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Sloan K, Kogan AC, Guller J, Feldman CT, Feldman BJ. Characteristics of Homeless Temporarily-Housed in Project RoomKey During the COVID-19 Pandemic. J Prim Care Community Health 2024; 15:21501319241234869. [PMID: 38491844 PMCID: PMC10943723 DOI: 10.1177/21501319241234869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/18/2024] Open
Abstract
INTRODUCTION People experiencing unsheltered homelessness (PEUH) have higher disease burden yet limited access to healthcare. COVID-19 introduced even greater risk for PEUH aged 65+ years with an underlying chronic health condition and were temporarily housed in hotels/motels for Project RoomKey (PRK). This study aimed to characterize a PRK cohort who received primary care from a street medicine program. METHODS This observational case series study included a sample of 35 PRK participants receiving primary care from a street medicine team at a single site from July to September 2020. We used the HOUSED BEDS assessment tool for taking history on PEUH. RESULTS Participants were 63% male, 40% Hispanic/Latino/a, 40% white, 94% English-speaking, and 73% had chronic health conditions. Assessment revealed: average Homelessness (H) of 4 years; 76% had no prior social service Outreach (O); average Utilization (U) was 4 emergency department visits in prior 6-months; 68% received Salary (S) from government income; Food access or Eat (E) was commonly purchased (29%) or donated (26%); clean water to Drink (D) for 59% of participants; 86% had access to a Bathroom (B); Encampment (E) was varied and 38% reported safety concerns; Daily routine (D) showed 76% could access a telephone, 32% received social support from family; 79% reported past or current Substance use (S). No participants contracted COVID-19 during study period. CONCLUSIONS This study describes health and demographic characteristics of PRK participants in Southern California. Findings inform policies to continue PRK that includes onsite healthcare such as via street medicine.
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Affiliation(s)
- Kylie Sloan
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Jodie Guller
- University of Southern California, Alhambra, CA, USA
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van der Leeden C, Kaduszkiewicz H, Boczor S, Kloppe T, Lohmann B, Mallon T, Rakebrandt A, Scherer M. Medical centres for the homeless in Hamburg - consultation reasons and diagnoses compared to primary care patients in the regular health care system. Arch Public Health 2023; 81:190. [PMID: 37891638 PMCID: PMC10605756 DOI: 10.1186/s13690-023-01198-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/01/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND In Germany, homeless people are entitled to health care within the regular health care system. However, due to their specific living conditions they make little use of these services. In 2013, three Medical centres for the homeless (MCH) were opened in Hamburg to provide general health care. This study aims to analyse the consultation reasons and diagnoses prevalent among the homeless in comparison to regular primary care patients. It also examines the means and obstacles of integrating the homeless into Germany's regular health care system. METHODS From 2013 to 2014, routine medical data of all patients of the MCH consenting to participate in the study were analysed descriptively, in particular consultation reasons (categorised by ICPC-2), ICD-10 diagnoses and data on health insurance status and the use of the regular health care system. Consultation reasons and diagnoses of homeless patients were compared descriptively with data from regular general practices. Additionally, anonymous data on patient numbers, gender and insurance status was exported from the MCH's software and analysed descriptively for the years 2013 to 2020. RESULTS A total of 840 homeless patients in 2013 and 2014 gave consent to the evaluation of consultation reasons and diagnoses. The most frequent consultation reasons in the MCH in 2013 were skin conditions (24%), musculoskeletal conditions (16%) and psychological disorders (14%), in GP practices these were musculoskeletal conditions (22%), conditions affecting the digestive system (14%) and skin conditions (12%). Essential (primary) hypertension, diabetes mellitus type 2 and back pain are among the top-10-diagnoses in GP practices, as well as in MCH. With regard to the other top-10-diagnoses, there are clear differences between GP practices and MCH: "Psychological behavioural disorder due to alcohol" and diagnoses in connection with trauma, skin infections and acute respiratory infections stand out in MCH. 35% of the homeless patients reported a lack of health insurance as the reason for "not making use of" the regular health care system, while 10% reported they were unable to visit a regular general practitioner due to physical or psychological reasons. In the years 2013-2020 46% to 73% of the 8.380 MCH patients had no health care insurance. CONCLUSION Patients consulting the MCH suffer from medical conditions typical for the homeless, namely skin diseases, wounds, injuries and behavioural disorders due to alcohol abuse, but also from "typical" symptoms in regular GP care as cough or lower back symptoms. Consultation reasons mostly are acute illnesses. Chronic diseases are equally present in regular GP and MCH patients, but pose a great challenge for the homeless among other things due to their irregular contact with the health care system. The lack of health insurance poses the greatest hurdle to the integration of the homeless into the regular health care system.
