Perceptions of mobile and acute healthcare services among people experiencing homelessness

Types and cost of wellness services provided by a neighborhood-based academic nursing center

Background

Despite increased insurance coverage since 2010, racial and ethnic minorities in the United States still receive less medical care than White counterparts. The Johns Hopkins School of Nursing's Center for Community Programs, Innovation, and Scholarship (COMPASS Center) provides free wellness services, aiming to address healthcare disparities in the neighborhoods.

Objective

To delineate the types and cost of wellness services provided by the COMPASS Center.

Methods

The study employed a secondary analysis design, utilizing Qualtrics surveys to assess wellness service data from 2017 to 2022 at two main program sites-Wald center and House of Ruth, Maryland.

Results

The analysis covered 2,194 encounters (826 at Wald center and 1,368 at House of Ruth, Maryland). Most encounters at both sites served African American/African/Black and low-income individuals. Examples of wellness services included pre-employment exams and immunizations, health literacy and self-care management education, health insurance advice, parenting support, and referrals to community resources. Cost analysis revealed varying expenses per encounter, with medium costs ranging from $5.45 to $14.91 across sites, considering service type and duration, including staff salaries, encounter numbers, and service hours.

Conclusion

The COMPASS Center delivers essential wellness services supplementing traditional healthcare to disadvantaged community members through student engagement and academic support. The next generation of healthcare teams is learning with and from the community creating a holistic educational experience in building skills outside of institutional bedsides. Future plans involve structured training for students and center staff to provide wellness services, while expanding social service referrals. More work is needed to evaluate the impact of our wellness services on client satisfaction and wellness improvements.

The Role of Street Medicine and Mobile Clinics for Persons Experiencing Homelessness: A Scoping Review

INTRODUCTION

An estimated 5800 to 46,500 lives are lost due to homelessness each year. Experiencing homelessness and poor health are cyclically related, with one reinforcing the other. Mobile programs, which include vehicles that travel to deliver care, and street medicine, the act of bringing care to spaces where PEH live, may play a role in alleviating this burden by providing trusted, affordable, and accessible care to this community.

METHODS

We conducted a scoping review of peer-reviewed literature on the role of mobile clinics and street medicine in providing care for PEH by searching PubMed, Embase, and Web of Science on 10 August 2023. Articles from 2013 to 2023 specific to programs in the United States were included. The protocol was developed following the PRISMA-ScR guidelines. The primary outcome was the role of mobile programs for persons experiencing homelessness.

RESULTS

A total of 15 articles were included in this review. The descriptive findings emphasized that street medicine and mobile clinics provide primary care, behavioral health, and social services. The utilization findings indicate that street medicine programs positively impact the health system through their ability to defer emergency department and hospital visits, providing financial benefits. The comparative findings between mobile programs and office-based programs indicate current successes and areas for improvement.

DISCUSSION

Mobile clinics and street medicine programs that serve PEH provide a wide range of services. While more significant structural change is needed to address healthcare costs and housing policies in the United States, mobile clinics and street medicine teams can improve healthcare access and the healthcare system.

A scoping review examining patient experience and what matters to people experiencing homelessness when seeking healthcare

BACKGROUND

Homelessness is associated with significant health disparities. Conventional health services often fail to address the unique needs and lived experience of homeless individuals and fail to include participatory design when planning health services. This scoping review aimed to examine areas of patient experience that are most frequently reported by people experiencing homelessness when seeking and receiving healthcare, and to identify existing surveys used to measure patient experience for this cohort.

METHODS

A scoping review was undertaken reported according to the PRISMA-ScR 2020 Statement. Databases were searched on 1 December 2022: MEDLINE, EMBASE, APA PsychINFO and CINAHL. Included studies focused on people experiencing homelessness, healthcare services and patient experience, primary research, published in English from 2010. Qualitative papers and findings were extracted and synthesized against a modified framework based on the National Institute for Health and Care Excellence guidelines for care for people experiencing homelessness, the Institute of Medicine Framework and Lachman's multidimensional quality model. People with lived experience of homelessness were employed as part of the research team.

RESULTS

Thirty-two studies were included. Of these, 22 were qualitative, seven quantitative and three mixed methods, from the United States of America (n = 17), United Kingdom (n = 5), Australia (n = 5) and Canada (n = 4). Health services ranged from primary healthcare to outpatient management, acute care, emergency care and hospital based healthcare. In qualitative papers, the domains of 'accessible and timely', 'person-centred', and values of 'dignity and respect' and 'kindness with compassion' were most prevalent. Among the three patient experience surveys identified, 'accessible and timely' and 'person-centred' were the most frequent domains. The least frequently highlighted domains and values were 'equitable' and 'holistic'. No questions addressed the 'safety' domain.

CONCLUSIONS

The Primary Care Quality-Homeless questionnaire best reflected the priorities for healthcare provision that were highlighted in the qualitative studies of people experiencing homelessness. The most frequently cited domains and values that people experiencing homelessness expressed as important when seeking healthcare were reflected in each of the three survey tools to varying degrees. Findings suggest that the principles of 'Kindness and compassion' require further emphasis when seeking feedback on healthcare experiences and the domains of 'safety', 'equitable', and 'efficiency' are not adequately represented in existing patient experience surveys.

The dynamics of providing street medicine to a geographically diverse homeless population in Hawaii

PURPOSE

Since Hawaii has the highest rate of per capita of persons experiencing homelessness (PEH) in the United States, the purpose of this qualitative evaluation study was to evaluate the experiences of both the providers and clients of a Street Medicine (SM) program serving one side of the island of O'ahu.

METHOD

This evaluation used Story Inquiry to qualitatively assess one SM program serving one side of the island of O'ahu in Hawa'i. Since the culture in Hawaii is largely based upon stories, a qualitative approach was taken to better understand the lived experiences of PEH who utilized the SM services, as well as provider perspectives.

RESULTS

The findings of this evaluation include strengths of increased primary care engagement and improved quality of life for PEH; barriers to success included transportation scarcity and limitations of services available.

CONCLUSIONS

The findings lend implications for new SM programs, including gathering community support, having culturally aware outreach and that mobility and flexibility can overcome health-care barriers for PEH.