A cross-sectional observational study of unmet health needs among homeless and vulnerably housed adults in three Canadian cities

Abstract

BackgroundHomeless persons experience a high burden of health problems; yet, they face significant barriers in accessing health care. Less is known about unmet needs for care among vulnerably housed persons who live in poor-quality or temporary housing and are at high risk of becoming homeless. The objectives of this study were to examine the prevalence of and factors associated with unmet needs for health care in a population-based sample of homeless and vulnerably housed adults in three major cities within a universal health insurance system.MethodsParticipants were recruited at shelters, meal programs, community health centers, drop-in centers, rooming houses, and single room occupancy hotels in Vancouver, Toronto, and Ottawa, Canada, throughout 2009. Baseline interviews elicited demographic characteristics, health status, and barriers to health care. Logistic regression was used to identify factors associated with self-reported unmet needs for health care in the past 12 months.ResultsOf the 1,181 participants included in the analysis, 445 (37%) reported unmet needs. In adjusted analyses, factors associated with a greater odds of reporting unmet needs were having employment in the past 12 months (AOR = 1.40, 95% CI = 1.03–1.91) and having ≥3 chronic health conditions (AOR = 2.17, 95% CI = 1.24–3.79). Having higher health-related quality of life (AOR = 0.21, 95% CI = 0.09–0.53), improved mental (AOR = 0.97, 95% CI = 0.96–0.98) or physical health (AOR = 0.98, 95% CI = 0.96–0.99), and having a primary care provider (AOR = 0.63, 95% CI = 0.46–0.85) decreased the odds of reporting unmet needs.ConclusionsHomeless and vulnerably housed adults have a similar likelihood of experiencing unmet health care needs. Strategies to improve access to primary care and reduce barriers to accessing care in these populations are needed.

Unmet health care needs among sex workers in five census metropolitan areas of Canada

“…In fact, the sex workers in our study were more likely to report unmet health care needs than several other subpopulations, including people with chronic illness, young adults, people with a mental health disorder, and the homeless and precariously housed. 6,9,[23][24][25] Importantly, sex workers were significantly more likely to report unmet health care needs than CCHS respondents across nearly all of the demographic groups, supporting the appropriateness of a social determinants of health perspective for understanding the multiple overlapping health inequities faced by sex workers in Canada. 18,19,25 Those with the greatest unmet health care needs in both groups were younger, unmarried or single and in poorer health, and reported lower income and a weaker sense of community belonging.…”

“…Unmet health care needs are also more pronounced among people with low income; the homeless and vulnerably housed; sexual minorities; women; people with one or more mental disorders, substance dependence or co-occurring disorders; and adults with disabilities. [2][3][4][5][6][7][8][9][10] The reasons people give for not accessing needed health care range from the cost and organization of health services to personal concerns and perceptions. 11 The most commonly reported barriers as worded in the Canadian Community Health Survey (CCHS) Cycle 1.1 are 1) "waiting time too long", 2) "service not available when needed", 3) "too busy", 4) "didn't get around to it/didn't bother", 5) "felt would be inadequate" and 6) "cost".…”

Vulnerabilidades clínicas e sociais em usuários de crack de acordo com a situação de moradia: um estudo multicêntrico de seis capitais brasileiras

“…Esse grupo tem uma maior probabilidade de não ter suas necessidades atendidas e, desta forma, estratégias de enfrentamento e acesso a serviços para esta população em especial devem estar entre as prioridades das políticas públicas 10,23 .…”

“…Muito embora não exista uma definição única para a conceituação de indivíduos em situação de rua, o viver na rua implica uma condição em que há inexistência de moradia estável 10 , utilização de áreas públicas e degradadas como espaço de moradia e sustento, existência de vínculos familiares rompidos e vida em situação de pobreza extrema 11,12 . Nesse contexto, a literatura demonstra uma importante interface entre o uso de substâncias e essa população em especial.…”

“…Especificamente, quando privados de acesso a serviços e ações de prevenção e apoio social, os usuários estão em maior risco de sofrerem abuso sexual, apresentarem algum diagnóstico de transtorno mental, bem como múltiplas comorbidades clínicas 10,13 . Entretanto, observa-se uma insuficiência de informações a respeito de como a vulnerabilidade social presente em usuários de crack, em especial naqueles indivíduos em situação de rua, pode estar relacionada à gravidade de uso de determinadas substâncias psicoativas.…”