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Health status of the homeless in Dublin: does the mobile health clinic improve access to primary healthcare for its users?

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Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Background

Homeless people experience substantially higher rates of illness and significant barriers to accessing health services. The mobile health clinic (MHC), staffed by trainee general practitioners, targets and provides homeless people in Dublin with free and easy access to primary healthcare services.

Aims

To explore and determine the specific health reasons for attending the mobile health unit and to investigate whether the MHC improves access to primary healthcare for homeless people.

Methods

Interviewer-administered questionnaire addressed demographic characteristics, physical and mental health status.

Results

Forty-two participants were recruited in this study. The majority were male (90%), single (74%), Irish (81%) and in the 25–44 age group (71%). Risky health behaviour was common: tobacco use (93%; 39/42), illicit drug use (60%; 25/42) and alcohol use (45%; 19/42). Most participants described their health status as fair (48%) or good (31%). There were high rates of physical and mental health conditions. Hepatitis C (29%; 12/42) and depression (43%; 18/42) were prevalent. Dental disease was present in 79%. Compared with MHC, most health conditions were diagnosed and treated at other healthcare facility (OHF) [134 vs 27]. Report of physical health symptoms, such as coughs (61%) and migraine headache (46%), was also high, an average of five per person/year.

Conclusion

While the findings of this study are limited by the small sample size, they nevertheless indicate that the MHC promotes access to primary care service. Results also highlight the need to expand the healthcare approaches on the MHC to adequately meet the health needs of its target population.

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References

  1. Central Statistics Office. 2012. Homeless persons in Ireland: a special census report http://www.cso.ie/en/media/csoie/census/documents/homelesspersonsinireland/HomelesspersonsinIrelandAspecialCensusreport.pdf

  2. The Department of Housing, Planning & Local Government. 2017. Homelessness report http://www.housing.gov.ie/sites/default/files/publications/files/homeless_report_-_december_2017.pdf

  3. Canavan R, Barry MM, Matanov A, Barros H, Gabor E, Greacen T, Holcnerová P, Kluge U, Nicaise P, Moskalewicz J, Díaz-Olalla JM, Straßmayr C, Schene AH, Soares JJF, Gaddini A, Priebe S (2012) Service provision and barriers to care for homeless people with mental health problems across 14 European capital cities. BMC Health Serv Res 12:222–230

    Article  PubMed  PubMed Central  Google Scholar 

  4. Smith M, McGee H, Shannon W, Holohan T (2001) One hundred homeless women: health status and health service use of homeless women and their children in Dublin. Royal College of Surgeons in Ireland, Dublin

    Google Scholar 

  5. O’Connell JJ (2004) Dying in the shadows: the challenge of providing health care for homeless people. CMAJ 170:1251–1252

    Article  PubMed  PubMed Central  Google Scholar 

  6. O’Carroll A, O’Reilly F (2008) Health of the homeless in Dublin: has anything changed in the context of Ireland’s economic boom? Eur J Pub Health 18:448–453

    Article  Google Scholar 

  7. Wright NMJ, Tompkins CNE (2006) How can health services effectively meet the health needs of homeless people? Br J Gen Pract 56:286–293

    PubMed  PubMed Central  Google Scholar 

  8. Morris DM, Gordon JA (2006) The role of the emergency department in the care of homeless and disadvantaged populations. Emerg Med Clin North Am 24:839–848

    Article  PubMed  Google Scholar 

  9. Hwang SW, Lebow JM, Bierer MF, O’Connell JJ, Orav EJ, Brennan TA (1998) Risk factors for death in homeless adults in Boston. Arch Intern Med 158:1454–1460

    Article  CAS  PubMed  Google Scholar 

  10. Hwang SW (2001) Homelessness and health. CMAJ 164:229–233

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Daiski I (2007) Perspectives of homeless people on their health and health needs priorities. J Adv Nurs 58:273–281

    Article  PubMed  Google Scholar 

  12. Cuddy R (1997) Anonymous demise: mortality in the homeless. J Emerg Med 15:373–374

    Article  CAS  PubMed  Google Scholar 

  13. Martens WH (2001) A review of physical and mental health in homeless persons. Public Health Rev 29:13–33

    CAS  PubMed  Google Scholar 

  14. Woollcott M (2008) Access to primary care services for homeless mentally ill people. Nurs Stand 22:40–44

    Article  PubMed  Google Scholar 

  15. North CS, Eyrich KM, Pollio DE, Spitznagel EL (2004) Are rates of psychiatric disorders in the homeless population changing? Am J Public Health 94:103–108

    Article  PubMed  PubMed Central  Google Scholar 

  16. Drake RE, Essock SM, Shaner A, Carey KB, Minkoff K, Kola L, Lynde D, Osher FC, Clark RE, Rickards L (2001) Implementing dual diagnosis services for clients with severe mental illness. Psychiatr Serv 52:469–476

    Article  CAS  PubMed  Google Scholar 

  17. Johnson TP, Fendrich M (2007) Homelessness and drug use: evidence from a community sample. Am J Prev Med 32:S211–S218

