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Health Care of the Homeless

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1. Health Care While Homeless: Barriers, Facilitators, and the Lived Experiences of Homeless Individuals Accessing Health Care in a Canadian Regional Municipality. (PubMed)

Health Care While Homeless: Barriers, Facilitators, and the Lived Experiences of Homeless Individuals Accessing Health Care in a Canadian Regional Municipality. Persons struggling with housing remain significantly disadvantaged when considering access to health care. Effective advocacy for their needs will require understanding the factors which impact their health care, and which of those most concern patients themselves. A qualitative descriptive study through the lens of a transformative (...) framework was used to identify barriers and facilitators to accessing health care as perceived by people experiencing homelessness in the regional municipality of Niagara, Canada. In-person, semi-structured interviews with 16 participants were completed, and inductive thematic analysis identified nine barriers and eight facilitators. Barriers included affordability, challenges finding primary care, inadequacy of the psychiatric model, inappropriate management, lack of trust in health care providers

2019 Qualitative Health Research

2. Providing Positive Primary Care Experiences for Homeless Veterans Through Tailored Medical Homes: The Veterans Health Administration's Homeless Patient Aligned Care Teams. (PubMed)

Providing Positive Primary Care Experiences for Homeless Veterans Through Tailored Medical Homes: The Veterans Health Administration's Homeless Patient Aligned Care Teams. In 2012, select Veterans Health Administration (VHA) facilities implemented a homeless-tailored medical home model, called Homeless Patient Aligned Care Teams (H-PACT), to improve care processes and outcomes for homeless Veterans.The main aim of this study was to determine whether H-PACT offers a better patient experience (...) ), and comprehensiveness (RD=9.3). Standard primary care patients in facilities with H-PACT available were more likely than those from facilities without H-PACT to report positive experiences with communication (RD=4.7) and self-management support (RD=4.6).Patient-centered medical homes designed to address the social determinants of health offer a better care experience for homeless patients, when compared with standard primary care approaches. The lessons learned from H-PACT can be applied throughout VHA and to other

2019 Medical Care

3. Advance Care Planning for Older Homeless-Experienced Adults: Results from the Health Outcomes of People Experiencing Homelessness in Older Middle Age Study. (PubMed)

Advance Care Planning for Older Homeless-Experienced Adults: Results from the Health Outcomes of People Experiencing Homelessness in Older Middle Age Study. Older homeless-experienced adults have low engagement in advance care planning (ACP) despite high morbidity and mortality. We conducted a cross-sectional analysis of a cohort of 350 homeless-experienced adults aged 50 and older in Oakland, California. We assessed the prevalence of potential surrogate decision-makers, ACP contemplation (...) interval (CI)=1.7-20.0), 3 or more chronic conditions versus none (aOR=2.3, 95% CI=0.9-5.6), and a recent primary care visit (aOR=2.1, 95% CI=1.0-4.4) were associated with higher odds of ACP discussions and each additional 5 years of homelessness (aOR=0.7, 95% CI=0.5-0.9) with lower odds. Having 1 to 5 confidants (aOR=5.0, 95% CI=1.4-17.5), being black (aOR=5.5, 95% CI=1.5-19.5), and having adequate versus limited literacy (aOR=7.0, 95% CI=1.5-32.4) were associated with higher odds of ACP documentation

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2018 Journal of the American Geriatrics Society

4. Care avoidance among homeless people and access to care: an interview study among spiritual caregivers, street pastors, homeless outreach workers and formerly homeless people. (PubMed)

Care avoidance among homeless people and access to care: an interview study among spiritual caregivers, street pastors, homeless outreach workers and formerly homeless people. Because of their poor health and social vulnerability, homeless people require specific care. However, due to care avoidance, homeless people are often not involved in care. This study aims to get insights into reasons for and kinds of care avoidance among homeless people and to provide suggestions to reach this target (...) group.Semi-structured individual interviews were conducted among street pastors (n = 9), spiritual caregivers (n = 9), homeless outreach workers (n = 7) and formerly homeless people (n = 3). Participants were recruited by purposive sampling in the four major cities in the Netherlands (Amsterdam, Utrecht, Rotterdam, The Hague). The verbatim transcripts were analysed using thematic analysis.The term care avoidance was perceived as stigmatizing. Care avoidance is found to be related to characteristics

