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O'Neill M, Redelmeier RJ, Michalski C, Macaraeg R, Gans M, Schoffel A, Diemert LM, Ogbaselassie L, Rosella LC, Boozary A. Implementation and evaluation of a novel community-based urban mobile health clinic in Toronto, Ontario. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2025:10.17269/s41997-024-00962-x. [PMID: 39806066 DOI: 10.17269/s41997-024-00962-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/16/2024] [Indexed: 01/16/2025]
Abstract
SETTING Despite Canada's single-payer health system, marginalized populations often experience poor health outcomes and barriers to healthcare access. In response, mobile health clinics (MHCs) have been deployed in several cities across Canada. MHCs are well established in the United States; however, little is known about their role and impact in a country with universal healthcare. We describe the implementation of an urban MHC and early learnings from a mixed methods process and outcome-oriented evaluation. INTERVENTION In February 2021, Parkdale Queen West Community Health Centre, TELUS Health for Good, and University Health Network's Gattuso Centre for Social Medicine partnered to launch a nurse practitioner‒led, community-based MHC in Toronto, Ontario. The MHC provides low-barrier primary healthcare, harm reduction, and mental health services at five convenient locations. OUTCOMES Through an intercept survey (n = 49) and semi-structured interviews (n = 10), we sought to understand the sociodemographic characteristics of clients, their experiences at the MHC, and barriers and facilitators to the MHC in comparison to traditional healthcare settings. Most clients surveyed reported being homeless (61%). Without the MHC, 37% of clients would have accessed care at an emergency department and 18% would not have sought care. Thematic analysis revealed two structural and two relational factors that improved care experiences and care access. IMPLICATIONS We demonstrate that in a single-payer health system, MHCs alleviate major barriers to care access for marginalized populations. Learnings provide context to the most salient factors influencing clients' decisions to seek care at MHCs and can inform how these outreach models are designed.
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Affiliation(s)
- Meghan O'Neill
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Robert J Redelmeier
- University Health Network, Toronto, ON, Canada
- Gattuso Centre for Social Medicine and Population Health, University Health Network, Toronto, ON, Canada
| | - Camilla Michalski
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Raymond Macaraeg
- Parkdale Queen West Community Health Centre, Toronto, ON, Canada
| | - Maureen Gans
- Parkdale Queen West Community Health Centre, Toronto, ON, Canada
| | - Alice Schoffel
- University Health Network, Toronto, ON, Canada
- Gattuso Centre for Social Medicine and Population Health, University Health Network, Toronto, ON, Canada
| | - Lori M Diemert
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Luwam Ogbaselassie
- University Health Network, Toronto, ON, Canada
- Gattuso Centre for Social Medicine and Population Health, University Health Network, Toronto, ON, Canada
| | - Laura C Rosella
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Andrew Boozary
- University Health Network, Toronto, ON, Canada.
- Gattuso Centre for Social Medicine and Population Health, University Health Network, Toronto, ON, Canada.
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
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Smith SM, Beaulieu-Jones BR, Nofal MR, Kobzeva-Herzog AJ, Ha EJ, Kang H, Dechert TA, Sanchez SE, Janeway MG. Outcomes of emergency general surgery admissions in patients experiencing homelessness: A matched cohort study. Surgery 2024; 176:1703-1710. [PMID: 39299850 PMCID: PMC11575721 DOI: 10.1016/j.surg.2024.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 08/15/2024] [Accepted: 08/18/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Housing status impacts outcomes after elective and emergent operations but has not been well studied in the emergency general surgery population. This study investigates the impact of housing status on complications and 30-day follow-up, emergency department visits, and readmissions after emergency general surgery admission. METHODS We conducted a retrospective matched cohort study of adult patients admitted with an emergency general surgery diagnosis at an urban, safety net hospital from 2014 to 2021. Patients were matched 1 to 2 on the basis of age, sex, Charlson Comorbidity Index, diagnosis, and operative status. The primary exposure was unhoused status. The primary outcome was in-hospital complications. Secondary outcomes included intensive care unit admission, extended length of stay, follow-up attendance, and emergency department visit or unplanned readmission within 30 days. Multivariable conditional logistic regression was used to determine the association between housing status and the outcomes of interest. RESULTS The study included 531 patients (177 unhoused, 354 housed). There were no significant differences in complications, intensive care unit admissions, or extended length of stay. Unhoused patients had lower odds of outpatient follow-up (odds ratio, 0.54; 95% confidence interval, 0.35-0.85, P = .008) and higher odds of emergency department utilization (odds ratio, 2.72; 95% confidence interval, 1.78-4.14, P < .001) and readmission (odds ratio, 1.87; 95% confidence interval, 1.09-3.19, P = .02). CONCLUSION Compared with housed patients, unhoused patients with emergency general surgery conditions have lower rates of outpatient follow-up and greater odds of using the emergency department and being readmitted within 30 days of discharge. This points to a need for dedicated posthospitalization care and creative methods of engaging with this population.
