Unmet Need for Medical Care and Safety Net Accessibility among Birmingham’s Homeless

Kertesz, Stefan G.; McNeil, Whitney; Cash, Julie J.; Desmond, Reneé A.; McGwin, Gerald; Kelly, Jason L.; Baggett, Travis P.

doi:10.1007/s11524-013-9801-3

Cited by 45 publications

(56 citation statements)

References 23 publications

(23 reference statements)

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“…25 Homeless Hispanic women were also more likely to have a usual source of care than White homeless women. 25 When examining unmet needs, Kertesz et al 19 concluded that Black homeless persons were less likely to report unmet needs for general medical care compared to White homeless persons (OR = 0.38; 95% CI = 0.17-0.85). Kushel et al 2 found substance abuse to be associated with increased primary care access.…”

Section: Characteristics Of the Homelessmentioning

confidence: 99%

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Access to Primary Care Services Among the Homeless

White

Newman

2014

J Prim Care Community Health

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Objective: To identify barriers and facilitators to primary care access among the homeless using the Equity of Access to Medical Care Framework and to provide recommendations for medical and public health practitioners to improve health among this underserved population. Methods: A quasi-systematic review of the literature was conducted using the PubMed, CINAHL, and PsycINFO databases. Study elements from articles in the final analysis were extracted and categorized into dimensions of access from the Framework. Results: The review identified multiple barriers to primary care access for the homeless. This included lack of insurance coverage and competing priorities. Facilitators to access included tailored health care delivery systems and having a regular source of care. Conclusion: This review provides evidence that health policy initiatives, patient-centered care, and targeted interventions can assist with improving primary care access among the homeless.

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Section: Characteristics Of the Homelessmentioning

confidence: 99%

“…19 In the survey, 86% of participants reported the inability to pay for care as a common barrier to obtaining health services. While having long wait times, free clinics provided gratis care and had less restrictive requirements when compared with county hospital clinics and EDs.…”

Section: Utilization Of Health Servicesmentioning

confidence: 99%

Access to Primary Care Services Among the Homeless

White

Newman

2014

J Prim Care Community Health

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“…5 In another report, an estimated 38 % of homeless patients had more than one chronic medical condition compared to only 27 % of their peers, and over half of homeless healthcare seekers have described unmet medical needs. 6,7 Homeless individuals also face a confluence of particular barriers, including competing sustenance needs, environmental stress (weather, violence, infections, trauma), and few social supports. 8,9 The literature has highlighted the cumulative and continued impact of these risk factors even when homeless individuals achieve housing.…”

Section: Introductionmentioning

confidence: 99%

“…8,9 The literature has highlighted the cumulative and continued impact of these risk factors even when homeless individuals achieve housing. 7,10,11 Diabetes mellitus is one example of a chronic medical condition where unmet healthcare needs may impact health outcomes. Type 2 diabetes affects nearly 26 million people in the United States, or 8.3 % of the U.S. population.…”

Section: Introductionmentioning

confidence: 99%

Differential Impact of Homelessness on Glycemic Control in Veterans with Type 2 Diabetes Mellitus

et al. 2016

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BACKGROUND: Veterans with evidence of homelessness have high rates of mental health and substance abuse disorders, but chronic medical conditions such as diabetes are also prevalent. OBJECTIVE: We aimed to determine the impact of homelessness on glycemic control in patients with type 2 diabetes mellitus. DESIGN: Longitudinal analysis of a retrospective cohort. SUBJECTS: A national cohort of 1,263,906 Veterans with type 2 diabetes. Subjects with evidence of homelessness were identified using a combination of diagnostic and administrative codes. MAIN MEASURES: Odds for poor glycemic control using hemoglobin A1C (HbA1C) cutoff values of 8 % and 9 %. Homeless defined as a score based on the number of indicator variables for homelessness within a veterans chart. KEY RESULTS: Veterans with evidence of homelessness had a significantly greater annual mean HbA1C ≥ 8 (32.6 % vs. 20.43 %) and HbA1C ≥ 9 (21.4 % vs. 9.9 %), tended to be younger (58 vs. 67 years), were more likely to be non-Hispanic black (39.1 %), divorced (43 %) or never married (34 %), to be urban dwelling (88.8 %), and to have comorbid substance abuse (46.7 %), depression (42.3 %), psychoses (39.7 %), liver disease (18.8 %), and fluid/ electrolyte disorders (20.4 %), relative to non-homeless veterans (all p < 0.0001). Homelessness was modeled as an ordinal variable that scored the number of times a homelessness indicator was found in the Veterans medical record. We observed a significant interaction between homelessness and race/ethnicity on the odds of poor glycemic control. Homelessness, across all racial-ethnic groups, was associated with increased odds of uncontrolled diabetes at a cut-point of 8 % and 9 % for hemoglobin A1C ; however, the magnitude of the association was greater in non-Hispanic whites [8 %, OR 1.55 (1.47;1.63 CONCLUSIONS: Homelessness is a significant risk factor for uncontrolled diabetes in Veterans, especially among non-Hispanic white and Hispanic patients. While efforts to engage homeless patients in primary care services have had some success in recent years, these data suggest that broader efforts targeting management of diabetes and other chronic medical conditions remain warranted.

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“…Across the nation, physical and mental healthcare needs have been documented among homeless adults (Brown, Kiely, Bharel, & Mitchell, 2012; Garibaldi, Conde-Martel, & O'Toole, 2005; Kertesz et al, 2013). In particular, addiction, mental illness, hypertension, and diabetes are significant issues among those experiencing homelessness (Kertesz et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Unmet Physical and Mental Healthcare Needs Among Stimulant-using Gay and Bisexual Homeless Men

Salem

Nyamathi

Reback

et al. 2015

Issues in Mental Health Nursing

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Purpose Homeless gay and bisexual (G/B) men evidence unmet physical and mental healthcare needs. To gain a greater understanding of predictors of unmet physical and mental healthcare needs, the purpose of this cross-sectional study was to understand correlates of baseline self-reported unmet physical and mental healthcare needs among stimulant-using homeless G/B men (N=422, 18-46 years of age). Methods A structured questionnaire was administered at baseline; data were collected from October 2009 to January 2013. The study was approved by the University of California Human Subjects' Protection committee and the Friends Research Institute Human Research Protection Committee. Results Logistic regression revealed that those who self-reported ever being married, being in fair or poor health and in moderate-to-very severe pain were more likely to experience unmet need for physical healthcare. Those who self-reported ever being married, being in fair or poor health and in moderate-to-very severe pain were more likely to experience unmet need for physical healthcare. In terms of unmet mental health needs, those who self-reported moderate-to-very severe pain and/or those reporting having sex while high were more likely to report unmet need for mental healthcare. In contrast, those reporting receiving social support from others were less likely to have an unmet mental healthcare need. Conclusions Research implications will be discussed as they relate to access to physical and/or mental healthcare needs among this vulnerable population.

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Unmet Need for Medical Care and Safety Net Accessibility among Birmingham’s Homeless

Cited by 45 publications

References 23 publications

Access to Primary Care Services Among the Homeless

Access to Primary Care Services Among the Homeless

Differential Impact of Homelessness on Glycemic Control in Veterans with Type 2 Diabetes Mellitus

Unmet Physical and Mental Healthcare Needs Among Stimulant-using Gay and Bisexual Homeless Men

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