Objective. Unsheltered homeless individuals ("rough sleepers") face considerable barriers to health care services and suffer high rates of morbidity and mortality. The Boston Health Care for the Homeless Program (BHCHP) has evolved a primary care service delivery model that coordinates medical street encounters with emergency room visits and admissions to acute care hospitals, respite care facilities, and public detoxification units. Methods. A multidisciplinary team (nurse practitioner, physician, and two nurses) is an integral component of Boston's street outreach program, providing a daily presence on the downtown walking teams and two night rescue vans. This team coordinates care and discharge planning with local hospitals and emergency rooms, public detoxification units, community mental health centers, as well as with the police and emergency medical services. Results: 193 individuals were seen 2 or more times on the streets by the BHCHP team in 1998. 107 (55%) met at least one of 7 established high-risk criteria, of whom 62 persons were still sleeping on Boston's streets in January of 2000. Outcome measures for this cohort, including preventive health indicators (PPD, influenza vaccine), measures of chronic disease management (e.g. diabetes, hypertension, and asthma), and patterns of health care service utilization are monitored and evaluated through data entered on handheld palm pilots. Conclusion. BHCHP’s multidisciplinary team model demonstrates that intensive street outreach, discharge planning, and aftercare treatment are effective means of coordinating primary and continuous care for an unsheltered street population that does not utilize traditional primary care clinics.
Learning Objectives: 1. Understand the differences between the sheltered and unsheltered homeless population. 2. Describe a coordinated primary care delivery model. 3. Evaluate the unique health care needs of persons living on urban streets
Keywords: Access to Health Care, Outreach Programs
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.