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Affiliation(s)
- Sophia M Smith
- Department of Surgery, Boston Medical Center, MA; Boston University Chobanian & Avedisian School of Medicine, MA
| | - Brendin R Beaulieu-Jones
- Department of Surgery, Boston Medical Center, MA; Boston University Chobanian & Avedisian School of Medicine, MA
| | - Maia R Nofal
- Department of Surgery, Boston Medical Center, MA; Boston University Chobanian & Avedisian School of Medicine, MA
| | - Anna J Kobzeva-Herzog
- Department of Surgery, Boston Medical Center, MA; Boston University Chobanian & Avedisian School of Medicine, MA
| | - Emily J Ha
- Boston University Chobanian & Avedisian School of Medicine, MA
| | - Heejoo Kang
- Boston University Chobanian & Avedisian School of Medicine, MA
| | - Tracey A Dechert
- Department of Surgery, Boston Medical Center, MA; Boston University Chobanian & Avedisian School of Medicine, MA
| | - Sabrina E Sanchez
- Department of Surgery, Boston Medical Center, MA; Boston University Chobanian & Avedisian School of Medicine, MA
| | - Megan G Janeway
- Department of Surgery, Boston Medical Center, MA; Boston University Chobanian & Avedisian School of Medicine, MA.
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Carmichael C, Schiffler T, Smith L, Moudatsou M, Tabaki I, Doñate-Martínez A, Alhambra-Borrás T, Kouvari M, Karnaki P, Gil-Salmeron A, Grabovac I. Barriers and facilitators to health care access for people experiencing homelessness in four European countries: an exploratory qualitative study. Int J Equity Health 2023; 22:206. [PMID: 37803317 PMCID: PMC10559410 DOI: 10.1186/s12939-023-02011-4] [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: 10/19/2022] [Accepted: 09/12/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND People experiencing homelessness (PEH) are known to be at higher risk of adverse health outcomes and premature mortality when compared to the housed population and often face significant barriers when attempting to access health services. This study aimed to better understand the specific health care needs of PEH and the barriers and facilitators associated with their timely and equitable access to health services in the European context. METHODS We conducted an exploratory cross-national qualitative study involving people with lived experience of homelessness and health and social care professionals in Austria, Greece, Spain, and the UK. A total of 69 semi-structured interviews comprising 15 social care professionals, 19 health care professionals, and 35 PEH were completed, transcribed, and analysed thematically. RESULTS Findings were organised into three overarching themes relating to the research question: (a) Health care needs of PEH, (b) Barriers to health care access, and (c) Facilitators to health care access. Overall, the general health of PEH was depicted as extremely poor, and mainstream health services were portrayed as ill-equipped to respond to the needs of this population. Adopting tailored approaches to care, especially involving trusted professionals in the delivery of care, was identified as a key strategy for overcoming existing barriers. CONCLUSIONS The results of this study indicate there to be a high degree of consistency in the health care needs of PEH and the barriers and facilitators associated with their access to health care across the various European settings. Homelessness in itself is recognized to represent an essential social determinant of health, with PEH at risk of unequal access to health services. Changes are thus required to facilitate PEH's access to mainstream primary care. This can also be further complemented by investment in 'in-reach' services and other tailored and person-centred forms of health care. TRIAL REGISTRATION This study was registered retrospectively on June 6, 2022, in the registry of ClinicalTrials.gov under the number NCT05406687.
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Affiliation(s)
- Christina Carmichael
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, East Rd, Cambridge, CB1 1PT, UK
- School of Psychology, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Tobias Schiffler
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, Vienna, 1090, Austria.
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, East Rd, Cambridge, CB1 1PT, UK
| | - Maria Moudatsou
- PRAKSIS - Programs of Development, Social Support and Medical Cooperation, Stournari 57, Athens, 104 32, Greece
| | - Ioanna Tabaki
- PRAKSIS - Programs of Development, Social Support and Medical Cooperation, Stournari 57, Athens, 104 32, Greece
| | - Ascensión Doñate-Martínez
- Polibienestar Research Institute, University of Valencia, Carrer del Serpis, 29, Valencia, 46022, Spain
| | - Tamara Alhambra-Borrás
- Polibienestar Research Institute, University of Valencia, Carrer del Serpis, 29, Valencia, 46022, Spain
| | - Matina Kouvari
- Environmental and Occupational Health, PROLEPSIS - Institute of Preventive Medicine, Fragoklisias street 7, Athens, 151 25, Greece
| | - Pania Karnaki
- Environmental and Occupational Health, PROLEPSIS - Institute of Preventive Medicine, Fragoklisias street 7, Athens, 151 25, Greece
| | - Alejandro Gil-Salmeron
- International Foundation for Integrated Care, Linton Road, Oxford, OX2 6UD, UK
- International University of Valencia, Calle del Pintor Sorolla, 21, Valencia, 46002, Spain
| | - Igor Grabovac
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, Vienna, 1090, Austria
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Maxwell D, Thomas J, Plassmeyer M. The dynamics of providing street medicine to a geographically diverse homeless population in Hawaii. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2023; 20:743-764. [PMID: 37461307 DOI: 10.1080/26408066.2023.2211067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
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.
