Health care of homeless veterans

O’Toole, Thomas; Conde-Martel, Alicia; Gibbon, Jeanette L.; Hanusa, Barbara H.; Fine, Michael J.

doi:10.1046/j.1525-1497.2003.21209.x

Cited by 79 publications

(48 citation statements)

References 13 publications

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“…Estimates of the number of homeless men who are veterans vary, ranging from 18% to 49% in community samples, [5][6][7] with Vietnam era veterans continuing to be at higher risk for homelessness than other veteran cohorts. 6 Among those receiving homeless services, 33% of male clients were veterans, compared to 31% of men in the general population.…”

Section: Prevalence Of Chronic Homelessnessmentioning

confidence: 99%

Collaborative Initiative to Help End Chronic Homelessness: Introduction

Rickards

McGraw

Araki

et al. 2009

J Behav Health Serv Res

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The Collaborative Initiative to Help End Chronic Homelessness was a coordinated effort by the US Departments of Health and Human Services (HHS), Housing and Urban Development (HUD), and Veterans Affairs (VA), and the US Interagency Council on Homelessness to house and provide comprehensive supportive services to individuals with serious psychiatric, substance use, health, and related disabilities who were experiencing long-term chronic homelessness. Eleven communities received 3-year grants from HHS and VA (2003-2006) and up to 5-year grants from HUD (2003-2008) to implement the initiative. This article provides background on chronic homelessness, describes the federal collaboration to comprehensively address chronic homelessness, and introduces the seven articles in this special issue that describe the findings and lessons learned from the participating communities in addressing chronic homelessness. Collectively, these articles offer insight into the challenges and benefits of providing housing and services to individuals experiencing chronic homelessness.

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Section: Prevalence Of Chronic Homelessnessmentioning

confidence: 99%

Collaborative Initiative to Help End Chronic Homelessness: Introduction

Rickards

McGraw

Araki

et al. 2009

J Behav Health Serv Res

View full text Add to dashboard Cite

show abstract

“…Homelessness is associated with significant health care needs and health complications, [1][2][3][4] often characterized by very high rates of emergency department use and inpatient hospitalizations [5][6][7] with an underutilizing of ambulatory care services. 8 Often the care provided can best be described as reactive to acute presentations: treating complications of homelessness such as frostbite or exposure-related illnesses; addressing acute complications of chronic conditions that are difficult to manage while homeless; and dealing with the consequences of untreated and undertreated mental health and substance abuse that often precipitate homelessness.…”

Section: Introductionmentioning

confidence: 99%

Tailoring Outreach Efforts to Increase Primary Care Use Among Homeless Veterans: Results of a Randomized Controlled Trial

et al. 2015

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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 treatmentresistant/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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“…Multiple prior studies have documented extensive use of emergency department and inpatient care by homeless individuals. [39][40][41][42] For example, Tsai and colleagues found that homeless Veterans had four times the odds of using EDs than non-homeless Veterans. 40 However, Gabrielian and colleagues noted that while HUD-VASH enrolled Veterans had initial significant increases in primary care and specialty utilization upon enrollment, HUD-VASH Veterans and low-income housed Veterans had similar likelihoods of medical/surgical inpatient and outpatient utilization compared with non-homeless peers over time.…”

Section: Discussionmentioning

confidence: 99%

Differential Impact of Homelessness on Glycemic Control in Veterans with Type 2 Diabetes Mellitus

et al. 2016

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BACKGROUND: Veterans with evidence of homelessness have high rates of mental health and substance abuse disorders, but chronic medical conditions such as diabetes are also prevalent. OBJECTIVE: We aimed to determine the impact of homelessness on glycemic control in patients with type 2 diabetes mellitus. DESIGN: Longitudinal analysis of a retrospective cohort. SUBJECTS: A national cohort of 1,263,906 Veterans with type 2 diabetes. Subjects with evidence of homelessness were identified using a combination of diagnostic and administrative codes. MAIN MEASURES: Odds for poor glycemic control using hemoglobin A1C (HbA1C) cutoff values of 8 % and 9 %. Homeless defined as a score based on the number of indicator variables for homelessness within a veterans chart. KEY RESULTS: Veterans with evidence of homelessness had a significantly greater annual mean HbA1C ≥ 8 (32.6 % vs. 20.43 %) and HbA1C ≥ 9 (21.4 % vs. 9.9 %), tended to be younger (58 vs. 67 years), were more likely to be non-Hispanic black (39.1 %), divorced (43 %) or never married (34 %), to be urban dwelling (88.8 %), and to have comorbid substance abuse (46.7 %), depression (42.3 %), psychoses (39.7 %), liver disease (18.8 %), and fluid/ electrolyte disorders (20.4 %), relative to non-homeless veterans (all p < 0.0001). Homelessness was modeled as an ordinal variable that scored the number of times a homelessness indicator was found in the Veterans medical record. We observed a significant interaction between homelessness and race/ethnicity on the odds of poor glycemic control. Homelessness, across all racial-ethnic groups, was associated with increased odds of uncontrolled diabetes at a cut-point of 8 % and 9 % for hemoglobin A1C ; however, the magnitude of the association was greater in non-Hispanic whites [8 %, OR 1.55 (1.47;1.63 CONCLUSIONS: Homelessness is a significant risk factor for uncontrolled diabetes in Veterans, especially among non-Hispanic white and Hispanic patients. While efforts to engage homeless patients in primary care services have had some success in recent years, these data suggest that broader efforts targeting management of diabetes and other chronic medical conditions remain warranted.

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Health care of homeless veterans

Cited by 79 publications

References 13 publications

Collaborative Initiative to Help End Chronic Homelessness: Introduction

Collaborative Initiative to Help End Chronic Homelessness: Introduction

Tailoring Outreach Efforts to Increase Primary Care Use Among Homeless Veterans: Results of a Randomized Controlled Trial

Differential Impact of Homelessness on Glycemic Control in Veterans with Type 2 Diabetes Mellitus

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