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2018 BMC Public Health

5. End-of-Life Care for People Experiencing Homelessness

End-of-Life Care for People Experiencing Homelessness Adapting Your Practice Recommendations for End-of-Life Care for People Experiencing Homelessness Health Care for the Homeless Clinicians’ Network 2018 Health Care for the Homeless Clinicians’ Network ADAPTING YOUR PRACTICE: Recommendations for End-of-Life Care for People Experiencing Homelessness i Adapting Your Practice: Recommendations for End-of-Life Care for People Experiencing Homelessness was developed with support from the Bureau (...) of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services. All material in this document is in the public domain and may be used and reprinted without special permission. Citation as to source, however, is appreciated. Health Care for the Homeless Clinicians’ Network ADAPTING YOUR PRACTICE: Recommendations for End-of-Life Care for People Experiencing Homelessness ii Disclaimer This project was supported by the Health Resources and Services

2018 National Health Care for the Homeless Council

6. Improving Health Care Management in Primary Care for Homeless People: A Literature Review (PubMed)

Improving Health Care Management in Primary Care for Homeless People: A Literature Review Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. We aimed to describe the main characteristics of the primary care programs that take care of homeless people, and to identify which could be most relevant.We performed a literature review that included articles (...) which described and evaluated primary care programs for homeless people.Most of the programs presented a team-based approach, multidisciplinary and/or integrated care. They often proposed co-located services between somatic health services, mental health services and social support services. They also tried to answer to the specific needs of homeless people. Some characteristics of these programs were associated with significant positive outcomes: tailored primary care organizations, clinic

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2018 International journal of environmental research and public health

7. Homeless health care: meeting the challenges of providing primary care. (PubMed)

Homeless health care: meeting the challenges of providing primary care. People experiencing homelessness have multiple complex health conditions yet are typically disengaged from primary health care services and place a significant burden on the acute health system. Barriers preventing people who are homeless from accessing primary care can be both personal and practical and include competing needs and priorities, illness and poor health, physical access to health services, difficulty (...) in contacting services, medication security, and the affordability of health care. Differences in social status and perceptions of being judged can lead to relationship barriers to accessing primary care. Key solutions include prioritising access to stable housing, continuity of health care, specialised homeless general practice, hospital inreach, discharge planning and coordinated care, general practice outreach, and medical recovery centres.

2018 Medical Journal of Australia

8. Health and Health Care for Homeless People in Various Contexts (PubMed)

Health and Health Care for Homeless People in Various Contexts Although there is some uncertainty about the exact number of homeless people at any given time in different countries, it is undeniable that this number has steadily and dramatically grown in the recent years [...].

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2018 International journal of environmental research and public health

9. Interventions to Improve Access to Primary Care for People Who Are Homeless: A Systematic Review

Interventions to Improve Access to Primary Care for People Who Are Homeless: A Systematic Review Health Quality Ontario ABOUT OHTAS DISCLAIMER Contact us: Evidence@hqontario.ca Ontario Health Technology Assessment Series Interventions to Improve Access to Primary Care for People Who Are Homeless: A Systematic Review KEY MESSAGES People who are homeless are more likely to become ill and die early than are people who are not homeless. They need more health care, but also have problems getting (...) at a variety of programs, including outreach (an examination by a health care professional, typically a nurse, along with a review of the results of the examination), orientation (the provision of information about services at the clinic), combining health care with other services that people who are homeless seek, and housing with supportive services. The most reliable study showed that people who receive either outreach plus clinic orientation or clinic orientation alone have better access to a primary

2016 Health Quality Ontario

10. Patient-aligned Care Team Engagement to Connect Veterans Experiencing Homelessness With Appropriate Health Care. (PubMed)

Patient-aligned Care Team Engagement to Connect Veterans Experiencing Homelessness With Appropriate Health Care. Veterans experiencing homelessness frequently use emergency and urgent care (ED).To examine the effect of a Patient-aligned Care Team (PACT) model tailored to the unique needs of Veterans experiencing homelessness (H-PACT) on frequency and type of ED visits in Veterans Health Administration (VHA) medical facilities.During a 12-month period, ED visits for 3981 homeless Veterans (...) enrolled in (1) H-PACT at 20 VHA medical centers (enrolled) were compared with those of (2) 24,363 homeless Veterans not enrolled in H-PACT at the same sites (nonenrolled), and (3) 23,542 homeless Veterans at 12 non-H-PACT sites (usual care) using a difference-in-differences approach.The primary outcome was ED and other health care utilization and the secondary outcome was emergent (not preventable/avoidable) ED visits.H-PACT enrollees were predominantly white males with a higher baseline Charlson