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Affiliation(s)
- Carolin van der Leeden
- Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Hanna Kaduszkiewicz
- Institute of General Practice, Medical Faculty of Christian-Albrecht-University, Kiel, Germany
| | - Sigrid Boczor
- Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Kloppe
- Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Lohmann
- Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Tina Mallon
- Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Rakebrandt
- Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Tadros AS, Smitaman E, Beck E, Tamayo-Murillo D. Imaging Among the Underserved: Utilization and Expenditures in a Student-Run Free Clinic. Curr Probl Diagn Radiol 2023; 52:353-356. [PMID: 37062640 DOI: 10.1067/j.cpradiol.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/16/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVE To determine imaging utilization and expenditures among an underserved population at a student-run free clinic. METHODS This was a retrospective review of billing records for all radiology studies performed over a 4-year period at a student-run free clinic supervised by physician faculty. All imaging services were outsourced through either direct payment by the clinic to a local imaging group or through in-kind donations. Radiology studies were grouped by modality and diagnostic category. Data were analyzed to determine overall and average imaging utilization and expenditures. RESULTS Across the 4-year study period, 413 radiology studies were performed with a yearly average of 103 (SD = 16). During this time, 192 (46%) ultrasounds, 123 (30%) radiographic studies, 40 (10%) MRIs, 37 (9%) CTs, 8 (2%) interventional procedures, and 5 (1%) nuclear imaging studies were obtained. Overall, expenditures were $157,888 with a yearly average of $39,472 (SD = $1982). In-kind donations accounted for $138,508 (88%) of expenditures. Across the 4-year study period, utilization increased by 15% with less than 1% increase in expenditures. DISCUSSION Ultrasound was the most common imaging modality used. Overall imaging utilization was considerably less than that of published data in an ambulatory setting.
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Affiliation(s)
- Anthony S Tadros
- Department of Radiology, University of California, San Diego, San Diego, CA.
| | - Edward Smitaman
- Department of Radiology, University of California, San Diego, San Diego, CA
| | - Ellen Beck
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
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4
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Silvestri F, Mellgard G, Goldstein J, Chennareddy S, Tang J, Tran M, Band I, Qian D, Fischer S, Castillo A, Jiang J, Skovran D, Thomas D, Meah YS. How Are We Doing? A Scoping Review of Published Patient-Centered Outcomes Research in United States Student-Run Free Clinics. TEACHING AND LEARNING IN MEDICINE 2023:1-13. [PMID: 37571960 DOI: 10.1080/10401334.2023.2245805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 07/02/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023]
Abstract
Phenomenon: Student-run free clinics (SRFCs) serve an integral role in most United States (US) medical schools and contribute substantially to literature on the quality of care to uninsured persons. There has been substantial growth over the past decade of scholarly work produced by SRFCs as they have increased in size and number. Research on patient care outcomes informs better care structures for patients, however there is no current synthesis of patient care outcomes research among SRFCs. This article provides an overview of SRFC research on patient outcomes to understand current research domains and to identify gaps in the literature. Approach: We completed a scoping review by searching Scopus, PubMed, and Journal of Student Run Clinics in June 2021. All peer-reviewed, English-language articles focused on patient-centered outcomes at SRFCs in the US were included. Two independent reviewers performed title, abstract, and full-text screening of relevant works, and eight reviewers conducted data extraction. Descriptive data analysis was performed along with relevant content analysis of patient-centered outcomes. Findings: The search strategy identified 784 studies, of which 87 met inclusion criteria. Most studies were published within the last six years (81.6%), located in California, New York, or Florida (43.7%), and intervention based (33.3%). Many studies (46.0%) had a specific disease of focus of which diabetes was the most researched(19.5%). Patient-centered studies were the leading focus of the study aims (40.2%), where key findings demonstrated primarily improved outcomes in clinic metrics post-intervention (36.8%) or equivalent/better clinical performance than national metrics (20.7%). Insights: This review brings to light gaps in the literature reporting research in SRFCs and can be applied to other low-resource settings. Future efforts to expand SRFC outcomes research should focus on community relationship building, understanding institutional support, and ensuring education on best practices for research within SRFCs. Doing so informs patient care improvement as SRFCs continue to operate as safety net clinics for marginalized populations.
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Affiliation(s)
- Francesca Silvestri
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - George Mellgard
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Medicine, New York Presbyterian - Columbia University Irving Medical Center, New York, New York, USA
| | - Jonathan Goldstein
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Susmita Chennareddy
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Justin Tang
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michelle Tran
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Isabelle Band
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Qian
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Abigail Castillo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joy Jiang
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David Skovran
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David Thomas
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yasmin S Meah
- Icahn School of Medicine at Mount Sinai, Brookdale, New York, New York, USA
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5
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Mavedatnia D, Hathi K, Feschuk AM, Grose EM, Eskander A. Individuals Experiencing Homelessness: A Systematic Review of Otolaryngology-Related Health Needs and Community-Based Interventions. Otolaryngol Head Neck Surg 2023; 168:1301-1311. [PMID: 36939409 DOI: 10.1002/ohn.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/04/2022] [Accepted: 11/15/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Access to and use of physician services is limited for those experiencing homelessness. Homelessness may predispose patients to several Otolaryngology-Head and Neck Surgery (OHNS) health conditions and barriers to care may leave these unaddressed. The aim of this review was to synthesize the literature on OHNS health needs and community-based interventions for patients experiencing homelessness. DATA SOURCES English literature was searched in MEDLINE, EMBASE, and CINAHL. REVIEW METHODS Studies were included if they reported on OHNS-related conditions in patients experiencing homelessness and/or interventions related to providing OHNS care to this patient population. RESULTS Twelve hundred and one articles were screened, and 12 articles were included. Most studies reported on otologic conditions (n = 8) and head and neck-related conditions (n = 6). Nasal trauma, chronic rhinosinusitis, dysphonia, hearing loss, and cancerous/precancerous head and neck lesions were common OHNS conditions reported in this patient population. Identified barriers to care included lack of transportation, financial considerations, and lower health literacy. Three articles on community-based interventions were included. Most of these interventions were single visits to shelters, and ensuring adequate follow-up was identified as a challenge. CONCLUSION The current literature brings attention to certain OHNS diseases that are prevalent in this unique patient population and identifies unique barriers these patients experience when accessing care. Future studies should focus on further delineating the impact of OHNS diseases in patients experiencing homelessness and screening interventions that can be employed to mitigate the impact of diseases of the head and neck.
