The Medical Treatment of Homeless People

Kaduszkiewicz, Hanna; Bochon, Benjamin; Bussche, Hendrik van den; Hansmann-Wiest, Julia; Leeden, Carolin van der

doi:10.3238/arztebl.2017.0673

Cited by 29 publications

(48 citation statements)

References 36 publications

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“…In addition, structural and administrative barriers that homeless people experience, such as lack of health coverage, limited access to and provision of both preventive and treatment services for dental and overall health conditions [15-19, 25, 27], should be eliminated to reduce the premature morbimortality of this population. Furthermore, to reduce experiences of discrimination and stigma, it is essential that health care professionals, including dentists, [16,17] receive training on serving homeless people in their settings.…”

Section: Discussionmentioning

confidence: 99%

“…Individuals who are homeless (those without a fixed, regular, and adequate night-time residence) had higher mortality rates and experience the dual burdens of DPs, CDs compared to the general population [4,5,14] due to structural and system-level barriers (e.g., lack of affordable housing, shrinking safety nets, health care systems models, health services affordability, lack of accessibility to health and social services) [15][16][17][18][19], social exclusion [18]. People experiencing homelessness frequently suffer serious mental disorders (e.g., psychotic disorders, mood and personality disorders, substance and alcohol use disorders) [20,21] and modifiable risk factors (e.g., diet, smoking) [22,23], which also contribute to poor health profiles and premature mortality [5,21].…”

Section: Introductionmentioning

confidence: 99%

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Dental problems and chronic diseases in mentally ill homeless adults: a cross-sectional study

et al. 2020

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Background: Dental problems (DPs) and physical chronic diseases (CDs) are highly prevalent and incident in people with low socioeconomic status such as homeless individuals. Yet, evidence on the association between DPs and physical CDs in this population is limited. In the present study, we assessed the association between DPs and type and number of CDs in individuals experienced chronic homelessness and serious mental health problems. Methods: We analyzed cross-sectional baseline data from 575 homeless adults with serious mental health problems participating in the Toronto site of the At Home/Chez Soi randomized controlled trial. Chronic DPs (lasting at least 6 months) were the primary exposure variable. Presence of self-reported CDs, including heart disease, effect of stroke, hypertension, diabetes, asthma, chronic bronchitis/emphysema, stomach or intestinal ulcer, inflammatory bowel disease, migraine, thyroid problems, arthritis, kidney/bladder problems, liver disease (other than hepatitis), and irondeficiency anemia, were the primary outcomes. The total number of CDs was also analyzed as a secondary outcome. Logistic regression models were used to assess the association between DPs with each of the studied CDs, and negative binomial regression was used to test the association between DPs with the number of CDs. Results: In our 575 homeless participants (68.5% males) with mean age 40.3 (11.8) years, a high proportion had DPs (42.5%). The presence of DPs was positively associated with heart disease (adjusted odds ratio (

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dental problems and chronic diseases in mentally ill homeless adults: a cross-sectional study

et al. 2020

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“…(33,34,(46)(47)(48)51,(55)(56)(57) Flexible healthcare delivery CMOC 6 ( g 8) explores the context of exibility in healthcare services delivery in terms of appointment length, availability of walk-in appointments and selfreferral, opportunistic add-on services such as vaccinations and screenings, allowing dogs, trauma-informed practice and understanding of behaviours that trauma can result in, and more. (21,26,37,40,46,47,50,51,55,(64)(65)(66)(67) In this context, providers and staff with expertise and experience with the population group are able to anticipate the common interventions that may be needed, to adapt to the particular needs of the patient in front of them, and to provide the treatment that is most needed in the current situation. Communication is tailored to the patient with awareness of potential literacy issues common in the population.…”

Section: Resourcingmentioning

confidence: 99%

Contexts and mechanisms that promote access to healthcare for populations experiencing homelessness: a realist review

