Fixed Nodes of Transience: Narratives of Homelessness and Emergency Department Use

McCallum, Ross; Medved, Maria I.; Hiebert‐Murphy, Diane; Distasio, Jino; Sareen, Jitender; Château, Dan

doi:10.1177/1049732319862532

Cited by 12 publications

(9 citation statements)

References 48 publications

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“… 480 , 484 , 488 , 493 , 494 , 500 , 509 , 526 , 535 , 539 Four (7%) observational studies looked into ED provider perspectives, 515 , 520 , 523 and two looked into homeless patient perspectives on ED services. 482 , 483 A few studies focused on specific sub-populations of homeless patients, including veterans, 492 , 519 , 524 , 528 older adults, 499 , 501 and pediatric patients. 485 , 486 , 507 , 534 Two (40%) interventional studies centered on analyzing the effect of case management interventions on ED utilization.…”

Section: Resultsmentioning

confidence: 99%

A Scoping Review of Current Social Emergency Medicine Research

Shah

Porta

Leung

et al. 2021

WestJEM

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Introduction: Social emergency medicine (EM) is an emerging field that examines the intersection of emergency care and social factors that influence health outcomes. We conducted a scoping review to explore the breadth and content of existing research pertaining to social EM to identify potential areas where future social EM research efforts should be directed. Methods: We conducted a comprehensive PubMed search using Medical Subject Heading terms and phrases pertaining to social EM topic areas (e.g., “homelessness,” “housing instability”) based on previously published expert consensus. For searches that yielded fewer than 100 total publications, we used the PubMed “similar publications” tool to expand the search and ensure no relevant publications were missed. Studies were independently abstracted by two investigators and classified as relevant if they were conducted in US or Canadian emergency departments (ED). We classified relevant publications by study design type (observational or interventional research, systematic review, or commentary), publication site, and year. Discrepancies in relevant publications or classification were reviewed by a third investigator. Results: Our search strategy yielded 1,571 publications, of which 590 (38%) were relevant to social EM; among relevant publications, 58 (10%) were interventional studies, 410 (69%) were observational studies, 26 (4%) were systematic reviews, and 96 (16%) were commentaries. The majority (68%) of studies were published between 2010–2020. Firearm research and lesbian, gay, bisexual, transgender, and queer (LGBTQ) health research in particular grew rapidly over the last five years. The human trafficking topic area had the highest percentage (21%) of interventional studies. A significant portion of publications -- as high as 42% in the firearm violence topic area – included observational data or interventions related to children or the pediatric ED. Areas with more search results often included many publications describing disparities known to predispose ED patients to adverse outcomes (e.g., socioeconomic or racial disparities), or the influence of social determinants on ED utilization. Conclusion: Social emergency medicine research has been growing over the past 10 years, although areas such as firearm violence and LGBTQ health have had more research activity than other topics. The field would benefit from a consensus-driven research agenda.

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Section: Resultsmentioning

confidence: 99%

A Scoping Review of Current Social Emergency Medicine Research

Shah

Porta

Leung

et al. 2021

WestJEM

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“…Earlier research found that members of EDGs, such as Indigenous peoples [ 28 , 29 ] and the vulnerably housed [ 6 , 14 ], perceived that they experience longer wait times in the ED. However, our study does not support these findings, with members of EDGs not perceiving that they had different wait times than controls (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…While anecdotal evidence exists, empirical data to document and understand systemic racism within Canadian healthcare is lacking. Existing research primarily consists of smaller qualitative studies, often without the inclusion of controls to provide insights about how EDGs perceive their care in comparison to those who do not identify as equity-deserving [ 6 , 7 , 13 , 14 ]. The Kingston Health Sciences Centre’s (KHSC) ED and urgent care centre (UCC) serve as the sole points of emergency care provision for patients who are members of EDGs in Kingston, Ontario, a city recognized for its income and quality of living disparities [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Emergency department care experiences among members of equity-deserving groups: quantitative results from a cross-sectional mixed methods study

et al. 2023

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Background Emergency departments (EDs) serve an integral role in healthcare, particularly for vulnerable populations. However, marginalized groups often report negative ED experiences, including stigmatizing attitudes and behaviours. We engaged with historically marginalized patients to better understand their ED care experiences. Method Participants were invited to complete an anonymous mixed-methods survey about a previous ED experience. We analysed quantitative data including controls and equity-deserving groups (EDGs) - those who self-identified as: (a) Indigenous; (b) having a disability; (c) experiencing mental health issues; (d) a person who uses substances; (e) a sexual and gender minority; (f) a visible minority; (g) experiencing violence; and/or (h) facing homelessness - to identify differences in their perspectives. Differences between EDGs and controls were calculated with chi squared tests, geometric means with confidence ellipses, and the Kruskal-Wallis H test. Results We collected a total of 2114 surveys from 1973 unique participants, 949 controls and 994 who identified as equity-deserving. Members of EDGs were more likely to attribute negative feelings to their ED experience (p < 0.001), to indicate that their identity impacted the care received (p < 0.001), and that they felt disrespected and/or judged while in the ED (p < 0.001). Members of EDGs were also more likely to indicate that they had little control over healthcare decisions (p < 0.001) and that it was more important to be treated with kindness/respect than to receive the best possible care (p < 0.001). Conclusion Members of EDGs were more likely to report negative ED care experiences. Equity-deserving individuals felt judged and disrespected by ED staff and felt disempowered to make decisions about their care. Next steps will include contextualizing findings using participants’ qualitative data and identifying how to improve ED care experiences among EDGs to make it more inclusive and better able to meet their healthcare needs.

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“…However, despite widespread implementation of HCH programs, barriers to care in homeless populations persist and engaging and retaining individuals experiencing homelessness in primary care remains a challenge. Qualitative studies have identified barriers to primary care retention ranging from stigma, distrust of medical professionals, prior negative encounters with rejection, to competing priorities, and logistical complexity [7][8][9]. Mental illness has also been shown to be a barrier to receiving primary care, with substance abuse, trauma, personality and/or psychiatric disorders contributing to the psychological vulnerability of this population [10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Understanding the primary health care experiences of individuals who are homeless in non-traditional clinic settings

et al. 2022

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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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Fixed Nodes of Transience: Narratives of Homelessness and Emergency Department Use

Cited by 12 publications

References 48 publications

A Scoping Review of Current Social Emergency Medicine Research

A Scoping Review of Current Social Emergency Medicine Research

Emergency department care experiences among members of equity-deserving groups: quantitative results from a cross-sectional mixed methods study

Understanding the primary health care experiences of individuals who are homeless in non-traditional clinic settings

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