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Affiliation(s)
- December Maxwell
- Thompson School of Social Work & Public Health, The University of Hawai'i at Manoa, Honolulu, United States
| | - Johanna Thomas
- School of Social Work, The University of Arkansas, Honolulu, United States
| | - Mark Plassmeyer
- School of Social Work, The University of Arkansas, Honolulu, United States
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Nussey L, Lamarche L, O'Shea T. 'It's so simple' Lessons from the margins: a qualitative study of patient experiences of a mobile health clinic in Hamilton, Ontario, Canada. BMJ Open 2023; 13:e066674. [PMID: 36958783 PMCID: PMC10040037 DOI: 10.1136/bmjopen-2022-066674] [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] [Indexed: 03/25/2023] Open
Abstract
OBJECTIVE Our study explored the experiences of clients of HAMSMaRT (Hamilton Social Medicine Response Team), a mobile health service, in the context of their experiences of the overall healthcare system. DESIGN We conducted a qualitative study with reflexive thematic analysis. SETTING HAMSMaRT is a mobile health service in Hamilton, Ontario Canada providing primary care, internal and addiction medicine and infectious diseases services. PARTICIPANTS Eligible participants were clients of HAMSMaRT who could understand English to do the interview and at least 16 years of age. Fourteen clients of HAMSMaRT were interviewed. RESULTS Our findings represented five themes. When the themes of people deserve care, from the margins to the centre, and improved and different access to the system are enacted, the model of care works, represented by the theme it works!. The way in which participants compared their experiences of HAMSMaRT to the mainstream healthcare system insinuated how simple it is, represented by the theme it's so simple. CONCLUSIONS Our findings offer guidance to the broader healthcare system for walking from the rhetoric to practice of person-centred care.
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Affiliation(s)
- Lisa Nussey
- McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Larkin Lamarche
- School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada
| | - Tim O'Shea
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Li Y, Hu H, Zheng Y, Donahoo WT, Guo Y, Xu J, Chen WH, Liu N, Shenkman EA, Bian J, Guo J. Impact of Contextual-Level Social Determinants of Health on Newer Antidiabetic Drug Adoption in Patients with Type 2 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20054036. [PMID: 36901047 PMCID: PMC10001625 DOI: 10.3390/ijerph20054036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 05/14/2023]
Abstract
BACKGROUND We aimed to investigate the association between contextual-level social determinants of health (SDoH) and the use of novel antidiabetic drugs (ADD), including sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1a) for patients with type 2 diabetes (T2D), and whether the association varies across racial and ethnic groups. METHODS Using electronic health records from the OneFlorida+ network, we assembled a cohort of T2D patients who initiated a second-line ADD in 2015-2020. A set of 81 contextual-level SDoH documenting social and built environment were spatiotemporally linked to individuals based on their residential histories. We assessed the association between the contextual-level SDoH and initiation of SGTL2i/GLP1a and determined their effects across racial groups, adjusting for clinical factors. RESULTS Of 28,874 individuals, 61% were women, and the mean age was 58 (±15) years. Two contextual-level SDoH factors identified as significantly associated with SGLT2i/GLP1a use were neighborhood deprivation index (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.81-0.94) and the percent of vacant addresses in the neighborhood (OR 0.91, 95% CI 0.85-0.98). Patients living in such neighborhoods are less likely to be prescribed with newer ADD. There was no interaction between race-ethnicity and SDoH on the use of newer ADD. However, in the overall cohort, the non-Hispanic Black individuals were less likely to use newer ADD than the non-Hispanic White individuals (OR 0.82, 95% CI 0.76-0.88). CONCLUSION Using a data-driven approach, we identified the key contextual-level SDoH factors associated with not following evidence-based treatment of T2D. Further investigations are needed to examine the mechanisms underlying these associations.
