Delivering Health Care on the Streets

Howe, Evan; Buck, David; Withers, Jim

doi:10.1097/qmh.0b013e3181bee2d9

Cited by 21 publications

(12 citation statements)

References 7 publications

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“…The homeless have been shown to suffer increased morbidity and mortality and multiple, poor social determinants of health in comparison to their housed counterparts [ 6 ]. As homelessness becomes a common social condition within large urban and some rural settings [ 5 , 7 , 8 ], medical educators have sought to include care of the homeless within their curricula to address health disparities [ 9 , 10 ]. Yet, little is known about student attitudes toward curricula inclusive of caring for the homeless as a vulnerable population, particularly in a street setting.…”

Section: Introductionmentioning

confidence: 99%

Inclusion of the homeless in health equity curricula: a needs assessment study

Feldman

Stevens

Lowe

et al. 2020

Medical Education Online

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Exposure to homeless patients is a potential strategy to teach about social determinants of health and health inequities. Little is known about student attitudes and preferences for learning about the homeless in curricula addressing vulnerable populations. A needs assessment to determine student readiness may inform strategies for teaching. A mixed-methods study of one matriculating physician assistant student class, with a cross-sectional survey and 3 focus groups (FG). The validated 19-item Health Professionals' Attitudes Toward Homelessness inventory (HPATHI) and new 7-item Learning Attitudes scale were administered to explore perceptions and preferences about relevance of caring for the homeless to future practice. FGs were conducted to theme saturation. Verbatim transcripts were independently read and coded by 3 researchers using constant comparison. Survey response rate was 100% (N = 60). Overall HPATHI mean score was 3.97 ± 0.04 of 5, indicating positive attitudes toward the homeless. The highest mean score (4.26 ± 0.04) was for the social advocacy subscale; the lowest (3.02 ± 0.06) for personal advocacy. The Learning Attitude scale (Cronbach's alpha 0.89) mean score was 4.47 ± 0.07 out of 5, showing a positive attitude toward curricular exposure. Older students and those with prior experience with the homeless had higher HPATHI scores (p < 0.05). Four major themes emerged: vulnerable patients cannot advocate for themselves; learning about homelessness is relevant to future practice; preference for multiple teaching strategies and adequate preparation for street rotations; and anticipated anxiety about safety. Students recognize the value of learning from homeless patients as part of gaining skills in caring for vulnerable populations. Experiential learning opportunities focusing on this group are seen as an acceptable and valuable way to gain skills applicable to all vulnerable patients. Students express fear and anxiety around non-traditional settings such as the street. Their anxieties should be adequately addressed when designing clinical rotations.

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Section: Introductionmentioning

confidence: 99%

Inclusion of the homeless in health equity curricula: a needs assessment study

Feldman

Stevens

Lowe

et al. 2020

Medical Education Online

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“…By providing care in this way, Street Medicine has been able to effectively mitigate disease outbreaks, prevent toxic sequelae stemming from untreated chronic diseases, and build trust and rapport in a community that rarely has access to welcoming provider relationships when receiving medical care. [25][26][27] Our research was conducted in partnership with Miami Street Medicine (MSM), a 501c nonprofit registered with the Florida to evaluate and understand older adult care vulnerabilities, including chronic disease management, to improve health outcomes for those who are aging, hypertensive, and unhoused. 28 Funding for equipment and medications is charity-based and nonprofit grant-sourced.…”

Section: Background On Street Medicinementioning

confidence: 99%

“…10,26,28,29 By conducting outreach in this way, PEUH living in the area have an opportunity to receive care they may not otherwise be able to access. 25 Blood Pressure Measurement: Blood pressure is routinely measured for each patient presenting at clinical street encounters. Blood pressure is measured by physicians, residents, and medical students volunteering for MSM.…”

Section: Background On Street Medicinementioning

confidence: 99%

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Analysis of older adult blood pressure readings and hypertension treatment rates among the unsheltered population of Miami‐Dade County

