Oster H, Andersen RM, Leake BD, Gelberg L; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2002; 19: 32.
Family Medicine and Health Services Research, UCLA, 50-071 Center for Health Sciences, Los Angeles, CA 90095-1683; Tel: (310) 825-6301; Fax: (310) 794-6097; E-mail: hoster@ucla.edu
RESEARCH OBJECTIVE: The homeless have greater morbidity and higher age-adjusted mortality rates than the general population. Despite having greater health care needs, homeless persons may have disproportionate difficulty accessing medical care. Homeless are likely to lack a regular source of care and to have basic subsistence needs competing with their need for health care. Lack of early medical attention for health problems can result in unnecessary complications and more costly medical care. We sought to identify homeless women at greatest risk for medical symptoms and for not using appropriate health care visits in response to their symptoms. This study is unique because: 1 it compares actual vs. recommended health care use for a predetermined set of symptoms, and 2 it incorporates an expert panel to determine recommendations for appropriate use. STUDY DESIGN: Homeless women were asked about eleven medical symptoms that were validated in a previous study. For each symptom given a positive response, the respondent was asked whether she saw a physician for that symptom. These data on homeless women's actual use of care were then compared to recommendations gathered from an expert panel. Using the Behavioral Model for Vulnerable Populations, we evaluated predisposing, enabling, and need variables as predictors of: 1) number of medical symptoms reported and 2) appropriateness of use of health care visits in response to symptoms. POPULATION STUDIED: The UCLA Homeless Women's Study is a probability survey of 974 homeless women of reproductive age living in the Los Angeles area. PRINCIPAL FINDINGS: 706 women (75%) had one or more of the eleven medical symptoms and 56% of these 706 women saw a doctor for any of their symptoms. Homeless women, on average, received a health care visit in response to symptoms half as often as was recommended by the expert panel. Predictors of having three or more of the eleven symptoms were rape (OR=2.739, p=0.004), depression (OR=1.907, p=0.003), and a longer total duration of homelessness (OR=1.222, p= 0.041). Failure to make appropriate health care visits in response to symptoms was predicted by: lack of a regular source of medical care (OR=2.545, p=0.008), a lifetime history of drug dependence (OR=2.166, p=0.023), more basic subsistence needs competing with the need for health care (OR=1.592, p=0.049), a greater sense of mastery (OR=1.466, p=0.046), and more symptoms (OR=1.203, p=0.026). CONCLUSIONS: Homeless women receive too few needed health care visits for their symptoms, which may lead to more costly care late in the course of illness. Provision of permanent housing, improved mental health outreach and treatment, and programs to address the needs of homeless women who have recently been raped are essential steps in addressing the medical problems of homeless women. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: To promote early and appropriate use of medical visits, efforts should be made to facilitate a regular source of care for all homeless women, drug and mental health treatment should be integrated with medical services, and medical outreach should be implemented at soup kitchens and shelters. PRIMARY FUNDING SOURCE: AHRQ, Robert Wood Johnson Foundation
Publication Types:
Keywords:
- Delivery of Health Care
- Female
- Health Services Needs and Demand
- Homeless Persons
- Housing
- Humans
- Insurance, Health
- Los Angeles
- diagnosis
- economics
- hsrmtgs
Other ID:
UI: 102273795
From Meeting Abstracts