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Affiliation(s)
- Yujia Li
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Hui Hu
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Yi Zheng
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - William Troy Donahoo
- Division of Endocrinology, Diabetes and Metabolism, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Yi Guo
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jie Xu
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Wei-Han Chen
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Ning Liu
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Elisabeth A. Shenkman
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jiang Bian
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jingchuan Guo
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
- Correspondence: ; Tel.: +1-352-273-6533
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Kopanitsa V, McWilliams S, Leung R, Schischa B, Sarela S, Perelmuter S, Sheeran E, d'Algue LM, Tan GC, Rosenthal DM. A systematic scoping review of primary health care service outreach for homeless populations. Fam Pract 2023; 40:138-151. [PMID: 35809035 DOI: 10.1093/fampra/cmac075] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Homeless populations (HPs) have difficulties obtaining necessary medical care, and primary health care service outreach (PHSO) might be useful to bridge this gap. OBJECTIVE Using the Centre for Evidence-Based Management Critically Appraised Topics framework, to provide systematic evidence of the usefulness of PHSO interventions for HPs. METHODS A systematic search was conducted in 4 electronic databases: PubMed, Web of Science, CINAHL, and Cochrane (publication dates between January 1980 and November 2020). In total, 2,872 articles were identified. Primary research about PHSO for HPs in high-income countries were included. Data were extracted from eligible studies, summarized, and collated into a narrative account. RESULTS Twenty-four studies that described and evaluated PHSO interventions for adults experiencing homelessness were selected in the final synthesis. Most studies had a nonrandomized design. PHSO was found to successfully address some barriers to health care access for HPs through flexible appointments in convenient locations, fostering an understanding relationship between doctor and patients, and provision of additional basic necessities and referrals. Outreach was provided for a range of health care concerns, and several solutions to engage more HPs in primary care, improve continuity of care and to decrease the running costs were identified. Outreach also helped to implement preventative measures and reduced emergency service admissions. CONCLUSION Our review adds to the evidence that PHSO likely improves health care access for HPs. Further studies over longer time periods, involving collaborations with experts with lived experience of homelessness, and utilizing randomized study designs are needed to test outreach efficacy.
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Affiliation(s)
- Valeriya Kopanitsa
- Faculty of Medical Sciences, University College London Medical School, London, UK
| | - Stephen McWilliams
- Faculty of Medical Sciences, University College London Medical School, London, UK
| | - Richard Leung
- Faculty of Medical Sciences, University College London Medical School, London, UK
| | | | - Shazia Sarela
- Faculty of Medical Sciences, University College London Medical School, London, UK
| | - Sara Perelmuter
- Faculty of Life Sciences, University College London, London, UK
| | - Emma Sheeran
- Health Humanities Centre, University College London, London, UK
| | | | - Guan Chwen Tan
- Arts and Sciences Department, University College London, London, UK
| | - Diana Margot Rosenthal
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
- UCL Collaborative Centre for Inclusion Health, University College London, London, UK
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Paradis-Gagné E, Kaszap M, Ben Ahmed HE, Pariseau-Legault P, Jacques MC, Potcoava S. Perceptions of mobile and acute healthcare services among people experiencing homelessness. Public Health Nurs 2023; 40:36-43. [PMID: 36372948 DOI: 10.1111/phn.13150] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/15/2022] [Accepted: 10/25/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This paper presents findings from our collaborative research on the perceptions and preferences of people experiencing homelessness regarding outreach nursing services. METHOD We conducted qualitative research using a critical ethnography approach. SAMPLE A total of 15 participants were interviewed individually (n = 12 people experiencing homelessness) and in focus groups (n = 3 care providers). We also conducted direct observation. RESULTS This paper focuses on one of the core categories that emerged from the data analysis "Perception of Health Care." This category emerged from the following three subcategories, which we will present in this paper: (1) Conflicting Relationships with Institutional Health Services; (2) Perception of Outreach Services; (3) Recommendations from Mobile Clinic Users. CONCLUSION There are a range of perceptions of health services among people experiencing homelessness. Some are satisfied with the care received in the public health system, while many have experienced dehumanizing practices. Overall, outreach services are a promising strategy to reach people who are not served by the traditional modes of care delivery. Based on our findings, we suggest several key practices to personalize and adapt healthcare services and foster inclusive environments to better serve people experiencing homelessness.