    Article  PubMed  Google Scholar 

  18. Verlinde E, Verdée T, de Walle M, Art B, De Maeseneer J, Willems S (2010) Unique health care utilization patterns in a homeless population in Ghent. BMC Health Serv Res 10:1–9

    Article  Google Scholar 

  19. O’Connor G, McGinty T, Yeung SJ, O’Shea D, Macken A, Brazil E, Mallon P (2014) Cross-sectional study of the characteristics, healthcare usage, morbidity and mortality of injecting drug users attending an inner city emergency department. Emerg Med J 31:625–629

    Article  PubMed  Google Scholar 

  20. Garner L, Ratschen E (2013) Tobacco smoking, associated risk behaviours, and experience with quitting: a qualitative study with homeless smokers addicted to drugs and alcohol. BMC Public Health 13:951

    Article  PubMed  PubMed Central  Google Scholar 

  21. Rotheram-Borus MJ, Desmond K, Comulada WS, Arnold EM, Johnson M (2009) Reducing risky sexual behavior and substance use among currently and formerly homeless adults living with HIV. Am J Public Health 99:1100–1107

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bharel M, Lin W-C, Zhang J, O’Connell E, Taube R, Clark RE (2013) Health care utilization patterns of homeless individuals in Boston: preparing for medicaid expansion under the affordable care act. Am J Public Health 103:S311–S317

    Article  PubMed  PubMed Central  Google Scholar 

  23. Link H (2014) The unhealthy state of homelessness: health audit results 2014. London: Homeless Link, http://www.homeless.org.uk/sites/default/files/site-attachments/The%20unhealthy%20state%20of%20homelessness%20FINAL.pdf

  24. Fiona O’Reilly SB, Hannigan A, Scriver S, Ruane L, McFarlane A, O’Carroll A (2015) Homelessness: an unhealthy state. Health status, risk behaviours and service utilisation among homeless people in two Irish cities. Dublin: The Partnership for Health Equity http://www.drugsandalcohol.ie/24541/1/Homelessness.pdf

  25. Kushel MB, Vittinghoff E, Haas JS (2001) Factors associated with the health care utilization of homeless persons. Jama 285:200–206

    Article  CAS  PubMed  Google Scholar 

  26. Power R, French R, Connelly J, George S, Hawes D, Hinton T, Klee H, Robinson D, Senior J, Timms P, Warner D (1999) Health, health promotion, and homelessness. BMJ 318:590–592

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Riley AJ, Harding G, Underwood MR, Carter YH (2003) Homelessness: a problem for primary care? Br J Gen Pract 53:473–479

    PubMed  PubMed Central  Google Scholar 

  28. Victor CR, Connelly J, Roderick P, Cohen C (1989) Use of hospital services by homeless families in an inner London health district. BMJ 299:725–727

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Little GF, Watson DP (1996) The homeless in the emergency department: a patient profile. J Accid Emerg Med 13:415–417

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. LaCalle E, Rabin E (2010) Frequent users of emergency departments: the myths, the data, and the policy implications. Ann Emerg Med 56:42–48

    Article  PubMed  Google Scholar 

  31. Kertesz SG, Hwang SW, Irwin J, Ritchey FJ, Lagory ME (2009) Rising inability to obtain needed health care among homeless persons in Birmingham, Alabama (1995-2005). J Gen Intern Med 24:841–847

    Article  PubMed  PubMed Central  Google Scholar 

  32. Lacy NL, Paulman A, Reuter MD, Lovejoy B (2004) Why we don’t come: patient perceptions on no-shows. Ann Fam Med 2:541–545

    Article  PubMed  PubMed Central  Google Scholar 

  33. Lester H, Bradley CP (2001) Barriers to primary healthcare for the homeless: the general practitioner’s perspective. Eur J Gen Pract 7:6–12

    Article  Google Scholar 

  34. Busch-Geertsema V, Benjaminsen L, Hrast MF, Pleace N (2014) Extent and profile of homelessness in European member states: a statistical update, http://www.feantsaresearch.org/IMG/pdf/feantsa-studies_04-web2.pdf

  35. Safran DG, Taira DA, Rogers WH, Kosinski M, Ware JE, Tarlov AR (1998) Linking primary care performance to outcomes of care. J Fam Pract 47:213–220

    CAS  PubMed  Google Scholar 

  36. Turnbull J, Muckle W, Masters C (2007) Homelessness and health. Can Med Assoc J 177:1065–1066

    Article  Google Scholar 

  37. Department of the Environment, H. L. G. The way home: a strategy to address adult homelessness in Ireland 2008–2013. http://www.environ.ie/sites/default/files/migrated-files/en/Publications/DevelopmentandHousing/Housing/FileDownLoad%2C18192%2Cen.pdf

  38. Koon AD, Kantayya VS, Choucair B (2010) Homelessness and health care: considerations for evaluation, management, and support within the primary care domain. Dis Mon 56:719–733