Seshadri,

Morgan,

Moore

et al. 2023

Aging Medicine

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ObjectiveTo assess prevalence of elevated blood pressure readings, rates of established hypertension diagnosis, and blood pressure control medication prescription rates in a cohort of older people experiencing unsheltered homelessness presenting to a Street Medicine clinic in Miami‐Dade County, Florida. In addition, we will compare outcomes found in the study cohort to that of the general population.MethodsDemographic information, clinical history, blood pressure control medication prescription, and blood pressure measurements were taken by a Street Medicine team of medical providers. The team routinely provides medical evaluations and care for people experiencing unsheltered homelessness who reside in rough sleeper tent encampments located on the street. Clinical information and vitals were recorded in REDCap. De‐identified data from patients 65 years and above were downloaded and compared to a general population data set—the Centers for Disease Control National Health and Nutrition Examination Survey (CDC NHANES) 2017–2020 Pre‐pandemic cohort. Data analysis was performed using R Studio version 4.3.2.ResultsBlood pressure was reported in 120 distinct interactions with older people experiencing homelessness. Compared to the age‐matched NHANES data, older people experiencing unsheltered homelessness were at significantly increased relative risk for elevated blood pressure within the range of Stage 1 Hypertension (RR: 3.914, 95% CI: 2.560–5.892, P < 0.001), and within range of Stage 2 Hypertension (RR: 5.550, 95% CI: 4.272–7.210, P < 0.001). According to NHANES, 49.6% of adults over 60 with diagnosed hypertension receive treatment. Of study participants, 69% of those with elevated blood pressure had previously received a diagnosis of hypertension and 15.9% on medication to control blood pressure.ConclusionOur cohort of older people experiencing unsheltered homelessness had higher rates of elevated blood pressure and reduced rates of hypertension diagnosis and treatment as compared to the general population. Older people experiencing unsheltered homelessness are a growing population, and future research should seek to evaluate and understand older adult care vulnerabilities, including chronic disease management, to improve health outcomes for those who are aging, hypertensive, and unhoused.

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“…"Street Medicine" includes the efforts used to provide healthcare to homeless patients who often have transient living situations and whose care requires a multitude of special considerations. Some elements include mobile clinics, extensive collaboration with social services, affiliations with continuity clinics and hospitals, a consistent set of providers who can build rapport with patients, and the use of technology to electronically track health information and disease progression [22]. We believe that incorporating measures like these is essential to improving care for homeless patients with rheumatic and musculoskeletal disease.…”

Section: Recommendations For Carementioning

confidence: 99%

Challenges of caring for homeless patients with rheumatic and musculoskeletal disorders in Los Angeles

et al. 2020

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Homelessness is a public health crisis. Homeless individuals have significantly worse health outcomes than the general population. We have begun examining challenges of caring for homeless patients with rheumatic and musculoskeletal diseases. Difficulties include physical environment, food and financial insecurity, access to healthcare, low health literacy, and comorbid mental illness, and substance abuse. Based on known prevalences of rheumatic and musculoskeletal diseases (RMSDs), we extrapolate that there are thousands of homeless with rheumatoid arthritis (RA), systemic lupus erythematosus, psoriatic arthritis, gout, and osteoarthritis. We present preliminary observations of disparities in the care of homeless patients with RA seen at the Los Angeles County Medical Center of the Keck School of Medicine of the University of Southern California. They tended to be African American males, missed appointments, utilized emergency services frequently, tended not to be on medications, and exhibited severe disease. We reviewed the available literature on homelessness and homeless healthcare to consider what further studies might be helpful and what interventions might improve the care of patients with RMSDs. We identified several aspirational and practical recommendations. These include ensuring access to healthcare for the homeless (indeed for all); reducing disparities through policy, tailored care, and enhanced social services; and recognizing and treating disease early. Developing better approaches for the care of these homeless has obvious and important implications for other underserved populations needing rheumatologic care, patients with early arthritis, or situations where rheumatologists are unavailable. We believe that physicians have a special responsibility to mitigate inequities in this particularly disadvantaged population.

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Delivering Health Care on the Streets

Cited by 21 publications

References 7 publications

Inclusion of the homeless in health equity curricula: a needs assessment study

Inclusion of the homeless in health equity curricula: a needs assessment study

Analysis of older adult blood pressure readings and hypertension treatment rates among the unsheltered population of Miami‐Dade County

Challenges of caring for homeless patients with rheumatic and musculoskeletal disorders in Los Angeles

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