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Affiliation(s)
- Dorsa Mavedatnia
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kalpesh Hathi
- Faculty of Medicine, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - Aileen M Feschuk
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Elysia M Grose
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Toronto, Canada
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Gomes RS, Passoni LCDL, Sirigatti RDP, Rozin L, Sanches LDC, Cavassin FB. Saúde dos indivíduos em situação de rua. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2022. [DOI: 10.5712/rbmfc17(44)3233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introdução: A população em situação de rua é vulnerabilizada por diversos fatores que determinam ou condicionam sua saúde e ocasionam aumento dos índices de comorbidades clínicas, entre elas as doenças mentais, crônicas e infectocontagiosas. A marginalização dos indivíduos que se encontram em situação de rua abre uma lacuna na assistência em saúde que, por vezes, é suprida por organizações sem fins lucrativos que exercem um papel social elementar. Objetivo: Mapear o perfil clínico da população em situação de rua de Curitiba (PR) atendida por iniciativa voluntária no período de um ano. Métodos: Trata-se de um estudo observacional descritivo de base documental realizado com fichas clínicas dos 509 pacientes maiores de 18 anos e que tiveram seu primeiro atendimento médico realizado pela Associação Médicos do Mundo, filial Curitiba (PR), no ano de 2019. Resultados: Indivíduos do sexo masculino, de etnia branca, faixa etária entre 36 e 45 anos, que cursaram o ensino fundamental e que se encontravam havia menos de um ano em situação de rua foram as condições sociodemográficas predominantes. As principais queixas motivadoras da procura pelo atendimento foram dor (45,19%), lesões cutâneas (15,71%) e queixas oftalmológicas (6,68%). Parte dos indivíduos mostrou acometimento crônico por hipertensão arterial sistêmica (9,03%), HIV/AIDS (3,53%) e diabetes mellitus (3,53%). Também foi identificada quantidade significativa de relatos de histórico de traumas físicos (59%). Encontrou-se correlação estatística entre hipertensão e medicamentos de uso contínuo (p=0,001). Menos que 10% dos indivíduos procuraram atendimento médico por queixas de saúde mental. Das mulheres que fizerem parte do estudo, 70% relataram fazer uso de substâncias e aproximadamente metade delas, uso regular de medicamentos. Já o uso de anticoncepcionais foi relatado por uma minoria delas (18,57%). Conclusões: As queixas de dor, as lesões cutâneas e as demandas oftalmológicas foram os principais motivadores da procura por ajuda médica pela população em situação de rua, além da prevalência de hipertensão arterial sistêmica como doença crônica. Os achados podem auxiliar e direcionar ações em saúde voltadas para essa população marginalizada.
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Rupert DD, Alvarez GV, Burdge EJ, Nahvi RJ, Schell SM, Faustino FL. Student-Run Free Clinics Stand at a Critical Junction Between Undergraduate Medical Education, Clinical Care, and Advocacy. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:824-831. [PMID: 34817408 PMCID: PMC9678019 DOI: 10.1097/acm.0000000000004542] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Student-run free clinics (SRFCs) act as primary care providers that bring health care to populations in need and are an important source of undergraduate medical education (UME), guiding trainees through the art of history taking and physical examination. However, they are also social justice and advocacy initiatives-addressing disparity in access to care and educating medical trainees with firsthand exposure to socioeconomic determinants of health as well as language and medical illiteracy barriers. Here, the authors review academic literature examining the impact of SRFCs in their 3 roles: as medical care providers, as components of medical education, and as advocacy organizations. Based on the evidence of that literature and decades of direct SRFC leadership experience, the authors make the case that SRFCs are an undersupported means by which UME institutions contribute to correcting health care disparities and to serving social justice reform.