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Affiliation(s)
| | - Myriam Kaszap
- Faculty of Nursing, Université de Montréal, Québec, Canada
| | | | | | - Marie-Claude Jacques
- Faculty of Medicine and Health Sciences, School of Nursing, Université de Sherbrooke, Québec, Canada
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Hajek A, Bertram F, Heinrich F, van Rüth V, Ondruschka B, Kretzler B, Schüler C, Püschel K, König HH. Determinants of health care use among homeless individuals: evidence from the Hamburg survey of homeless individuals. BMC Health Serv Res 2021; 21:317. [PMID: 33827570 PMCID: PMC8026095 DOI: 10.1186/s12913-021-06314-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/22/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To identify the determinants of health care use among homeless individuals. METHODS Data were taken from the Hamburg survey of homeless individuals (n = 100 individuals in the here used model, mean age 44.8 years, SD 12.5) focusing on homeless individuals in Hamburg, Germany. The number of physician visits in the past 3 months and hospitalization in the preceding 12 months were used as outcome measures. Drawing on the Andersen model of health care use as a conceptual framework, predisposing characteristics, enabling resources and need factors as well as psychosocial variables were included as correlates. RESULTS Negative binomial regressions showed that increased physician visits were associated with being female (IRR: 4.02 [95% CI: 1.60-10.11]), absence of chronic alcohol consume (IRR: 0.26 [95% CI: 0.12-0.57]) and lower health-related quality of life (IRR: 0.97 [95% CI: 0.96-0.98]). Furthermore, logistic regressions showed that the likelihood of hospitalization was positively associated with lower age (OR: 0.93 [95% CI: 0.89-0.98]), having health insurance (OR: 8.11 [2.11-30.80]) and lower health-related quality of life (OR: 0.97 [95% CI: 0.94-0.99]). CONCLUSIONS Our study showed that predisposing characteristics (both age and sex), enabling resources (i.e., health insurance) and need factors in terms of health-related quality of life are main drivers of health care use among homeless individuals. This knowledge may assist in managing health care use.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Franziska Bertram
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Heinrich
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victoria van Rüth
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benedikt Kretzler
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Schüler
- Deutsches Rotes Kreuz Kreisverband Hamburg Altona und Mitte e.V, Hamburg, Germany
| | - Klaus Püschel
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Omerov P, Craftman ÅG, Mattsson E, Klarare A. Homeless persons' experiences of health- and social care: A systematic integrative review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1-11. [PMID: 31524327 DOI: 10.1111/hsc.12857] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 05/22/2023]
Abstract
Homelessness is associated with high risks of morbidity and premature death. Many interventions aimed to improve physical and mental health exist, but do not reach the population of persons experiencing homelessness. Despite the widely reported unmet healthcare needs, more information about the barriers and facilitators that affect access to care for persons experiencing homelessness is needed. A systematic integrative review was performed to explore experiences and needs of health- and social care for persons experiencing homelessness. The following databases were searched: AMED, ASSIA, Academic Search Complete, CINAHL, Cochrane library, Nursing and Allied Database, PsycInfo, PubMed, Scopus and Web of Science Core Collection. Twenty-two studies met the inclusion criteria of empirical studies with adult persons experiencing homelessness, English language, and published 2008-2018. Fifty percent of the studies were of qualitative and quantitative design, respectively. Most studies (73%) were conducted in the United States (n=11) and Canada (n=5). The analysis resulted in three themes Unmet basic human needs, Interpersonal dimensions of access to care, and Structural and organizational aspects to meet needs. The findings highlight that persons in homelessness often must prioritize provision for basic human needs, such as finding shelter and food, over getting health- and social care. Bureaucracy and rigid opening hours, as well as discrimination and stigma, hinder these persons' access to health- and social care.
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Affiliation(s)
- Pernilla Omerov
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | | | - Elisabet Mattsson
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women's and Children's Health, Clinical Psychology in Healthcare, Uppsala University, Uppsala, Sweden
| | - Anna Klarare
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women's and Children's Health, Clinical Psychology in Healthcare, Uppsala University, Uppsala, Sweden
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Bekele T, Globerman J, Watson J, Hwang SW, Hambly K, Koornstra J, Walker G, Bacon J, Rourke SB. Elevated Mortality and Associated Social Determinants of Health in a Community-Based Sample of People Living with HIV in Ontario, Canada: Findings from the Positive Spaces, Healthy Places (PSHP) Study. AIDS Behav 2018; 22:2214-2223. [PMID: 29557541 DOI: 10.1007/s10461-018-2040-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We examined social determinants of health associated with all-cause mortality among 602 people living with HIV/AIDS in Ontario, Canada. Mortality status was verified at 1-, 3-, and 5-year follow-up visits with information obtained from proxies (family members, partners, and friends), obituaries, and local AIDS memorial lists. Of the 454 people for whom mortality information was available, 53 individuals died yielding a crude mortality rate of 22.3 deaths per 1000 person-years, a rate substantially higher than the rate in the general population (6.8 per 1000 population). Experiencing both homelessness and incarceration independently predicted high risk of mortality among men who have sex with men (MSM) while suboptimal self-rated general health at previous visit predicted higher greater risk of mortality in both MSM and women and heterosexual men. Homelessness and incarceration may contribute to HIV disease progression and mortality. Intensive case management that increases retention in care and facilitates linkage to housing services may help to reduce excess deaths among people with HIV.
