records using electronic and free-text searches to provide context to the evaluation. Semi-structured interviews with 11 patients and four staff were used to explore attitudes and experiences. RESULTS Patients had high needs compared with the general population. Patients valued continuity of care, ease of access, multidisciplinary care, and person-centred care. Staff were concerned that they lacked opportunities for reflection and learning, and that low clinical capacity affected service safety and quality. Staff also wanted more patient involvement in service planning. CONCLUSION PEH's complex health and social problems benefited from a specialist primary care service, which is thought to reduce barriers to access, treat potentially challenging patients in a non-judgmental way, and provide personal continuity of care in order to develop trust.
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Lima NNR, de Souza RI, Feitosa PWG, Moreira JLDS, da Silva CGL, Neto MLR. People experiencing homelessness: Their potential exposure to COVID-19. Psychiatry Res 2020; 288:112945. [PMID: 32302813 PMCID: PMC7151321 DOI: 10.1016/j.psychres.2020.112945] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Insufficient housing quality is associated with stress and mental health impacts. Crowding, pollution, noise, inadequate lighting, lack of access to green spaces, and other environmental factors associated with slums can exacerbate mental health disorders, including depression, anxiety, violence, and other forms of social dysfunction. METHOD The studies were identified using large-sized newspapers with international circulation. RESULTS Experts say that people who sleep in shelters or on the streets already have lower life expectancy, suffer from addiction, and have underlying health conditions that put them at greater risk should they develop the virus. There are just so many competing and unmet needs, which makes it much harder for homeless to contend with all of this. If exposed, people experiencing homelessness might be more susceptible to illness or death due to the prevalence of underlying physical and mental medical conditions and a lack of reliable and affordable health care. Nevertheless, without an urgent solution, people experiencing homelessness will remain in limbo. CONCLUSIONS Many people living on the streets already have a diminished health condition, higher rates of chronic illnesses or compromised immune systems, all of which are risk factors for developing a more serious manifestation of the coronavirus infection. Those suffering from mental illness may have difficulty in recognizing and responding to the threat of infection. Homeless people have less access to health care providers who could otherwise order diagnostic testing and, if confirmed, isolate them from others in coordination with local health departments.
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Affiliation(s)
- Nádia Nara Rolim Lima
- The Suicidology Research Group from Universidade Federal do Ceará (UFC), Fortaleza, Ceará, Brazil
| | | | | | | | | | - Modesto Leite Rolim Neto
- The Suicidology Research Group from Universidade Federal do Ceará (UFC), Fortaleza, Ceará, Brazil.; School of Medicine of Juazeiro do Norte - FMJ/Estácio, Juazeiro do Norte, Ceará, Brazil.; School of Medicine, Federal University of Cariri - UFCA, Barbalha, Ceará, Brazil..
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de Veer AJE, Stringer B, van Meijel B, Verkaik R, Francke AL. Access to palliative care for homeless people: complex lives, complex care. BMC Palliat Care 2018; 17:119. [PMID: 30355351 DOI: 10.1186/s12904-018-0368-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People experiencing homelessness often encounter progressive incurable somatic diseases in combination with psychiatric and psychosocial problems, and many need palliative care at the end of their lives. Little is known about how palliative care for this group can be started in good time and provided optimally. The objective of this paper is to give insight into the extent people experiencing homelessness have access to good palliative care. METHODS Qualitative in-depth interviews were held to reconstruct the cases of 19 people experiencing homelessness in the Netherlands. Eight cases concerned persons being in the palliative phase (using the surprise question) and the other 11 cases concerned persons recently died after a period of ill health due to somatic illness. We used purposive sampling until data saturation was reached. The total number of interviews was 52. All interviews were transcribed verbatim and analysed inductively. RESULTS Three key themes were: 'late access', 'capricious trajectory' and 'complex care'. The first key theme refers to the often delayed start of palliative care, because of the difficulties in recognizing the need for palliative care, the ambivalence of people experiencing homelessness about accepting palliative care, and the lack of facilities with specific expertise in palliative care for them. The second key theme refers to the illness trajectory, which is often capricious because of the challenging behaviour of people experiencing homelessness, an unpredictable disease process and a system not being able to accommodate or meet their needs. The third key theme refers to the complexity of their care with regard to pain and symptom control, psychosocial and spiritual aspects, and the social network. CONCLUSIONS The care for in the palliative phase does not satisfy the core requirements of palliative care since there are bottlenecks regarding timely identification, the social network, and the assessment and management of physical symptoms and psychosocial and spiritual care needs. Education in palliative care of outreach professionals, training staff in shelters in the provision of palliative care, and building a network of palliative care specialists for people experiencing homelessness.
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