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Affiliation(s)
- Deborah D Rupert
- D.D. Rupert is a seventh-year MD-PhD student, Medical Scientist Training Program, Stony Brook University, Stony Brook, New York, and Department of Neuroscience, Cold Spring Harbor Laboratory, Cold Spring Harbor, New York; ORCID: https://orcid.org/0000-0002-3426-3912
| | - George V Alvarez
- G.V. Alvarez is resident physician, Department of Family Medicine, Northwell Glen Cove Hospital, Glen Cove, New York
| | - Eric J Burdge
- E.J. Burdge is a fourth-year medical student, Long Island School of Medicine, New York University, Mineola, New York; ORCID: https://orcid.org/0000-0002-4724-0226
| | - Roxanna J Nahvi
- R.J. Nahvi is a sixth-year MD-PhD student, School of Medicine and Department of Biochemistry and Molecular Biology, New York Medical College, Valhalla, New York; ORCID: https://orcid.org/0000-0002-7512-9736
| | - Spencer M Schell
- S.M. Schell is resident physician, Department of Family Medicine, OhioHealth Grant Medical Center, Columbus, Ohio; ORCID: https://orcid.org/0000-0002-2212-3760
| | - Francis L Faustino
- F.L. Faustino is assistant professor and chair, Department of Family Medicine, NYU Langone Hospital-Long Island, Mineola, New York
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Győrffy Z, Békási S, Döbrössy B, Bognár VK, Radó N, Morva E, Zsigri S, Tari P, Girasek E. Exploratory attitude survey of homeless persons regarding telecare services in shelters providing mid- and long-term accommodation: The importance of trust. PLoS One 2022; 17:e0261145. [PMID: 34990458 PMCID: PMC8735598 DOI: 10.1371/journal.pone.0261145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 11/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND With the expansion of digital health, it is imperative to consider intervention techniques in order not to be the cause of even more social health inequalities in underserved populations struggling with chronic diseases. Telemedicine solutions for homeless persons might compensate for shortcomings in access to valuable health services in different settings. The main aim of our research was to examine the attitudes and openness of homeless persons regarding telecare on a Hungarian sample. METHODS Quantitative survey among homeless people (n = 98) was completed in 4 shelters providing mid- and long-term accommodation in Budapest, Hungary. Attitudes regarding healthcare service accessibility and telecare were measured by a self-developed questionnaire of the research team. Telecare attitude comparison was made with data of a Hungarian weighted reference group of non-homeless persons recruited from 2 primary care units (n = 110). RESULTS A significant fraction of homeless people with mid- or long-term residency in homeless shelters did not oppose the use of telecare via live online video consultation and there was no difference compared to the national reference group (averages of 3.09 vs. 3.15, respectively). Results of the homeless group indicate that those more satisfied with healthcare services, in general, manifest more openness to telecare. It is clearly demonstrated by the multivariate analysis that those participants in the homeless group who had problems getting health care in the last year definitely preferred in-person doctor-patient consultations. CONCLUSION Digital health technologies offer a potentially important new pathway for the prevention and treatment of chronic conditions among homeless persons. Based on the attitudes towards telecare, initiating an on-site telecare program for mid- and long-term residents of homeless shelters might enable better care continuity. Our results draw attention to the key factors including building trust in the implementation of such programs among underserved and other vulnerable patient groups.
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Affiliation(s)
- Zsuzsa Győrffy
- Faculty of Medicine, Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Sándor Békási
- Health Center, Hungarian Charity Service of the Order of Malta, Budapest, Hungary
- Telemedicine Workgroup, FitPuli Kft., Győr, Hungary
| | - Bence Döbrössy
- Faculty of Medicine, Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Virág Katalin Bognár
- Faculty of Medicine, Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Nóra Radó
- Faculty of Medicine, Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Emília Morva
- Regional Directorate, Hungarian Charity Service of the Order of Malta, Budapest, Hungary
| | | | | | - Edmond Girasek
- Faculty of Medicine, Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
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9
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Nagel DA, Naccarato TT, Philip MT, Ploszay VK, Winkler J, Sanchez-Ramirez DC, Penner JL. Understanding Student-Run Health Initiatives in the Context of Community-Based Services: A Concept Analysis and Proposed Definitions. J Prim Care Community Health 2022; 13:21501319221126293. [PMID: 36164929 PMCID: PMC9520185 DOI: 10.1177/21501319221126293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Student-run health initiatives in the community setting have been utilized to provide practical experience for undergraduate students to develop professional competencies, gain exposure to diverse populations, and to engage in activities of social accountability. There is much literature on student-run health initiatives; however, there is no consensus on a definition of this concept or a comprehensive synthesis of the literature that describes student-run health initiatives offered by students in pre-licensure healthcare education programs. PURPOSE To provide a concept analysis of, and propose a definition for, student-run health initiatives that provide community-based services for students during pre-licensure health discipline education. METHODS A systematic literature search and review process was used to identify and synthesize peer-reviewed articles from 7 academic databases covering a range of pre-licensure health disciplines and education. Walker and Avant's framework for concept analysis was used to guide exploration of attributes, antecedents and consequences of student-run initiatives, and to inform development of a definition for this concept. RESULTS The review yielded 222 articles for data extraction and represented 17 distinct pre-licensure health disciplines, 18 health-related disciplines, and a range of other baccalaureate and graduate programs. Our analysis revealed 16 definitions, 5 attributes, 6 antecedents, and consequences identified for student-run health initiatives. Attributes were Provision of Service, Service is Free, Target Clientele, Volunteerism, and Student Governance. Antecedents included Purpose/Rationale, Affiliation with Academic Unit, Location and Partnerships, Funding and Resources, Professional Oversight, and Preparation for Student Role. Consequences were improved access to services and outcomes for clients; competency development, personal gains and interprofessional learning for students; and positive outcomes for broader systems, such as decrease of service utilization and cost/benefit. CONCLUSIONS There was no clear conceptual definition for student-run health initiatives, but many defining characteristics and well-described exemplars in the literature. Given the variations in purpose and scope of these initiatives, particularly to distinguish degree of students' roles in operations and the involvement of academic institutions, we propose 3 distinct conceptual definitions: student-run, student-led, and student-infused health initiatives.