    Article  PubMed  Google Scholar 

  39. Hewett N, Halligan A, Boyce T (2012) A general practitioner and nurse led approach to improving hospital care for homeless people. BMJ 345:e5999

    Article  PubMed  Google Scholar 

  40. Campbell DJ, O’Neill BG, Gibson K, Thurston WE (2015) Primary healthcare needs and barriers to care among Calgary’s homeless populations. BMC Fam Pract 16:139

    Article  PubMed  PubMed Central  Google Scholar 

  41. Harvey DKWB (2015) Family experiences of pathways into homelessness. Housing Agency, https://www.housing.ie/getattachment/Our-Publications/Latest-Publications/Family-Experiences-Report-PDF.pdf

  42. Gelberg L, Gallagher TC, Andersen RM, Koegel P (1997) Competing priorities as a barrier to medical care among homeless adults in Los Angeles. Am J Public Health 87:217–220

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. McCarty D, Argeriou M, Huebner RB, Lubran B (1991) Alcoholism, drug abuse, and the homeless. Am Psychol 46:1139–1148

    Article  CAS  PubMed  Google Scholar 

  44. O’Toole TP, Conde-Martel A, Gibbon JL, Hanusa BH, Freyder PJ, Fine MJ (2007) Where do people go when they first become homeless? A survey of homeless adults in the USA. Health Soc Care Community 15:446–453

    Article  PubMed  Google Scholar 

  45. Single E, Robson L, Rehm J, Xie X, Xi X (1999) Morbidity and mortality attributable to alcohol, tobacco, and illicit drug use in Canada. Am J Public Health 89:385–390

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Keogh C, O’Brien KK, Hoban A, O’Carroll A, Fahey T (2015) Health and use of health services of people who are homeless and at risk of homelessness who receive free primary health care in Dublin. BMC Health Serv Res 15:1–8

    Article  Google Scholar 

  47. Zlotnick C, Zerger S (2009) Survey findings on characteristics and health status of clients treated by the federally funded (US) Health Care for the Homeless Programs. Health Soc Care Community 17:18–26

    Article  PubMed  Google Scholar 

  48. Gibson BA, Ghosh D, Morano JP, Altice FL (2014) Accessibility and utilization patterns of a mobile medical clinic among vulnerable populations. Health Place 28:153–166

    Article  PubMed  PubMed Central  Google Scholar 

  49. DiBlasio FA, Belcher JR (1993) Social work outreach to homeless people and the need to address issues of self-esteem. Health Soc Work 18:281–287

    Article  CAS  PubMed  Google Scholar 

  50. Hudson AL, Nyamathi A, Greengold B, Slagle A, Koniak-Griffin D, Khalilifard F, Getzoff D (2010) Health-seeking challenges among homeless youth. Nurs Res 59:212–218

    Article  PubMed  PubMed Central  Google Scholar 

  51. Rowe R, Calnan M (2006) Trust relations in health care--the new agenda. Eur J Pub Health 16:4–6

    Article  Google Scholar 

  52. ICGP. Certification of satisfactory completion of training (CSCT). http://www.icgp.ie/go/become_a_gp/gp_training/8B785A12-19B9-E185-838CACC4B4C28A42.html

  53. Bindman AB, Forrest CB, Britt H, Crampton P, Majeed A (2007) Diagnostic scope of and exposure to primary care physicians in Australia, New Zealand, and the United States: cross sectional analysis of results from three national surveys. BMJ 334:1261

    Article  PubMed  PubMed Central  Google Scholar 

  54. Lewis JH, Andersen RM, Gelberg L (2003) Health care for homeless women. J Gen Intern Med 18:921–928

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors wish to express a sincere gratitude to the 42 participants of the study, to acknowledge the efforts of Ciara Ann Sears and David Greene, to thank Tony Byrne (Order of Malta, Ireland) and Stephanie Lordan (Dublin Simon Community) who referred people to the study and to thank Dr. Austin O’Carroll for supervising the project.

Author information

Authors and Affiliations

  1. School of Medicine, Trinity College Dublin, College Green, University of Dublin, Dublin 2, Ireland

    Jahbyn Swabri, Chiadika Uzor & Eamon Laird

  2. Division of Population Health Sciences, Department of Family Medicine and General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland

    Eamon Laird & Austin O’Carroll

Authors
  1. Jahbyn Swabri
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  2. Chiadika Uzor
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  3. Eamon Laird
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  4. Austin O’Carroll
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Corresponding authors

Correspondence to Jahbyn Swabri, Chiadika Uzor, Eamon Laird or Austin O’Carroll.

Ethics declarations

Ethical approval for this study was granted by the Faculty of Science Research Ethics Committee, Trinity College Dublin.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Swabri, J., Uzor, C., Laird, E. et al. Health status of the homeless in Dublin: does the mobile health clinic improve access to primary healthcare for its users?. Ir J Med Sci 188, 545–554 (2019). https://doi.org/10.1007/s11845-018-1892-0

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  • DOI: https://doi.org/10.1007/s11845-018-1892-0

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