2017 Medical Care

11. Palliative care as a public health issue: understanding disparities in access to palliative care for the homeless population living in Toronto, based on a policy analysis (PubMed)

Palliative care as a public health issue: understanding disparities in access to palliative care for the homeless population living in Toronto, based on a policy analysis Even in a developed country such as Canada, there are disparities in just access to adequate health care-and, more specifically, palliative care. That inequality is most notable in an underserved group such as the homeless population. Even the word "homeless" has become both a negative descriptor and a stereotype in our (...) society. We posit that the provision of hospice palliative care is structured on several problematic assumptions: an expectation that patients will have an informal support network (family and friends), a stable and secure residence, a predictive terminal illness trajectory, and reasonable access to health care. Those assumptions create structural inequality within the system. Homeless individuals have considerable experience with death and dying, and qualitative research has shown them to hold

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2017 Current Oncology

12. Towards Better Health: Improving Access to Health Care for Homeless People (PubMed)

Towards Better Health: Improving Access to Health Care for Homeless People 29070425 2018 11 20 2018 11 20 1866-0452 114 40 2017 10 06 Deutsches Arzteblatt international Dtsch Arztebl Int Towards Better Health. 663-664 10.3238/arztebl.2017.0663 arztebl.2017.0663 Hensel Frank Johannes FJ Diözesan-Caritas verband of the archdiocese of Cologne. eng Editorial Germany Dtsch Arztebl Int 101475967 1866-0452 2017 10 27 6 0 2017 10 27 6 0 2017 10 27 6 1 ppublish 29070425 arztebl.2017.0663 10.3238/arztebl

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2017 Deutsches Ärzteblatt international

13. Interventions to improve access to primary care for people who are homeless: a systematic review

Interventions to improve access to primary care for people who are homeless: a systematic review Interventions to improve access to primary care for people who are homeless: a systematic review Interventions to improve access to primary care for people who are homeless: a systematic review Health Quality Ontario Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made (...) for the HTA database. Citation Health Quality Ontario. Interventions to improve access to primary care for people who are homeless: a systematic review. Toronto: Health Quality Ontario (HQO). Ontario health technology assessment series; 16(9). 2016 Authors' conclusions Our systematic review of the literature identified various types of interventions that seek to improve access to primary care by attempting to address barriers to care encountered by people who are homeless. Moderate-quality evidence

2016 Health Technology Assessment (HTA) Database.

14. Using Peer Navigators to Address the Integrated Health Care Needs of Homeless African Americans With Serious Mental Illness. (PubMed)

Using Peer Navigators to Address the Integrated Health Care Needs of Homeless African Americans With Serious Mental Illness. The study examined the impact of a peer navigator program (PNP) developed by a community-based participatory research team and used with a group of African Americans with serious mental illness who were homeless.Sixty-seven research participants were randomly assigned to receive PNP or treatment as usual (control) for one year. Data on general health and mental health (...) even though both groups showed significant reductions in homelessness and increases in insurance coverage.Implications for improving in-the-field health care for this population are discussed. Whether these results occurred because navigators were peers per se needs to be examined in future research.

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2018 Psychiatric services (Washington, D.C.)

15. Integrating a mental health clinical pharmacy specialist into the Homeless Patient Aligned Care Teams (PubMed)

Integrating a mental health clinical pharmacy specialist into the Homeless Patient Aligned Care Teams To address the complex needs of the homeless veteran population, the US Department of Veterans Affairs created the Homeless Patient Aligned Care Team (H-PACT) model. The South Texas Veterans Health Care System has an established H-PACT model, however it does not include a clinical pharmacy specialist in mental health (MH).An H-PACT MH pharmacy resident clinic was created and managed (...) by a postgraduate year-2 psychiatric pharmacy resident. Improvements in access to MH care, Veterans Health Administration performance metrics, and estimated cost savings associated with resident interventions were reviewed to evaluate clinic utility.Over the 6-month clinic time frame, there were a total of 40 patient encounters in which 21 veterans had MH medication evaluation on at least 1 occasion. The average wait time for Veterans previously followed by the H-PACT psychiatrist was approximately 8 weeks

