OBJECTIVE: To describe sources of health care used by homeless and housed poor adults.
DESIGN: In a cross-sectional survey, face-to-face interviews were conducted to assess source of usual care, preferred site of care for specific problems, perceived need for health insurance at different sites of care, and satisfaction with care received. Polychotomous logistic regression analysis was used to identify the factors associated with selecting non-ambulatory-care sites for usual care.
SETTING: Twenty-four community-based sites (i.e., soup kitchens, drop-in centers, and emergency shelters) frequented by the homeless and housed poor in Allegheny County, Pa.
PARTICIPANTS: Of the 388 survey respondents, 85.6% were male, 78.1% African American, 76.9% between 30 and 49 years of age, 59.3% were homeless less than 1 year, and 70.6% had health insurance.
MAIN RESULTS: Overall, 350 (90.2%) of the respondents were able to identify a source of usual medical care. Of those, 51.3% identified traditional ambulatory care sites (i.e., hospital-based clinics, community and VA clinics, and private physicians offices); 28.9% chose emergency departments; 8.0%, clinics based in shelters or drop-in centers; and 2.1%, other sites. Factors associated with identifying nonambulatory sites for usual care included lack of health insurance (relative risk range for all sites [RR]=3.1–4.0), homelessness for more than 2 years (RR=1.4–3.0), receiving no medical care in the previous 6 months (RR=1.6–7.5), nonveteran status (RR=1.0–2.5), being unmarried (RR=1.2–3.1), and white race (RR=1.0–3.3).
CONCLUSIONS: Having no health insurance or need for care in the past 6 months increased the use of a non-ambulatory-care site as a place for usual care. Programs designed to decrease emergency department use may need to be directed at those not currently accessing any care.
homeless health service utilization emergency department care preferences for care
O’Toole TP, Gibbon JL, Hanusa BH, Fine MJ. Utilization of health care services among subgroups of the urban homeless. J Health Polit Policy Law. 1999;24(1):91–114.PubMedGoogle Scholar
Wenzel SL, Bakhtiar L, Caskey NH, et al. Homeless veterans’ utilization of medical, psychiatric, and substance abuse services. Med Care. 1995;33(11):1132–44.PubMedCrossRefGoogle Scholar
Wood D, Valdez RB. Barriers to medical care for homeless families compared with housed poor families. Am J Dis Child. 1991;145:1109–15.PubMedGoogle Scholar
Gelberg L, Gallagher TC, Andersen RM, Koegel P. Competing priorities as a barrier to medical care among homeless adults in Los Angeles. Am J Public Health. 1997;87:217–20.PubMedGoogle Scholar
Robertson MJ, Cousineau MR. Health status and access to health services among the urban homeless. Am J Public Health. 1986;76:561–3.PubMedGoogle Scholar
Padgett D, Struening EL, Andrews H. Factors affecting the use of medical, mental health, alcohol, and drug treatment services by homeless adults. Med Care. 1990;28:805–21.PubMedCrossRefGoogle Scholar
Martell JV, Seitz RS, Harada JK, Kobayashi J, Sasaki VK, Wong C. Hospitalization in an urban homeless population: the Honolulu Urban Homeless Project. Ann Intern Med. 1992;116:299–303.PubMedGoogle Scholar
O’Brien GM, Stein MD, Zierler S, Shapiro M, O’Sullivan P, Woolard R. Use of the ED as a regular source of care: associated factors beyond lack of health insurance. Ann Emerg Med. 1997;30:286–91.PubMedCrossRefGoogle Scholar
Gallagher TC, Andersen RM, Koegel P, Gelberg L. Determinants of regular source of care among homeless adults in Los Angeles. Med Care. 1997;35:814–30.PubMedCrossRefGoogle Scholar
Davis PB, Morris JC, Grant E. Brief screening tests versus clinical staging in senile dementia of the Alzheimer type. J Am Geriatr Soc. 1990;38(12): 129–35.PubMedGoogle Scholar
Fillenbaum GG, Heyman A, Wilkinson WE, Haynes CS. Comparison of two screening tests in Alzheimer’s disease: the correlation and reliability of the Mini-Mental State Examination and the modified Blessed test. Arch Neurol. 1987;44(9):924–7.PubMedGoogle Scholar
Fischer PJ, Shapiro S, Breakey WR, Anthony JC, Kramer M. Mental health and social characteristics of the homeless: a survey of mission users. Am J Public Health. 1986;76:519–24.PubMedGoogle Scholar
Wood D, Valdez RB, Hayashi T, Shen A. Homeless and housed families in Los Angeles: a study comparing demographic, economic, and family function characteristics. Am J Public Health. 1990;80(9):1049–52.PubMedCrossRefGoogle Scholar
Elias CJ, Inui TS. When a house is not a home: exploring the meaning of shelter among chronically homeless older men. Gerontologist. 1993;33:396–402.PubMedGoogle Scholar
Redelmeier DA, Molin JP, Tibshirani RJ. A randomised trial of compassionate care for the homeless in an emergency department. Lancet. 1995;345:1131–4.PubMedCrossRefGoogle Scholar