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Affiliation(s)
| | | | - James Watson
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 193 Yonge Street, 6th floor, Toronto, ON, M5B 1M4, Canada
| | - Stephen W Hwang
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 193 Yonge Street, 6th floor, Toronto, ON, M5B 1M4, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | - Glen Walker
- Positive Living Niagara, St. Catharines, ON, Canada
| | - Jean Bacon
- The Ontario HIV Treatment Network, Toronto, ON, Canada
| | - Sean B Rourke
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 193 Yonge Street, 6th floor, Toronto, ON, M5B 1M4, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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12
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Boyd A, Bottero J, Carrat F, Gozlan J, Rougier H, Girard PM, Lacombe K. Testing for hepatitis B virus alone does not increase vaccine coverage in non-immunized persons. World J Gastroenterol 2017; 23:7037-7046. [PMID: 29097876 PMCID: PMC5658321 DOI: 10.3748/wjg.v23.i38.7037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/11/2017] [Accepted: 09/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To determine whether hepatitis B virus (HBV)-testing could serve as a gateway to vaccinate non-immunized individuals in a low-prevalent country.
METHODS Non-immunized subjects participating in a multi-center, HBV-testing campaign in Paris, France were identified and contacted via telephone 3-9 mo after testing in order to determine vaccination status. Vaccination coverage was evaluated in per-protocol (for all respondents) and intent-to-treat analysis (assuming all non-responders did not vaccinate).
RESULTS In total, 1215/4924 (24.7%) enrolled subjects with complete HBV serology were identified as non-immunized and eligible for analysis. There were 99/902 successfully contacted subjects who had initiated HBV vaccination after screening: per-protocol, 11.0% (95%CI: 9.0-13.2); intent-to-treat, 8.2% (95%CI: 6.7-9.8). In multivariable analysis, vaccination was more likely to be initiated in individuals originating from moderate or high HBV-endemic countries (P < 0.001), patients with limited healthcare coverage (P = 0.01) and men who have sex with men (P = 0.02). When asked about the reasons for not initiating HBV vaccination, the most frequent response was “will be vaccinated later” (33.4%), followed by “did not want to vaccinate” (29.8%), and “vaccination was not proposed by the physician” (21.5%). Sub-group analysis indicated a stark contrast in vaccination coverage across centers, ranging from 0%-56%.
CONCLUSION HBV-vaccination after HBV screening was very low in this study, which appeared largely attributed to physician-patient motivation towards vaccination. Increased vaccination coverage might be achieved by emphasizing its need at the organizational level.
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Affiliation(s)
- Anders Boyd
- Institute Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Universités, F-75012 Paris, France
| | - Julie Bottero
- Institute Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Universités, F-75012 Paris, France
- Service de maladies infectieuses, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
| | - Fabrice Carrat
- Institute Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Universités, F-75012 Paris, France
- Département de santé publique, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
| | - Joël Gozlan
- Laboratoire de Virologie, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
- INSERM, UMR_S1135 CIMI, Paris F-75013, France
| | - Hayette Rougier
- Service de maladies infectieuses, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
| | - Pierre-Marie Girard
- Institute Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Universités, F-75012 Paris, France
- Service de maladies infectieuses, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
| | - Karine Lacombe
- Institute Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), INSERM, Sorbonne Universités, F-75012 Paris, France
- Service de maladies infectieuses, Hôpital Saint-Antoine, AP-HP, F-75012 Paris, France
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Roux P, Rojas Castro D, Ndiaye K, Debrus M, Protopopescu C, Le Gall JM, Haas A, Mora M, Spire B, Suzan-Monti M, Carrieri P. Increased Uptake of HCV Testing through a Community-Based Educational Intervention in Difficult-to-Reach People Who Inject Drugs: Results from the ANRS-AERLI Study. PLoS One 2016; 11:e0157062. [PMID: 27294271 PMCID: PMC4905684 DOI: 10.1371/journal.pone.0157062] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/23/2016] [Indexed: 01/19/2023] Open
Abstract
Aims The community-based AERLI intervention provided training and education to people who inject drugs (PWID) about HIV and HCV transmission risk reduction, with a focus on drug injecting practices, other injection-related complications, and access to HIV and HCV testing and care. We hypothesized that in such a population where HCV prevalence is very high and where few know their HCV serostatus, AERLI would lead to increased HCV testing. Methods The national multisite intervention study ANRS-AERLI consisted in assessing the impact of an injection-centered face-to-face educational session offered in volunteer harm reduction (HR) centers (“with intervention”) compared with standard HR centers (“without intervention”). The study included 271 PWID interviewed on three occasions: enrolment, 6 and 12 months. Participants in the intervention group received at least one face-to-face educational session during the first 6 months. Measurements The primary outcome of this analysis was reporting to have been tested for HCV during the previous 6 months. Statistical analyses used a two-step Heckman approach to account for bias arising from the non-randomized clustering design. This approach identified factors associated with HCV testing during the previous 6 months. Findings Of the 271 participants, 127 and 144 were enrolled in the control and intervention groups, respectively. Of the latter, 113 received at least one educational session. For the present analysis, we selected 114 and 88 participants eligible for HCV testing in the control and intervention groups, respectively. In the intervention group, 44% of participants reported having being tested for HCV during the previous 6 months at enrolment and 85% at 6 months or 12 months. In the control group, these percentages were 51% at enrolment and 78% at 12 months. Multivariable analyses showed that participants who received at least one educational session during follow-up were more likely to report HCV testing, compared with those who did not receive any intervention (95%[CI] = 4.13[1.03;16.60]). Conclusion The educational intervention AERLI had already shown efficiency in reducing HCV at-risk practices and associated cutaneous complications and also seems to have a positive impact in increasing HCV testing in PWID.