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2018 The Mental Health Clinician

16. Health Care Utilization and Expenditures of Homeless Family Members Before and After Emergency Housing. (PubMed)

Health Care Utilization and Expenditures of Homeless Family Members Before and After Emergency Housing. To describe longitudinal health service utilization and expenditures for homeless family members before and after entering an emergency shelter.We linked Massachusetts emergency housing assistance data with Medicaid claims between July 2008 and June 2015, constructing episodes of health care 12 months before and 12 months after families entered a shelter. We modeled emergency department (...) preventable.Increased service utilization and expenditures begin months before families become homeless and are potentially preventable with early intervention. Infants are at greater risk. Public Health Implications. Early identification and intervention to prevent homeless episodes, focusing on family members with behavioral health disorders, who are pregnant, or who have young children, may save money and improve family health.

2018 American Journal of Public Health

17. Homeless Status, Postdischarge Health Care Utilization, and Readmission After Surgery. (PubMed)

Homeless Status, Postdischarge Health Care Utilization, and Readmission After Surgery. Homeless Veterans are vulnerable to poor care transitions, yet little research has examined their risk of readmission following inpatient surgery. This study investigates the predictors of surgical readmission among homeless relative to housed Veteran patients.Inpatient general, vascular, and orthopedic surgeries occurring in the Veterans Health Administration from 2008 to 2014 were identified. Administrative (...) International Classification of Diseases, Ninth Revision, Clinical Modification codes and Veterans Health Administration clinic stops were used to identify homeless patients. Bivariate analyses examined characteristics and predictors of readmission among homeless patients. Multivariate logistic models were used to estimate the association between homeless experience and housed patients with readmission following surgery.Our study included 232,373 surgeries: 43% orthopedic, 39% general, and 18% vascular

2018 Medical Care

18. Should health care dollars be used to house the homeless? (PubMed)

Should health care dollars be used to house the homeless? 30373747 2018 11 14 1488-2329 190 43 2018 Oct 29 CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne CMAJ Should health care dollars be used to house the homeless? E1291-E1292 10.1503/cmaj.109-5671 Glauser Wendy W Toronto. eng Journal Article Canada CMAJ 9711805 0820-3946 2018 10 31 6 0 2018 10 31 6 0 2018 10 31 6 0 ppublish 30373747 190/43/E1291 10.1503/cmaj.109-5671 PMC6205836

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2018 CMAJ : Canadian Medical Association Journal

19. Reflections of Homeless Women and Women with Mental Health Challenges on Breast and Cervical Cancer Screening Decisions: Power, Trust, and Communication with Care Providers (PubMed)

Reflections of Homeless Women and Women with Mental Health Challenges on Breast and Cervical Cancer Screening Decisions: Power, Trust, and Communication with Care Providers This study conducted in Toronto, Canada, explored the perceptions of women living in homeless shelters and women with severe mental health challenges about the factors influencing their decision-making processes regarding breast and cervical cancer screening. Twenty-six in-depth qualitative interviews were conducted (...) in 2013-2014 provided insights on both positive and negative prior cancer screening experiences, the role of power and trust in women's decision-making, and areas for improvement in health care provider/patient interactions. Outcomes of this investigation contribute to the future development of appropriately designed intervention programs for marginalized women, as well as for sensitivity training for health care providers. Tailored and effective health promotion strategies leading to life-long cancer

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2018 Frontiers in public health

20. Mental disorders and the use of primary health care services among homeless shelter users in the Helsinki metropolitan area, Finland. (PubMed)

Mental disorders and the use of primary health care services among homeless shelter users in the Helsinki metropolitan area, Finland. Homelessness is associated with increased morbidity, mortality and health care use. The aim of this study was to examine the role of mental disorders in relation to the use of 1) daytime primary health care services and 2) after hours primary health care emergency room (PHER) services among homeless shelter users in the Helsinki Metropolitan Area, Finland.The (...) study cohort consists of all 158 homeless persons using the four shelters operating in the study area during two selected nights. The health records were analyzed over a period of 3 years prior to the sample nights and data on morbidity and primary health care visits were gathered. We used negative binomial regression to estimate the association between mental disorders and daytime visits to primary health care and after hours visits to PHERs.During the 3 years the 158 homeless persons in the cohort

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2017 BMC health services research

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