Material Needs of Emergency Department Patients: A Systematic Review

Abstract

Despite some limitations in the individual studies examined in this review, the plurality of prior research confirms that the ED serves a vulnerable population with high rates of material needs. Future research is needed to better understand the role these needs play for ED patients and how to best address them.

Substance use and homelessness among emergency department patients

“…The relationship between homelessness and substance use is especially relevant for emergency medicine, as ED patients have significantly higher than average rates of both substance use (Bernstein and D'Onofrio, 2013) and homelessness (Malecha et al, 2017). Our study found that patients experiencing homelessness were more likely than other patients to report that their ED visit was related to substance use, which has also been suggested in national research (Ayangbayi et al, 2016; Ku et al, 2010).…”

“It Wasn't Just One Thing”: A Qualitative Study of Newly Homeless Emergency Department Patients

“…Yet despite the uniqueness of each individual's situation, there was significant commonality in the broad underlying factors contributing to homelessness. These factors encompassed both “traditional” health issues (i.e., substance use and physical health problems), as well as a variety of social factors that—in addition to contributing to homelessness—are also known to contribute to ED visits and overall health . The most common contributors to homelessness mentioned by participants were job loss, not having enough money, not being able to live with family or friends, moving from another city or state, substance use, and other physical health problems.…”

“…While homelessness prevention services are generally provided in community‐based settings, some experts have suggested that hospitals may be important sites to identify people at high risk for homelessness and refer them to services . Prior research has shown that emergency department (ED) patients have particularly high rates of housing instability and vulnerability for homelessness . EDs may therefore be promising sites for homelessness risk screening and prevention services.…”

Toward Structural Competency in Emergency Medical Education

“…Using principles and literature from fields such as public health, sociology, medical anthropology, and history, scholars are able to illustrate how social cohesion, inequality, and material deprivation are critical to understanding health disparities and poor health outcomes of ED patients . EPs have advocated for ways to diversify the workforce of emergency providers, to combat implicit bias in the clinical encounter, to address the material needs of patients that extend well beyond the ED, and to equip EDs with the resources to meet the diverse social needs of our patients. In fact, the ACGME has recognized these steps as crucial to creating an inclusive workplace, now requiring residency programs, departments, and hospital systems to have plans in place to assure their makeup reflects their community’s makeup and diversity.…”

“…Health policy, material deprivation, inequality, and stigma are implicated in poor health outcomes among emergency department (ED) patients . Researchers have emphasized the role of the social determinants of health, structural racism, gender discrimination, homophobia, and transphobia on the health of ED patients. These topics continue to gain interest and attention as their ties to medical education, clinical care, and population health are elucidated and emphasized.…”