A qualitative study of recently homeless emergency department patients found multiple contributors to homelessness that can inform future homelessness prevention interventions. The study findings are published in the September issue of Academic Emergency Medicine, a journal of the Society for Academic Emergency Medicine.
Homelessness is a social determinant of health, and ranks alongside age, transportation access, income, ethnicity and social supports as factors that can influence the quality and quantity of healthcare services a person receives.
WHAT’S THE IMPACT
Homelessness plays an oversized role in U.S. EDs, in part due to the ED’s role as a medical and social safety net and in part due to the greater-than-average health needs of people who are homeless.
The researchers found that among the contributors to homelessness are unexpectedness, health and social conditions, lack of support from family or friends, and structural issues such as the job market and affordable housing availability.
The findings demonstrate gaps in current homeless prevention services and can help inform future interventions for unstably housed and homeless ED patients. More broadly, the findings may help ED providers better understand the SDOH and life experiences of patients that contribute to their health and ED use.
Perhaps the strongest recommendation from the study is to listen carefully to patients’ needs, allowing providers to determine the additional social determinants that can lead to homelessness when left unaddressed.
For emergency departments, that means presuming that each patient who walks in is there because of what the authors call a “critical lesion” in the public health system, which, when addressed, can aid in preventing homelessness.
THE LARGER TREND
Acute hospital use among the homeless is rising, driven largely by mental illness and substance use disorder, reveal findings published in December in the journal Medical Care.
A homeless individual is one who lacks fixed and reliable housing, and it is estimated that 553,000 people fit that description on any given night in the U.S.
An estimated 70 percent of the variation in healthcare outcomes is attributable to social determinants — but it is only in recent years that healthcare settings have begun formally looking at these factors to better understand and treat patients.
A May study co-authored by Boston University School of Public Health researchers and published in the Journal of the American Board of Family Medicine finds that these social determinant screening systems need to be tailored to individual clinics.
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