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10
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Cha S, Henry A, Montgomery MP, Laws RL, Pham H, Wortham J, Garg S, Kim L, Mosites E. Morbidity and Mortality Among Adults Experiencing Homelessness Hospitalized With COVID-19. J Infect Dis 2021; 224:425-430. [PMID: 33993309 PMCID: PMC8194564 DOI: 10.1093/infdis/jiab261] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/12/2021] [Indexed: 12/22/2022] Open
Abstract
People experiencing homelessness (PEH) are at higher risk for chronic health conditions, but clinical characteristics and outcomes for PEH hospitalized with COVID-19 are not known. We analyzed population-based surveillance data of COVID-19-associated hospitalizations during March 1-May 31, 2020. Two percent of the people hospitalized with COVID-19 for whom a housing status was recorded were homeless. Of 199 cases in the analytic sample, most were of racial/ethnic minority groups, and had underlying health conditions. Clinical outcomes such as ICU admission, respiratory support including mechanical ventilation, and deaths were documented. Hispanic and Non-Hispanic Black persons accounted for most mechanical ventilation and deaths. Severe illness was common among persons experiencing homelessness who were hospitalized with COVID-19.
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Affiliation(s)
- Susan Cha
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,CDC COVID-19 Response, Homelessness Unit, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ankita Henry
- CDC COVID-19 Response, Homelessness Unit, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Martha P Montgomery
- CDC COVID-19 Response, Homelessness Unit, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rebecca L Laws
- CDC COVID-19 Response, Homelessness Unit, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Huong Pham
- CDC COVID-19 Response, COVID-NET Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonathan Wortham
- CDC COVID-19 Response, COVID-NET Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,US Public Health Service, Rockville, Maryland, USA
| | - Shikha Garg
- CDC COVID-19 Response, COVID-NET Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,US Public Health Service, Rockville, Maryland, USA
| | - Lindsay Kim
- CDC COVID-19 Response, COVID-NET Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,US Public Health Service, Rockville, Maryland, USA
| | - Emily Mosites
- CDC COVID-19 Response, Homelessness Unit, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,US Public Health Service, Rockville, Maryland, USA.,Office of the Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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11
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Supportive and palliative care of adults with respiratory problems experiencing structural vulnerability from homelessness, prison or other criminal justice system involvement. Curr Opin Support Palliat Care 2021; 14:197-205. [PMID: 32701858 DOI: 10.1097/spc.0000000000000511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW This review seeks to identify the current prevalence of potentially life-limiting respiratory conditions among those who have experienced homelessness, incarceration or had criminal justice involvement, and current developments in, and barriers to, delivery of supportive and palliative respiratory care to these populations. These structurally vulnerable populations are known to be growing, their health behaviours more risky, and their morbidity and mortality higher, with evidence of accelerated ageing. RECENT FINDINGS Most studies identified investigated prevalence of respiratory conditions, which were found to be high. In contrast, only one study directly explored supportive and palliative care (in a prison population) and none considered or addressed palliative and end-of-life needs of these populations, or mechanisms to address them. There was an absence of qualitative work and studies of the impact on, or role of, family, friends or informal networks. SUMMARY There is a need for evidence-based interventions to reduce the risk of communicable respiratory conditions and a greater understanding of disease trajectories and management for these vulnerable populations, including provision of accessible appropriate supportive, palliative and end-of-life care.
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12
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Lech S, Schenk L, De la Torre Castro J, Schindel D. A retrospective analysis of the health and social situation of homeless people in Berlin: study protocol. Arch Public Health 2021; 79:28. [PMID: 33676557 PMCID: PMC7937212 DOI: 10.1186/s13690-021-00546-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Homelessness is often described as both a driver and a consequence of poor health, social exclusion and economic marginalisation. The present protocol provides a detailed description of the study Examining the health situation of homeless people in Berlin: a retrospective analysis of data from the health centre for the homeless of the Jenny De la Torre Foundation from 2006 to 2020 (GIG study). The primary objective of the GIG study is to describe and analyse the social and health situation of homeless people in Berlin. METHODS A retrospective secondary data analysis of an anonymous full census of medical records for the years 2006 until 2020 from a health centre for homeless people will be carried out. The main outcome is the description and analysis of the social and health situation of homeless people in Berlin. Total and cross-sectional sample characteristics will be presented in a descriptive analysis using Chi-Square Test, Mann-Whitney-U-Test or independent t-Test as appropriate to test (sub) group differences. Further, outcomes will be analysed using finite mixture modelling in order to distinguish different types of social and health conditions. Latent variable regressions will be applied in order to identify sociodemographic and disease-related factors associated with decreasing health conditions. DISCUSSION Given the high number of homeless individuals in Germany, it is of great importance to examine their social and health situation in order to gain a better understanding of challenges and needs of homeless people and work on new approaches and solutions to effectively address these. TRAIL REGISTRATION The study was prospectively registered with the German Clinical Trials Register (trial registration number: DRKS00021172 ). Registered 26 June 2020.
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Affiliation(s)
- Sonia Lech
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany.
