Abstract
Objectives
Homelessness is associated with increased hospital costs and length of stay, and medical or surgical conditions are typically complicated by secondary diagnoses of substance abuse or mental illness. Convalescence care to provide timely treatment has not been analyzed. This is a retrospective study of diagnoses and utility of shelter-based convalescence in a cohort of homeless subjects.
Methods
A 20-bed shelter-based unit providing up to 3 months stay post hospital discharge, or for treatment of addictions or for those too ill to remain in the general shelter was studied. Charting was by the use of an electronic health record developed for the project. Demographics, reason for admission and outcomes are retrospectively described.
Results
140 men had 181 admissions from July 2000–April 2003; 23.8% were post hospital discharge, 57.4% were from the general shelter. Average length of stay was 40 days. 83.4% were treated for a medical or surgical condition, 83.6% for psychiatric disease and 29.8% for addictions. Medication adherence was >80% in the majority. During admission, 20% obtained a new health card, 43.6% a new drug card, 89.3% received transportation to appointments, 60% applied for housing and 24.3% obtained housing.
Conclusion
A shelter-based convalescence unit can provide health care to homeless persons, treat medical and mental illness, ensure adherence to treatment regimes, decrease substance abuse and assist with housing.
MeSH terms: Homeless persons, convalescence, patient non-adherence, mental health, health services research, drug addiction, alcoholism
Résumé
Objectifs
L’itinérance est associée à des frais d’hospitalisation plus élevés et à une durée d’hospitalisation plus longue, et les troubles médicaux et chirurgicaux sont en général plus compliqués en présence d’un diagnostic secondaire de toxicomanie ou de maladie mentale. Les soins à offrir pendant la convalescence pour traiter ces problèmes en temps utile n’ont pas été analysés. Notre étude rétrospective, fondée sur une cohorte de sans-abri, porte sur les diagnostics des sujets hospitalisés et sur l’utilité d’une convalescence en maison d’hébergement.
Méthode
Nous avons étudié une maison de 20 lits pouvant héberger pendant trois mois des sansabri sortant de l’hôpital, recevant un traitement en toxicomanie ou trop malades pour séjourner dans un centre d’hébergement ordinaire. La représentation graphique des données a été réalisée à partir d’un dossier médical informatisé mis au point pour le projet. Le profil démographique des sujets, la raison de leur hébergement et son résultat sont décrits rétrospectivement.
Résultats
Cent quarante hommes ont séjourné 181 fois en maison d’hébergement entre juillet 2000 et avril 2003. De ces hommes, 23,8 % sortaient de l’hôpital et 57,4 % venaient d’un centre d’hébergement ordinaire. Ils ont passé en moyenne 40 jours dans la maison d’hébergement. De ces personnes, 83,4 % ont été traitées pour un trouble médical ou chirurgical, 83,6 % pour une maladie psychiatrique, et 29,8 % pour une toxicomanie. L’observance médicamenteuse a été supérieure à 80 % dans la majorité des cas. Pendant leur séjour, 20 % ont obtenu une nouvelle carte-santé, 43,6 % une nouvelle carte d’assurance-médicaments, 89,3 % ont été transportés à leurs rendez-vous, 60 % ont fait une demande de logement, et 24,3 % ont obtenu un logement.
Conclusion
Une maison d’hébergement pour les sans-abri en convalescence peut fournir des soins de santé, traiter les troubles médicaux et les maladies mentales, favoriser l’assiduité aux traitements, réduire la toxicomanie et aider ces personnes à trouver un logement.
