Homeless Persons and Health Care

Brickner, Philip W.

doi:10.7326/0003-4819-104-3-405

Cited by 82 publications

(28 citation statements)

References 16 publications

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“…Prior work has suggested that health behaviors lack salience to homeless individuals because of more pressing competing issues. 25,26 Finally, we explored patients' self-efficacy to execute recommended health behaviors. Work by Bandura et al [27][28][29] suggests that low-SES is associated with low self-efficacy.…”

Section: Data Collectionmentioning

confidence: 99%

Challenges Faced by Patients with Low Socioeconomic Status During the Post-Hospital Transition

et al. 2013

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BACKGROUND:Patients with low socioeconomic status (low-SES) are at risk for poor outcomes during the posthospital transition. Few prior studies explore perceived reasons for poor outcomes from the perspectives of these high-risk patients. OBJECTIVE: We explored low-SES patients' perceptions of hospitalization, discharge and post-hospital transition in order to generate hypotheses and identify common experiences during this transition. DESIGN: We conducted a qualitative study using indepth semi-structured interviewing. PARTICIPANTS: We interviewed 65 patients who were: 1) uninsured, insured by Medicaid or dually eligible for Medicaid and Medicare; 2) residents of five low-income ZIP codes; 3) had capacity or a caregiver who could be interviewed as a proxy; and 4) hospitalized on the general medicine or cardiology services of two academically affiliated urban hospitals. APPROACH: Our interview guide investigated patients' perceptions of hospitalization, discharge and the posthospital transition, and their performance of recommended post-hospital health behaviors related to: 1) experience of hospitalization and discharge; 2) external constraints on patients' ability to execute discharge instructions; 3) salience of health behaviors; and 4) self-efficacy to execute discharge instructions. We used a modified grounded theory approach to analysis. KEY RESULTS: We identified six themes that low-SES patients shared in their narratives of hospitalization, discharge and post-hospital transition. These were: 1) powerlessness during hospitalization due to illness and socioeconomic factors; 2) misalignment of patient and care team goals; 3) lack of saliency of health behaviors due to competing issues; 4) socioeconomic constraints on patients' ability to perform recommended behaviors; 5) abandonment after discharge; and 6) loss of self-efficacy resulting from failure to perform recommended behaviors.CONCLUSIONS: Low-SES patients describe discharge goals that are confusing, unrealistic in the face of significant socioeconomic constraints, and in conflict with their own immediate goals. We hypothesize that this goal misalignment leads to a cycle of low achievement and loss of self-efficacy that may underlie poor post-hospital outcomes among low-SES patients.

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Section: Data Collectionmentioning

confidence: 99%

Challenges Faced by Patients with Low Socioeconomic Status During the Post-Hospital Transition

et al. 2013

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“…When HCH programs first began in the late 1980s, there was programmatic emphasis on tailoring services to meet the unique needs of a population poorly served by mainstream institutions. 32,33 As funding was brought under a common federal legal umbrella in 1996, requirements on HCH programs were simplified. 10 HCH programs retain funding by documenting a number of patient encounters.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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Although homeless individuals often experience health problems requiring care, there are limitations to available research concerning the scale of their needs and the accessibility of safety net agencies to meet them. Traditional access-to-care surveys calculate unmet need among all persons queried (rather than persons needing care), making it difficult to calculate what percentage of persons requiring care actually obtain it. Additionally, no research has compared the relative accessibility of safety net programs to homeless persons in need. This cross-sectional, community-based survey assessed the prevalence of unmet need for several specific types of health care and compared the accessibility of agencies in Birmingham, AL. Substantial proportions of respondents reported unmet needs for general medical care (46 %), specialty care (51 %), mental health care (51 %), dental care (62 %), medications (57 %), and care of a child (23 %). The most commonly mentioned sites where care was sought included a federally funded Health Care for the Homeless (HCH) program (59 %), a religious free clinic (31 %), and a public hospital emergency department (51 %). The HCH program was most commonly cited as the location where care, once sought, could not be obtained (15 %), followed by the county hospital primary care clinics (13 %). In this survey, unmet need was common for all types of care queried, including primary care. Key components of the safety net, including a federally funded homeless health care program, had suboptimum accessibility.

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“…The homeless are particularly at risk because life in the city streets is unsafe and they may choose hazardous sleeping accommodations and suffer from burns caused by fires used for warmth (16). In a study of 581 homeless female veterans 99% of participants endorsed at least one trauma item; the homeless women reported being exposed to a mean of 7.40 different types of trauma and a median of 31 total events (17).…”

Section: Traumamentioning

confidence: 99%

“…Common viral respiratory diseases are easily transmitted from person to person. Crowded shelters and food lines provide the ideal circumstances for the spread of respiratory infections (16). Minor upper respiratory infections have been found to be twice as common in homeless children and represent 40% of the acute medical complaints of the homeless (20).…”

Section: Infectious Diseasesmentioning

confidence: 99%

Some aspects of the health status of homeless people

Bartošovič¹

2016

CSWHI

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Abstract40% of homeless people report at least one chronic health problem. Some medical problems are particularly prevalent such as chronic obstructive pulmonary diseases, arthritis and musculoskeletal disorders. Trauma is a significant cause of disability and death. Homeless people are predisposed to infections because of their poor physical state and lack of hygiene; hence outbreaks of contagious diseases are more prevalent in the homeless. Tuberculosis is an important health problem among the homeless. Homeless people are at high risk of Key words:Homeless, nutrition, infectious diseases, tuberculosis, trauma, health care, hospitalization, health status, ageing, death. AbstractSpectrum of infections and non-infections diseases among refuges from Syria/Iraq to Hungary/ Austria in September 2015 is analyzed. Respiratory isolates from patients with pneumonia were obtained from respiratory tract secretions and tested for antimicriobial susceptibility. Majority of ID were upper and lower respiratory tract infections, scabies and other skin and soft tissue infections. However, infections represented only about one half of cases seeking medical help -the rest 40-60% were hypertension, exhaustion, depression, diabetes, neuropsychiatric disorders.bloodborne infections and disproportionately suffer from mental illness and substance use disorders. Homelessness negatively impacts child health and development. There are a number of internal and external barriers to providing health care for homeless persons. Hospitalizations are more frequent and they take a longer time. The homeless are not registered with their Doctor and try to get health assistance by using emergency services. They have problems with health system or social insurance. The health status is substantially worse than in other population. Homeless people have a greatly Original Articles 40Clinical social Work and Health Intervention increased risk of death. Problems of providing health care to the homeless depend in every country on the existing health policy and the economy. Insufficient care for homeless people means not only aggravation of their health state but it could have negative impacts on the health of the broader group of people.

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Homeless Persons and Health Care

Cited by 82 publications

References 16 publications

Challenges Faced by Patients with Low Socioeconomic Status During the Post-Hospital Transition

Challenges Faced by Patients with Low Socioeconomic Status During the Post-Hospital Transition

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

Some aspects of the health status of homeless people

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