| | - Liane Schenk
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
| | | | - Daniel Schindel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
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13
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Racial Differences in Prevalence of Cardiometabolic Morbidities Among Homeless Men. J Racial Ethn Health Disparities 2021; 9:456-461. [PMID: 33543445 DOI: 10.1007/s40615-021-00976-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Homelessness is associated with an increased risk of cardiometabolic morbidities. However, few studies have been performed to evaluate the racial differences on these morbidities commonly seen in the homeless. METHODS A retrospective chart review was conducted to examine the racial differences in the prevalence of cardiometabolic morbidities among the homeless men served at a local health care screening clinic. Medical information was extracted and collated into a single Excel spreadsheet. Racial differences in cardiometabolic morbidities were evaluated using multivariable binary or ordinal logistic regression analyses, adjusting for age, body mass index, and smoking status. RESULTS Of the 551 homeless men, 377 (68.4%) were Black, and 174 (31.6%) were White. The mean age (47.8±11.9 years) of Black homeless men was significantly older than that (45.4±13.0 years) of White homeless men (p=0.03). Blacks were 2.7 (95% CI = 1.75, 4.16) times more likely to be in the less desirable HbA1c categories than Whites. By contrast, Blacks were less likely to have non-desirable lipid profile than Whites. Blacks were 0.42 (95% CI = 0.29, 0.62) times and 0.51 (95% CI = 0.28, 0.94) times likely to be in the non-desirable high-density lipoprotein (HDL) and low-density lipoprotein (LDL) categories than Whites, respectively. CONCLUSION Black homeless men are more likely to have pre-diabetes or diabetes than White counterparts. On the other hand, Black homeless men have better lipid profiles of HDL or LDL than their White counterparts. Our findings reveal the health challenges of the homeless men and can provide guidance on policy changes related to diet and nutrition of meal programs provided by homeless shelters and congregate meal program to address the health disparities by race in this population.
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14
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Smith CM, Feigal J, Sloane R, Biederman DJ. Differences in Clinical Outcomes of Adults Referred to a Homeless Transitional Care Program Based on Multimorbid Health Profiles: A Latent Class Analysis. Front Psychiatry 2021; 12:780366. [PMID: 34987429 PMCID: PMC8721199 DOI: 10.3389/fpsyt.2021.780366] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: People experiencing homelessness face significant medical and psychiatric illness, yet few studies have characterized the effects of multimorbidity within this population. This study aimed to (a) delineate unique groups of individuals based on medical, psychiatric, and substance use disorder profiles, and (b) compare clinical outcomes across groups. Methods: We extracted administrative data from a health system electronic health record for adults referred to the Durham Homeless Care Transitions program from July 2016 to June 2020. We used latent class analysis to estimate classes in this cohort based on clinically important medical, psychiatric and substance use disorder diagnoses and compared health care utilization, overdose, and mortality at 12 months after referral. Results: We included 497 patients in the study and found 5 distinct groups: "low morbidity" (referent), "high comorbidity," "high tri-morbidity," "high alcohol use," and "high medical illness." All groups had greater number of admissions, longer mean duration of admissions, and more ED visits in the 12 months after referral compared to the "low morbidity" group. The "high medical illness" group had greater mortality 12 months after referral compared to the "low morbidity" group (OR, 2.53, 1.03-6.16; 95% CI, 1.03-6.16; p = 0.04). The "high comorbidity" group (OR, 5.23; 95% CI, 1.57-17.39; p < 0.007) and "high tri-morbidity" group (OR, 4.20; 95% CI, 1.26-14.01; p < 0.02) had greater 12-month drug overdose risk after referral compared to the referent group. Conclusions: These data suggest that distinct groups of people experiencing homelessness are affected differently by comorbidities, thus health care programs for this population should address their risk factors accordingly.
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Affiliation(s)
- Colin M Smith
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.,Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Jacob Feigal
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.,Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Richard Sloane
- Center for the Study of Aging, Duke University Medical Center, Durham, NC, United States
| | - Donna J Biederman
- Clinical Health Systems & Analytics Division, Duke University School of Nursing, Durham, NC, United States
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15
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Joud H, Mohamed E, Mirza S, Tabbaa H, Tabbaa M, Khan F, Ayoubi N, MacDonald M, Woodard L, Oxner A, Guerra L, Bakour C, Mirza AS. Prevalence and management of diabetes among the uninsured: A multicenter study in Tampa Bay, FL. Diabetes Res Clin Pract 2021; 171:108560. [PMID: 33271229 DOI: 10.1016/j.diabres.2020.108560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/03/2020] [Accepted: 11/16/2020] [Indexed: 11/23/2022]
Abstract
AIMS This study describes the prevalence and management of uninsured patients with diabetes in free clinics around the Tampa Bay area. METHODS A retrospective chart review collected data from uninsured patients who visited nine free clinics from January 2016 to December 2017. The data included sociodemographics, chronic disease diagnoses and treatments, and social history. Statistical analysis including chi-square tests and logistic regression were used to describe patients with diabetes. RESULTS With a prevalence of 19.41% among 6815 uninsured patients and a mean HbA1c of 7.9% (63 mmol/mol), patients with diabetes were more likely to be White, women, obese, unemployed, and have hypertension and depression compared to patients without diabetes. There were no significant differences in sociodemographic variables between those with controlled and uncontrolled diabetes. Among the variables studied by logistic regression, unemployment was found to be a significant predictor of poor glycemic control among men. CONCLUSIONS Diabetes is a challenging chronic disease among the uninsured of Tampa Bay due to its prevalence and suboptimal glycemic control. Obesity and unemployment represent significant challenges that increase the burden of diabetes among the uninsured. Free clinics may benefit from additional resources and intervention programs, with future research assessing their effects on care outcomes.