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Affiliation(s)
- Perrine Roux
- INSERM U912 (SESSTIM), Marseille, France
- Aix Marseille Université, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
- * E-mail:
| | | | - Khadim Ndiaye
- INSERM U912 (SESSTIM), Marseille, France
- Aix Marseille Université, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | | | - Camélia Protopopescu
- INSERM U912 (SESSTIM), Marseille, France
- Aix Marseille Université, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | | | | | - Marion Mora
- INSERM U912 (SESSTIM), Marseille, France
- Aix Marseille Université, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Bruno Spire
- INSERM U912 (SESSTIM), Marseille, France
- Aix Marseille Université, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
- AIDES, Pantin, France
| | - Marie Suzan-Monti
- INSERM U912 (SESSTIM), Marseille, France
- Aix Marseille Université, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
- AIDES, Pantin, France
| | - Patrizia Carrieri
- INSERM U912 (SESSTIM), Marseille, France
- Aix Marseille Université, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
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Tailoring Outreach Efforts to Increase Primary Care Use Among Homeless Veterans: Results of a Randomized Controlled Trial. J Gen Intern Med 2015; 30:886-98. [PMID: 25673574 PMCID: PMC4471019 DOI: 10.1007/s11606-015-3193-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 12/01/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Homeless individuals often have significant unmet health care needs that are critical to helping them leave homelessness. However, engaging them in primary and mental health care services is often elusive and difficult to achieve. OBJECTIVE We aimed to increase health-seeking behavior and receipt of health care among homeless Veterans. DESIGN This was a multi-center, prospective, community-based, two-by-two randomized controlled trial of homeless Veterans. PARTICIPANTS Homeless Veterans not receiving primary care participated in the study. INTERVENTIONS An outreach intervention that included a personal health assessment and brief intervention (PHA/BI), and/or a clinic orientation (CO) was implemented. MAIN MEASURE We measured receipt of primary care within 4 weeks of study enrollment. KEY RESULTS Overall, 185 homeless Veterans were enrolled: the average age was 48.6 years (SD 10.8), 94.6% were male, 43.0% were from a minority population, 12.0% were unsheltered, 25.5% were staying in a dusk-to-dawn emergency shelter, 26.1% were in transitional housing, while 27.7% were in an unstable, doubled-up arrangement. At one month, 77.3% of the PHA/BI plus CO group accessed primary care and by 6 months, 88.7% had been seen in primary care. This was followed by the CO-only group, 50.0% of whom accessed care in the first 4 weeks, the PHI/BI-only arm at 41.0% and the Usual Care arm at 30.6%. Chi-squared tests by group were significant (p < 0.001) at both 4 weeks and 6 months. There was no difference in attitudes about care at baseline and 6 months or in use patterns once enrolled in care. CONCLUSIONS Our findings suggest that treatment-resistant/avoidant homeless Veterans can be effectively engaged in primary and other clinical care services through a relatively low intensity, targeted and tailored outreach effort.
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15
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Strategies for hepatitis C testing and linkage to care for vulnerable populations: point-of-care and standard HCV testing in a mobile medical clinic. J Community Health 2015; 39:922-34. [PMID: 25135842 DOI: 10.1007/s10900-014-9932-9] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Despite new Hepatitis C virus (HCV) therapeutic advances, challenges remain for HCV testing and linking patients to care. A point-of-care (POC) HCV antibody testing strategy was compared to traditional serological testing to determine patient preferences for type of testing and linkage to treatment in an innovative mobile medical clinic (MMC). From 2012 to 2013, all 1,345 MMC clients in New Haven, CT underwent a routine health assessment, including for HCV. Based on patient preferences, clients could select between standard phlebotomy or POC HCV testing, with results available in approximately 1 week versus 20 min, respectively. Outcomes included: (1) accepting HCV testing; (2) preference for rapid POC HCV testing; and (3) linkage to HCV care. All clients with reactive test results were referred to a HCV specialty clinic. Among the 438 (32.6 %) clients accepting HCV testing, HCV prevalence was 6.2 % (N = 27), and 209 (47.7 %) preferred POC testing. Significant correlates of accepting HCV testing was lower for the "baby boomer" generation (AOR 0.67; 95 % CI 0.46-0.97) and white race (AOR 0.55; 95 % CI 0.36-0.78) and higher for having had a prior STI diagnosis (AOR 5.03; 95 % CI 1.76-14.26), prior injection drug use (AOR 2.21; 95 % CI 1.12-4.46), and being US-born (AOR 1.76; 95 % CI 1.25-2.46). Those diagnosed with HCV and preferring POC testing (N = 16) were significantly more likely than those choosing standard testing (N = 11) to be linked to HCV care within 30 days (93.8 vs. 18.2 %; p < 0.0001). HCV testing is feasible in MMCs. While patients equally preferred POC and standard HCV testing strategies, HCV-infected patients choosing POC testing were significantly more likely to be linked to HCV treatment. Important differences in risk and background were associated with type of HCV testing strategy selected. HCV testing strategies should be balanced based on costs, convenience, and ability to link to HCV treatment.
