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Hircock C, Huan P, Pizzola C, McDonald M. A scoping review of surgical care for people experiencing homelessness: prevalence, access, and disparities. Can J Surg 2024; 67:E27-E39. [PMID: 38278550 PMCID: PMC10824397 DOI: 10.1503/cjs.004023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Numerous studies have highlighted the inequitable access to medical and psychiatric care that people experiencing homelessness (PEH) face, yet the surgical needs of this population are not well understood. We sought to assess evidence describing surgical care for PEH and to perform a thematic analysis of the results. METHODS Ovid MEDLINE, Embase, and Web of Science were searched using the terms "surgery" AND "homelessness." Grey literature was also searched. We used a stepwise scoping review methodology, followed by thematic analysis using an inductive approach. RESULTS We included 104 articles in our review. Studies were included from 5 continents; 63% originated in the United States. All surgical specialties were represented with varying surgical conditions and procedures for each. Orthopedic surgery (21%) was the most frequently reported specialty. Themes identified included characteristics of PEH receiving surgical care, homeless-to-housed participants, interaction with the health care system, educational initiatives, barriers and challenges, and interventions and future strategies. CONCLUSION We identified significant variation and gaps, representing opportunities for further research and interventions. Further addressing the barriers and challenges that PEH face when accessing surgical care can better address the needs of this population.
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Affiliation(s)
- Caroline Hircock
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Hircock, Huan); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (McDonald); and the Department of Surgery, McMaster University, Hamilton, Ont. (McDonald).
| | - Peter Huan
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Hircock, Huan); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (McDonald); and the Department of Surgery, McMaster University, Hamilton, Ont. (McDonald)
| | - Christina Pizzola
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Hircock, Huan); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (McDonald); and the Department of Surgery, McMaster University, Hamilton, Ont. (McDonald)
| | - Madeline McDonald
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Hircock, Huan); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (McDonald); and the Department of Surgery, McMaster University, Hamilton, Ont. (McDonald)
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Kobashigawa L, Mathias K, Amarnani A, Panush RS. And high-quality and equitable care for all. Clin Rheumatol 2022; 41:3269-3273. [PMID: 36181553 DOI: 10.1007/s10067-022-06386-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Laura Kobashigawa
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. .,Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA.
| | - Kristen Mathias
- Division of Rheumatology, Department of Medicine, The Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Abhimanyu Amarnani
- Division of Rheumatology, Department of Medicine, Grossman School of Medicine, New York University, New York, NY, USA
| | - Richard S Panush
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA.,Division of Rheumatology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Rai B, Kobashigawa L, Amarnani A, Ward NKZ, Feldman C, Feldman B, Panush RS. Challenges of caring for homeless patients with inflammatory arthritis: 12-month follow-up observations and identification of certain barriers to care. Clin Rheumatol 2022; 41:1653-1657. [PMID: 35499771 PMCID: PMC9058743 DOI: 10.1007/s10067-022-06167-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/25/2022] [Accepted: 04/03/2022] [Indexed: 11/26/2022]
Abstract
Homelessness is a public health crisis and there is a paucity of information about patients with rheumatic disease experiencing homelessness. We sought to develop approaches to improve care for this unique patient population. We previously reported observations on 17 homeless patients with inflammatory arthritis (15 rheumatoid arthritis (RA), 2 psoriatic arthritis (PsA)). We obtained follow-up information from our original 17 patients and compared this to data summarized and published about them from 12 months previously. We also created and administered a 100-question needs assessment survey. Follow-up 12-month clinical information was available from 13/17 homeless and 13/17 non-homeless controls. Homeless patients remained less well with more disease than non-homeless patients-poorer access to clinic appointments (80% vs 91%, p < 0.05), more emergency services use (20 vs 5 ED visits), less DMARDs use (43% vs 100%, p < 0.01), and more steroid use (29% vs 0%, p < 0.01). Homeless patients also had higher inflammatory markers than non-homeless patients (ESR 32 vs 26 mm/h and CRP 17 vs 5 mg/L), although these findings were not statistically significantly different. Seventy-eight percent of homeless patients were stable, 14% improved, and 7% worse; 21% had stable controlled and 57% stable active disease vs 62% and 0% of non-homeless (p < 0.01). Among the homeless, 6 (4 RA, 2 PsA) completed the survey, 2 declined, and 9 could not be reached. All 6 had found housing although all still had housing insecurity; 4 (67%) were homeless in the past. Three out of six (50%) obtained housing from social assistance during hospitalization following disease exacerbation while homeless. The average monthly income was $873. 5/6 (83.3%), were unable to work due to health, and were in considerable pain that adversely impacted their physical and mental health and ability to perform ADLs. Their perceived "greatest need" included dental care, physical therapy, knee surgery, employment, socialization secondary to isolation, and stable housing. Our understanding of the unique challenges of patients with rheumatic disease experiencing homelessness is improved, but not complete. Strengthened collaboration between street medicine providers and rheumatologists is necessary to improve care for homeless patients, especially given poorer outcomes compared with non-homeless counterparts. Key Points • We report 12-month follow-up information from our original 17 homeless patients with inflammatory arthritis (related in this journal in 2021) and their responses to an extensive needs assessment survey designed to identify barriers to care. • Homeless patients with inflammatory arthritis continued to have worse disease outcomes, use more corticosteroids and less DMARDs, and be seen less often in rheumatology clinics and more frequently in emergency departments than their non-homeless counterparts. • Survey data indicated that social assistance during hospitalization was a key area where healthcare providers could intervene to provide housing security for homeless patients and improve outcomes. Patients perceived "greatest needs" went beyond housing and rheumatological care and critically included access to social/specialty services. • Street medicine is the direct delivery of healthcare to people experiencing homelessness wherever they reside. Our observations, obtained in collaboration with street medicine colleagues, suggest important and salutary opportunities for this partnership to improve care for these particular patients.
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Affiliation(s)
- Baljeet Rai
- Departments of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA.
| | - Laura Kobashigawa
- Departments of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Abhimanyu Amarnani
- Departments of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Nicole K Zagelbaum Ward
- Division of Rheumatology, Departments of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Corinne Feldman
- Division of Street Medicine, Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brett Feldman
- Division of Street Medicine, Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Richard S Panush
- Division of Rheumatology, Departments of Medicine, Keck School of Medicine, University of Southern California, and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
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