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Affiliation(s)
- Hadi Joud
- USF Health Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA.
| | - Eslam Mohamed
- Family Medicine, Ocala Regional Medical Center, 1431 SW 1st Ave, Ocala, FL 34478, USA
| | - Sabbir Mirza
- William Carey University College of Osteopathic Medicine, 710 William Carey Parkway, Hattiesburg, MS 39401, USA
| | - Hozaifa Tabbaa
- Lake Erie College of Osteopathic Medicine, 5000 Lakewood Ranch Blvd., Bradenton, FL 34211, USA
| | - Mouaz Tabbaa
- College of Arts and Sciences, University of South Florida, 4202 E. Fowler Avenue, CPR 107, Tampa, FL 33620, USA
| | - Firaas Khan
- USF Health Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Noura Ayoubi
- USF Health Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Madeline MacDonald
- USF Health Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Laurie Woodard
- Department of Family Medicine, USF Health Morsani College of Medicine, 13330 USF Laurel Drive, 5th Floor, Tampa, FL 33612, USA
| | - Asa Oxner
- Department of Internal Medicine, USF Health Morsani College of Medicine, 13330 USF Laurel Drive, 5th Floor, Tampa, FL 33612, USA
| | - Lucy Guerra
- Department of Internal Medicine, USF Health Morsani College of Medicine, 13330 USF Laurel Drive, 5th Floor, Tampa, FL 33612, USA
| | - Chighaf Bakour
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL 33612, USA
| | - Abu-Sayeef Mirza
- Department of Internal Medicine, USF Health Morsani College of Medicine, 13330 USF Laurel Drive, 5th Floor, Tampa, FL 33612, USA
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MacDonald MR, Zarriello S, Swanson J, Ayoubi N, Mhaskar R, Mirza AS. Secondary prevention among uninsured stroke patients: A free clinic study. SAGE Open Med 2020; 8:2050312120965325. [PMID: 33110604 PMCID: PMC7564623 DOI: 10.1177/2050312120965325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 09/18/2020] [Indexed: 01/03/2023] Open
Abstract
Objectives: Free clinics manage a diversity of diseases among the uninsured. We sought to assess the medical management of stroke in a population of uninsured patients. Methods: A retrospective chart review was conducted to collect chronic disease statistics from 6558 electronic medical records and paper charts at nine free clinics in Tampa, Florida, from January 2016 to December 2017. Demographics and risk factors were compared between stroke patients and non-stroke patients. Medication rates for several comorbidities were also assessed. Results: Two percent (107) of patients had been diagnosed with a stroke. Stroke patients were older (mean (M) = 56.0, standard deviation (SD) = 11.2) than the rest of the sample (M = 43.3, SD = 15.4), p < 0.001 and a majority were men (n = 62, 58%). Of the stroke patients with hypertension (n = 79), 81% (n = 64) were receiving anti-hypertensive medications. Of the stroke patients with diabetes (n = 43), 72% (n = 31) were receiving diabetes medications. Among all stroke patients, 44% were receiving aspirin therapy (n = 47). Similarly, 39% of all stroke patients (n = 42) were taking statins. Conclusions: Uninsured patients with a history of stroke may not be receiving adequate secondary prevention highlighting the risk and vulnerability of uninsured patients. This finding identifies an area for improvement in secondary stroke prevention in free clinics.
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Affiliation(s)
| | - Sydney Zarriello
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Justin Swanson
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Noura Ayoubi
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Rahul Mhaskar
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Abu-Sayeef Mirza
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Internal Medicine, University of South Florida, Tampa, FL, USA
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Yoon JC, Montgomery MP, Buff AM, Boyd AT, Jamison C, Hernandez A, Schmit K, Shah S, Ajoku S, Holland DP, Prieto J, Smith S, Swancutt MA, Turner K, Andrews T, Flowers K, Wells A, Marchman C, Laney E, Bixler D, Cavanaugh S, Flowers N, Gaffga N, Ko JY, Paulin HN, Weng MK, Mosites E, Morris SB. COVID-19 Prevalence among People Experiencing Homelessness and Homelessness Service Staff during Early Community Transmission in Atlanta, Georgia, April-May 2020. Clin Infect Dis 2020; 73:e2978-e2984. [PMID: 32898272 PMCID: PMC7499502 DOI: 10.1093/cid/ciaa1340] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022] Open
Abstract
Background In response to reported COVID-19 outbreaks among people experiencing homelessness (PEH) in other U.S. cities, we conducted multiple, proactive, facility-wide testing events for PEH living sheltered and unsheltered and homelessness service staff in Atlanta, Georgia. We describe SARS-CoV-2 prevalence and associated symptoms and review shelter infection prevention and control (IPC) policies Methods PEH and staff were tested for SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR) during April 7–May 6, 2020. A subset of PEH and staff was screened for symptoms. Shelter assessments were conducted concurrently at a convenience sample of shelters using a standardized questionnaire Results Overall, 2,875 individuals at 24 shelters and nine unsheltered outreach events underwent SARS-CoV-2 testing and 2,860 (99.5%) had conclusive test results. SARS-CoV-2 prevalence was 2.1% (36/1,684) among PEH living sheltered, 0.5% (3/628) among PEH living unsheltered, and 1.3% (7/548) among staff. Reporting fever, cough, or shortness of breath in the last week during symptom screening was 14% sensitive and 89% specific for identifying COVID-19 cases compared with RT-PCR. Prevalence by shelter ranged 0%–27.6%. Repeat testing 3–4 weeks later at four shelters documented decreased SARS-CoV-2 prevalence (0%–3.9%). Nine of 24 shelters completed shelter assessments and implemented IPC measures as part of the COVID-19 response Conclusions PEH living in shelters experienced higher SARS-CoV-2 prevalence compared with PEH living unsheltered. Facility-wide testing in congregate settings allowed for identification and isolation of COVID-19 cases and is an important strategy to interrupt SARS-CoV-2 transmission
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Affiliation(s)
- Jane C Yoon
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Martha P Montgomery
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ann M Buff
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrew T Boyd
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Calla Jamison
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alfonso Hernandez
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Kristine Schmit
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarita Shah
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - David P Holland
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.,Fulton County Board of Health, Atlanta, GA, USA
| | | | - Sasha Smith
- Fulton County Board of Health, Atlanta, GA, USA