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16
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Gibson BA, Ghosh D, Morano JP, Altice FL. Accessibility and utilization patterns of a mobile medical clinic among vulnerable populations. Health Place 2014; 28:153-66. [PMID: 24853039 DOI: 10.1016/j.healthplace.2014.04.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 04/23/2014] [Accepted: 04/26/2014] [Indexed: 01/08/2023]
Abstract
We mapped mobile medical clinic (MMC) clients for spatial distribution of their self-reported locations and travel behaviors to better understand health-seeking and utilization patterns of medically vulnerable populations in Connecticut. Contrary to distance decay literature, we found that a small but significant proportion of clients was traveling substantial distances to receive repeat care at the MMC. Of 8404 total clients, 90.2% lived within 5 miles of a MMC site, yet mean utilization was highest (5.3 visits per client) among those living 11-20 miles of MMCs, primarily for those with substance use disorders. Of clients making >20 visits, 15.0% traveled >10 miles, suggesting that a significant minority of clients traveled to MMC sites because of their need-specific healthcare services, which are not only free but available at an acceptable and accommodating environment. The findings of this study contribute to the important research on healthcare utilization among vulnerable population by focusing on broader dimensions of accessibility in a setting where both mobile and fixed healthcare services coexist.
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Affiliation(s)
- Britton A Gibson
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
| | - Debarchana Ghosh
- University of Connecticut, Department of Geography, Storrs, CT, USA.
| | - Jamie P Morano
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Frederick L Altice
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA; University of Malaya, Centre of Excellence on Research in AIDS (CERiA), Kuala Lumpur, Malaysia
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Happell B, Platania-Phung C, Scott D. Proposed nurse-led initiatives in improving physical health of people with serious mental illness: a survey of nurses in mental health. J Clin Nurs 2013; 23:1018-29. [PMID: 24606393 DOI: 10.1111/jocn.12371] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2013] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES To identify nurse perceptions on the potential value of general and specific nursing approaches to improving physical health outcomes of people with serious mental illness. BACKGROUND People diagnosed with serious mental illnesses experience heightened rates of physical illnesses and can be supported better via healthcare system prevention and management. Nurses working in mental health are a critical part of a system-wide approach to improving physical health care, but there is little known on their views on specific approaches within Australia (e.g. screening for risks, stigma reduction). DESIGN A national, cross-sectional and nonrandom survey study delivered online. METHODS Members of the Australian College of Mental Health Nurses (n = 643), representing nurses employed in mental healthcare services across Australia (71·6% from public mental health services). Participants were asked to rate the potential of nine nurse-based strategies for improving physical health (options: 'yes', 'no', 'not sure') and the potential value of 10 nursing and general strategies for improving physical health (rating from 'negative value' to 'significant value'). RESULTS There was a high endorsement of all nine nurse-based strategies for physical health (e.g. lifestyle programmes, screening, linking services), although there was less support for reducing antipsychotics or advocating for fewer side effects. Participants mainly viewed all strategies as of moderate to significant value, with the most promising value attached to colocation of primary and mental care services, lifestyle programmes and improving primary care services (reduce stigma, train GPs). CONCLUSIONS Australian nurses working in mental health services view a range of nurse-based strategies for improving physical healthcare services and standards as important. RELEVANCE TO CLINICAL PRACTICE Nurses collectively need to work with consumers, health agencies and the general public to further define how to organise and implement physical health integration strategies, towards more comprehensive health care of people with serious mental illness.
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Affiliation(s)
- Brenda Happell
- Institute for Health and Social Science Research, Engaged Research Chair in Mental Health Nursing, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
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18
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Needs of the hidden homeless – no longer hidden: a pilot study. Public Health 2013; 127:674-80. [DOI: 10.1016/j.puhe.2013.04.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 03/07/2013] [Accepted: 04/08/2013] [Indexed: 10/26/2022]
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Point-of-Care Diagnostic Tools in Canadian Urban Mobile Health Clinic Contexts. POINT OF CARE 2011. [DOI: 10.1097/poc.0b013e31820f8613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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