Background: Although the poor health of people experiencing homelessness is increasingly recognised in health discourse, there is a dearth of research that has quantified the nature and magnitude of chronic health issues and morbidity among people experiencing homelessness, particularly in the Australian context. Methods: Analysis of the medical records of 2068 “active” patients registered with a specialist homeless health service in Perth, Western Australia as of 31 December 2019. Results: Overall, 67.8% of patients had at least one chronic physical health condition, 67.5% had at least one mental health condition, and 61.6% had at least one alcohol or other drug (AOD) use disorder. Nearly half (47.8%) had a dual diagnosis of mental health and AOD use issues, and over a third (38.1%) were tri-morbid (mental health, AOD and physical health condition). Three-quarters (74.9%) were multimorbid or had at least two long-term conditions (LTCs), and on average, each patient had 3.3 LTCs. Conclusions: The study findings have substantial implications from both a health risk and healthcare treatment perspective for people experiencing homeless. The pervasiveness of preventable health conditions among people experiencing homelessness also highlights the imperative to improve the accessibility of public health programs and screening to reduce their morbidity and premature mortality.

Multimorbidity among People Experiencing Homelessness-Insights from Primary Care Data.

There is a paucity of information surrounding dermatologic care for persons experiencing homelessness (PEH) This scoping review aims to map existing literature and provide a summary of the most common cutaneous manifestations among PEH, risk factors for dermatologic disease, describe any reported interventions, as well as identify research gaps for future studies Search strategies developed for MEDLINE and hand searching yielded 486 articles Out of the 486 articles screened, 93 articles met the inclusion criteria The majority were cohort studies, cross-sectional studies, and case-control studies concentrated in North America and Europe Excluding the pediatric population, the prevalence of dermatologic conditions ranged from 166% to 535% Common skin conditions described in PEH were: acne, psoriasis, seborrheic dermatitis, atopic dermatitis, and lichen simplex chronicus There were no studies comparing the extent or severity of these cutaneous diseases in PEH and the general population PEH have a higher prevalence of skin infections and non-melanoma skin cancers This scoping review has direct implications on public health interventions for PEH and highlights the need for evidence-based interventions to provide optimum and safe dermatologic healthcare for PEH We propose several recommendations for improved care delivery, including addressing upstream factors and comorbidities impacting skin health, providing trauma informed care, reducing barriers to care, preventing and managing skin conditions, as well as including PEH in the planning and implementation of any proposed intervention

https://journals.sagepub.com/doi/pdf/10.1177/12034754211004558

Understanding Dermatologic Concerns Among Persons Experiencing Homelessness: A Scoping Review and Discussion for Improved Delivery of Care.

Improving health outcomes requires understanding the complex role of structural determinants of homelessness, such as the availability of secure housing and employment, gender equality, racism, in addition to the funding and structure of health and social services.3 The requirement for health service responses that are tailored to people experiencing homelessness has been highlighted by the COVID-19 pandemic. People experiencing homelessness have few resources with which to support prevention measures from COVID-19, such as accommodation that enables social distancing and self-isolation or hygiene facilities, compounding the risk from higher rates of diseases such as chronic respiratory conditions.4 These factors require an integrated service response from health and housing in order to successfully protect health and reduce transmission risk. Individuals who can provide an address and people who do not appear ‘typically homeless’ may not be asked about their housing status.6 Better recognition of homelessness in healthcare services requires the development of screening tools and processes, as well as systems that support healthcare workers in understanding and responding to homelessness.7 Though issues exist with the use of administrative health service data for research purposes (eg, ‘no fixed address’ being shown to be a poor indicator of homelessness),6 there is potential for such data to better characterise the composition and the needs of this population. In Australia, implementing the healthcare component of such wraparound support is complicated by a complex health system with differing state, federal and ‘out-of-pocket’ funding mechanisms and a blended public and private service delivery model.

https://ihj.bmj.com/content/ihj/4/1/e000065.full.pdf

Integrating healthcare services for people experiencing homelessness in Australia: key issues and research principles

Background:Housing First (HF)-based interventions have been implemented in North America and beyond to help people exit homelessness. The effect of these interventions on access to primary and spec...

https://journals.sagepub.com/doi/pdf/10.1177/21501327211027102

The Long-Term Effects of a Housing First Intervention on Primary Care and Non-Primary Care Physician Visits Among Homeless Adults with Mental Illness: A 7-Year RCT Follow-Up.

Health Services and the Project RoomKey COVID-19 Initiative for the Unhoused: A University and Community Partnership

Objective To guide family physicians working in a range of primary care clinical settings on how to provide care and support for patients who are vulnerably housed or experiencing homelessness. Sources of information The approach integrates recommendations from evidence-based clinical guidelines, the views of persons with lived experience of homelessness, the theoretical tenets of the Patient’s Medical Home framework, and practical lessons learned from family physicians working in a variety of clinical practice settings. Main message Family physicians can use simple and effective approaches to identify patients who are homeless or vulnerably housed; take initial steps to initiate access to housing, income assistance, case management, and treatment for substance use; and work collaboratively using trauma-informed and anti-oppressive approaches to better assist individuals with health and social needs. Family physicians also have a powerful advocacy voice and can partner with local community organizations and people with lived experience of homelessness to advocate for policy changes to address social inequities. Conclusion Family physicians can directly address the physical health, mental health, and social needs of patients who are homeless or vulnerably housed. Moreover, they can champion outreach and onboarding programs that assist individuals who have experienced homelessness in accessing patient medical homes and can advocate for broader action on the underlying structural causes of homelessness.

https://www.cfp.ca/content/cfp/66/8/563.full.pdf

Caring for patients with lived experience of homelessness

INTRODUCTION: While much of the literature on homelessness is centred on the experience of men, women make up over one-quarter of Canada's homeless population. Research has shown that women experiencing homelessness are often hidden (i.e. provisionally housed) and have different pathways into homelessness and different needs as compared to men. The objective of this research is to identify evidence-based interventions and best practices to better support women experiencing or at risk of homelessness. METHODS: We conducted a scoping review with a gender and equity analysis. This involved searching MEDLINE, CINAHL, PsycINFO and other databases for systematic reviews and randomized trials, supplementing our search through reference scanning and grey literature, followed by a qualitative synthesis of the evidence that examined gender and equity considerations. RESULTS: Of the 4102 articles identified on homelessness interventions, only 4 systematic reviews and 9 randomized trials were exclusively conducted on women or published disaggregated data enabling a gender analysis. Interventions with the strongest evidence included post-shelter advocacy counselling for women experiencing homelessness due to intimate partner violence, as well as case management and permanent housing subsidies (e.g. tenant-based rental assistance vouchers), which were shown to reduce homelessness, food insecurity, exposure to violence and psychosocial distress, as well as promote school stability and child well-being. CONCLUSION: Much of the evidence on interventions to better support women experiencing homelessness focusses on those accessing domestic violence or family shelters. Since many more women are experiencing or at risk of hidden homelessness, population-based strategies are also needed to reduce gender inequity and exposure to violence, which are among the main structural drivers of homelessness among women.

Evidence-informed interventions and best practices for supporting women experiencing or at risk of homelessness: a scoping review with gender and equity analysis./ Interventions fondées sur des données probantes et pratiques exemplaires en matière de soutien apporté aux femmes en situation ou à risque d'itinérance : examen de la portée avec analyse fondée sur le sexe et l'équité.

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Caring for patients with lived experience of homelessness