Siersbaek

Ford

Burke

et al. 2020

Preprint

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Objective: The objective of this study was to identify and understand the health system contexts and mechanisms that allow for homeless populations to access appropriate healthcare when needed.Design: A realist review.Data sources: Ovid MEDLINE, embase.com, CINAHL, ASSIA and grey literature until April 2019. Eligibility criteria for selecting studies: The purpose of the review was to identify health system patterns which enable access to healthcare for people who experience homelessness. Peer reviewed articles were first identified through a systematic search, grey literature searching, citation tracking and expert recommendations. Studies meeting the inclusion criteria were assessed for rigour and relevance and coded to identify data relating to contexts, mechanisms and/or outcomes.Analysis: Inductive coding was used to generate Context-Mechanism-Outcome configurations which were refined and then used to build several iterations of the overarching programme theory.Results: Searching identified 330 review articles, of which 24 were included. Additional searching of grey literature yielded 50 records of which 12 were included. An additional 11 grey literature and primary sources were identified through citation tracking and expert recommendation for a total of 47 included sources. The analysis found that healthcare access for populations experiencing homelessness is improved when services are coordinated and delivered in a way that is organised around the person with a high degree of flexibility and a culture that rejects stigma generating trusting relationships between patients and staff/providers. Health systems should provide long-term, dependable funding for services to ensure sustainability and staff retention. Conclusions: With homelessness on the rise internationally, this study will inform health systems policy-making and implementation. It contributes to our understanding how healthcare systems can be more accessible for populations experiencing homelessness by providing long-term stable funding, promoting inclusive cultures and limiting stigma. Health systems should be flexible, timely and connected.

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“…Lee et al [ 15 ] found that, in North America, hypertension, high cholesterol, and diabetes were not more prevalent in the homeless than in the general population but were often poorly controlled. It was not easy to control hypertension, hyperlipidemia, and hyperglycemia for the homeless [ 16 ]. The prevalence of CVD risk for the homeless is often different in different regions, races, and countries.…”

Section: Introductionmentioning

confidence: 99%

The Effects of Obesity-Related Anthropometric Factors on Cardiovascular Risks of Homeless Adults in Taiwan

Chen

Liu

2020

IJERPH

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Homelessness is a pre-existing phenomenon in society and an important public health issue that national policy strives to solve. Cardiovascular disease (CVD) is an important health problem of the homeless. This cross-sectional study explored the effects of four obesity-related anthropometric factors—body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR)—on cardiovascular disease risks (expressed by three CVD markers: hypertension, hyperglycemia, and hyperlipidemia) among homeless adults in Taipei and compared the relevant results with ordinary adults in Taiwan. The research team sampled homeless adults over the age of 20 in Taipei City in 2018 and collected 297 participants. Through anthropometric measurements, blood pressure measurements, and blood tests, we calculated the obesity-related indicators of the participants and found those at risks of cardiovascular disease. The results showed that the prevalence of hypertension, hyperglycemia, and hyperlipidemia in homeless adults was significantly higher than that of ordinary adults in Taiwan. Among the four obesity-related indicators, WHtR showed the strongest association with the prevalence of hypertension and hyperlipidemia, followed by WHR, both of which showed stronger association than traditional WC and BMI indicators. It can be inferred that abdominal obesity characterized by WHtR is a key risk factor for hypertension and hyperlipidemia in homeless adults in Taiwan. We hope that the results will provide medical clinical references and effectively warn of cardiovascular disease risks for the homeless in Taiwan.

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The Medical Treatment of Homeless People

Abstract: More heath care resources need to be made available to the homeless beyond standard medical care. Concrete suggestions are discussed in the text.

Cited by 29 publications

References 36 publications

Dental problems and chronic diseases in mentally ill homeless adults: a cross-sectional study

Dental problems and chronic diseases in mentally ill homeless adults: a cross-sectional study

Contexts and mechanisms that promote access to healthcare for populations experiencing homelessness: a realist review

The Effects of Obesity-Related Anthropometric Factors on Cardiovascular Risks of Homeless Adults in Taiwan

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