References
- 1.Kinchen K, Wright JD. Hypertension management in health care for the homeless clinics: Results from a survey. Am J Public Health. 1991;81(9):1163–1165. doi: 10.2105/AJPH.81.9.1163. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Hwang SW, Bugeja AL. Barriers to appropriate diabetes management among homeless people in Toronto. CMAJ. 2000;163(2):161–165. [PMC free article] [PubMed] [Google Scholar]
- 3.O’Connell JJ. Nontuberculous respiratory infections among the homeless. Semin Respir Infect. 1991;6(4):247–53. [PubMed] [Google Scholar]
- 4.Gelberg L, Linn LS, Usatine RP, Smith MH H. homelessness, and poverty. A study of clinic users. Arch Intern Med. 1990;150(11):2325–2330. doi: 10.1001/archinte.1990.00390220069014. [DOI] [PubMed] [Google Scholar]
- 5.D’Amore J, Hung O, Chiang W, Goldfrank L. The epidemiology of the homeless population and its impact on an urban emergency department. Acad Emerg Med. 2001;8(11):1051–55. doi: 10.1111/j.1553-2712.2001.tb01114.x. [DOI] [PubMed] [Google Scholar]
- 6.Kushel MB, Vittinghoff E, Haas JS. Factors associated with the health care utilization of homeless persons. JAMA. 2001;285(2):200–206. doi: 10.1001/jama.285.2.200. [DOI] [PubMed] [Google Scholar]
- 7.Salit SA, Kuhn EM, Hartz AJ, Vu JM, Mosso AL. Hospitalization costs associated with home-lessness in New York City. N Engl J Med. 1998;338(24):1734–1740. doi: 10.1056/NEJM199806113382406. [DOI] [PubMed] [Google Scholar]
- 8.McGuire J, Mares A. Hoptel equalizes length of stay for homeless and domiciled inpatients. Med Care. 2000;38(10):1003–1010. doi: 10.1097/00005650-200010000-00004. [DOI] [PubMed] [Google Scholar]
- 9.Tulsky JP, Pilote L, Hahn JA, Zolopa AJ, Burke M, Chesney M, et al. Adherence to isoniazid prophylaxis in the homeless: A randomized controlled trial. Arch Intern Med. 2000;160(5):697–702. doi: 10.1001/archinte.160.5.697. [DOI] [PubMed] [Google Scholar]
- 10.Bangsberg DR, Hecht FM, Charlebois ED, Zolopa AR, Holodniy M, Sheiner L, et al. Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS. 2000;14(4):357–66. doi: 10.1097/00002030-200003100-00008. [DOI] [PubMed] [Google Scholar]
- 11.McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: Scientific review. JAMA. 2002;288(22):2868–2879. doi: 10.1001/jama.288.22.2868. [DOI] [PubMed] [Google Scholar]
- 12.Farrell SAT, Klodawsky F, Pettey D. Describing the homeless population of Ottawa-Carleton. Ottawa, ON: University of Ottawa; 2000. [Google Scholar]
- 13.Koegel P, Burnam MA, Farr RK. The prevalence of specific psychiatric disorders among homeless individuals in the inner city of Los Angeles. Arch Gen Psychiatry. 1988;45(12):1085–1092. doi: 10.1001/archpsyc.1988.01800360033005. [DOI] [PubMed] [Google Scholar]
- 14.Lacro JP, Dunn LB, Dolder CR, Leckband SG, Jeste DV. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: A comprehensive review of recent literature. J Clin Psychiatry. 2002;63(10):892–909. doi: 10.4088/JCP.v63n1007. [DOI] [PubMed] [Google Scholar]
- 15.Opler LA, White L, Caton CL, Dominguez B, Hirshfield S, Shrout PE. Gender differences in the relationship of homelessness to symptom severity, substance abuse, and neuroleptic non-compliance in schizophrenia. J Nerv Ment Dis. 2001;189(7):449–456. doi: 10.1097/00005053-200107000-00006. [DOI] [PubMed] [Google Scholar]
- 16.Robertson MJ, Zlotnick C, Westerfelt A. Drug use disorders and treatment contact among homeless adults in Alameda County, California. Am J Public Health. 1997;87(2):221–228. doi: 10.2105/AJPH.87.2.221. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Hibbs JR, Benner L, Klugman L, Spencer R, Macchia I, Mellinger A, et al. Mortality in a cohort of homeless adults in Philadelphia. N Engl J Med. 1994;331(5):304–309. doi: 10.1056/NEJM199408043310506. [DOI] [PubMed] [Google Scholar]
- 18.Hwang SW, Orav EJ, O’Connell JJ, Lebow JM, Brennan TA. Causes of death in homeless adults in Boston. Ann Intern Med. 1997;126(8):625–628. doi: 10.7326/0003-4819-126-8-199704150-00007. [DOI] [PubMed] [Google Scholar]
- 19.Hwang SW, Lebow JM, Bierer MF, O’Connell JJ, Orav EJ, Brennan TA. Risk factors for death in homeless adults in Boston. Arch Intern Med. 1998;158(13):1454–1460. doi: 10.1001/archinte.158.13.1454. [DOI] [PubMed] [Google Scholar]
- 20.Hwang SW. Mortality among men using homeless shelters in Toronto, Ontario. JAMA. 2000;283(16):2152–2157. doi: 10.1001/jama.283.16.2152. [DOI] [PubMed] [Google Scholar]
- 21.Nordentoft M, Wandall-Holm N. 10 year follow up study of mortality among users of hostels for homeless people in Copenhagen. BMJ. 2003;327(7406):81. doi: 10.1136/bmj.327.7406.81. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Tadic VMW, Turnbull J. Internet-based medical record keeping of the Ottawa homeless. In: Galea SVD, Sisco S, editors. The Second International Conference on Urban Health, 2003. New York Academy of Medicine: Oxford University Press; 2003. p. ii79. [Google Scholar]