Homeless Patients Associate Clinician Bias With Suboptimal Care for Mental Illness, Addictions, and Chronic Pain

Abstract

Objective: To determine how accessible health care services are for people who are experiencing homelessness and to understand from their perspectives what impact clinician bias has on the treatment they receive. Methods: Narrative interviews were conducted with 53 homeless/vulnerably housed individuals in Ontario, Canada. Visit history records were subsequently reviewed at 2 local hospitals, for 52 of the interview participants. Results: Of the 53 participants only 28% had a primary care provider in town, an additional 40% had a provider in another town, and 32% had no access to a primary care provider at all. A subset of the individuals were frequent emergency department users, with 15% accounting for 75% of the identified hospital visits, primarily seeking treatment for mental illness, pain, and addictions. When seeking primary care for these 3 issues participants felt medication was overprescribed. Conversely, in emergency care settings participants felt prejudged by clinicians as being drug-seekers. Participants believed they received poor quality care or were denied care for mental illness, chronic pain, and addictions when clinicians were aware of their housing status. Conclusion: Mental illness, chronic pain, and addictions issues were believed by participants to be poorly treated due to clinician bias at the primary, emergency, and acute care levels. Increased access to primary care in the community could better serve this marginalized population and decrease emergency department visits but must be implemented in a way that respects the rights and dignity of this patient population.

Pharmacist led homeless outreach engagement and non-medical independent prescribing (Rx) (PHOENIx) intervention for people experiencing homelessness: a non- randomised feasibility study

“…Unmet health needs are common [10,11]. Mental illness, pain and addictions may be poorly managed [12] with evidence suggesting under prescribing and low rates of prescription adherence [13,14] Patterns of emergency healthcare utilisation differ between people experiencing homelessness and those who are housed: ED visits, hospitalisations and readmissions are higher [15,16]. Reasons also differ, with people who are homeless experiencing more emergency healthcare contacts for drug, alcohol and mental health related problems [15,16].…”

Humanitarian reason and the movement for overdose prevention sites: The NGOization of the Opioid “Crisis”

“…Even those who are covered under Medicare do not have guaranteed access to primary care, particularly for those who are homeless (Hwang, 2009), who often encounter unsurmountable barriers in obtaining treatment. Many, for example, are subjected to “clinical biases”—of being prejudged in emergency settings (Gilmer & Buccieri, 2020; Russell et al., 2019), and their ability to access adequate healthcare decreases as the duration of their homelessness increases (see, also, Health Quality Ontario, 2016; Khandor et al., 2011; Russell et al., 2019). NGOs responding to the underlying inequalities by caring for suffering bodies without addressing the causes of inequalities are complicit in reproducing them.…”

Pharmacist Led Homeless Outreach Engagement and Non-Medical Independent Prescribing (Rx) (PHOENIx) Intervention for People Experiencing Homelessness: A Non- Randomised Feasibility Study

“…8,9 Unmet health needs are common. 10,11 Mental illness, pain and addictions may be poorly managed 12 with evidence suggesting under prescribing and low rates of prescription adherence 13,14 Patterns and reasons for emergency healthcare utilisation differ between people experiencing homelessness and those who are housed: ED visits, hospitalisations and readmissions are higher. 15,16 Availability and uptake of preventative healthcare is lower 9,16,17 and presentations to Family (General) Practitioners tend to be reactive.…”