| | | | - Kim Turner
- Fulton County Board of Health, Atlanta, GA, USA
| | | | | | | | | | - Emaline Laney
- Emory University School of Medicine, Atlanta, GA, USA
| | - Danae Bixler
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sean Cavanaugh
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicole Flowers
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicholas Gaffga
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jean Y Ko
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Heather N Paulin
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark K Weng
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily Mosites
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sapna Bamrah Morris
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
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18
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Medical Comorbidities and Medication Use Among Homeless Adults Seeking Mental Health Treatment. Community Ment Health J 2020; 56:885-893. [PMID: 31955290 DOI: 10.1007/s10597-020-00552-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/11/2020] [Indexed: 10/25/2022]
Abstract
Little is known about the medical conditions and medication use of individuals who are homeless and have mental health problems. This study used secondary data (N = 933) from a mental health clinic serving homeless adults. Primary outcomes were the number and types of self-reported medical conditions and medications. About half (52.60%) of participants were taking one or more medications (mean = 1.67; SD = 2.30), most commonly antidepressants, antipsychotics, and anticonvulsants. Most frequently reported medical conditions were headaches/migraines, hypertension, and arthritis with a mean of 3.09 (SD = 2.74) conditions. Age and sex were significant predictors of the number of medical conditions. Age and the length of time homeless were significant predictors of the number of medications taken. Results suggest that those who are older and have been homeless longer appear to be increased risk for health problems and may need more medications to manage these conditions.
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19
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Chhabra M, Spector E, Demuynck S, Wiest D, Buckley L, Shea JA. Assessing the relationship between housing and health among medically complex, chronically homeless individuals experiencing frequent hospital use in the United States. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:91-99. [PMID: 31476092 DOI: 10.1111/hsc.12843] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 08/14/2019] [Accepted: 08/19/2019] [Indexed: 06/10/2023]
Abstract
In the United States and abroad, health systems have begun to address housing insecurity through programs that adhere to the Housing First model. The model provides permanent supportive housing without disqualification due to current mental health problems or substance use, along with optional case management services. This study used qualitative methods to explore how housing stability affected chronic disease management and social and community relationships among individuals with complex health and social needs and patterns of high hospital utilisation who were housed as part of a scattered-site Housing First program in a mid-size city in the northeastern United States. 26 individual, semi-structured interviews were conducted with Housing First clients in their homes or day program sites between March and July 2017. Interviews were digitally recorded and transcripts were analysed using a qualitative descriptive methodology until thematic saturation was reached. Findings suggest that housing provided the physical location to manage the logistical aspects of care for these clients, and an environment where they were better able to focus on their health and wellness. Study participants reported less frequent use of emergency services and more regular interaction with primary care providers. Additionally, case managers' role in connecting clients to behavioural health services removed barriers to care that clients had previously faced. Housing also facilitated reconnection with family and friends whose relationships with participants had become strained or distant. Changes to physical and social communities sometimes resulted in experiences of stigmatisation and exclusion, especially for clients who moved to areas with less racial and socioeconomic diversity, but participation in the program promoted an increased sense of safety and security for many clients.
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Affiliation(s)
- Manik Chhabra
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine at the Cpl. Michael Crescenz VA Medical Center, U.S. Department of Veterans Affairs, Philadelphia, PA, USA
| | - Emily Spector
- Camden Coalition of Health Care Providers, Camden, NJ, USA
| | - Sophia Demuynck
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Dawn Wiest
- Camden Coalition of Health Care Providers, Camden, NJ, USA
| | - Laura Buckley
- Camden Coalition of Health Care Providers, Camden, NJ, USA
| | - Judy A Shea
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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20
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The Effect of Place of Service on Diabetic Screening Adherence in the Homeless Population. J Community Health 2019; 45:73-80. [PMID: 31396826 DOI: 10.1007/s10900-019-00718-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study examined the association between place of service and adherence to select diabetes screening measures in a homeless population. At a Midwestern metropolitan federally qualified health center (FQHC), 508 participants with diabetes and also experiencing homelessness were studied throughout calendar year 2018. Diabetes measures included controlled blood pressure, diabetic foot exam and hemoglobin A1C screening. Patients were seen at one of three locations: FQHC only, shelter only and both shelter and FQHC. After controlling for primary insurance, insurance status, homeless status, age group, ethnicity, primary language, race, sex and poverty level, a stepwise binary logistic regression demonstrated significant model improvement in A1c screening (p ≤ 0.001) and controlled blood pressure (p = 0.009) when place of service was added as a predictor. Specifically, results showed significant negative associations in screening adherence for shelter as compared to FQHC for both controlled blood pressure (OR = 0.40; 95% CI = 0.20-0.79; p = 0.009) and A1c screening (OR = 0.06; 95% CI = 0.03-0.16; p ≤ 0.001). Our results support the hypothesis that FQHC care results in higher rates of adherence than shelter only or FQHC and shelter combined care. The study addresses the gap in literature surrounding place of service and patient adherence. Recommendations for future research are included.
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