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APHA Scientific Session and Event Listing

M. Christopher Gibbons, MD, MPH and Nadra C. Tyus, DrPH. Urban Health Institute, Johns Hopkins University, 111 Market Place, Suite 850, Baltimore, MD 21202, (410) 895-1116, ntyus@jhsph.edu

Background: Previous reports suggest that homeless populations suffer disproportionately from disease and poor access to care. However, knowledge about healthcare utilization patterns among urban homeless adults is limited.

Objectives: The purpose of this study is to enhance our understanding regarding access to care among urban homeless adults.

Methods: Seven community health workers (CHWs) administered a 62 question survey to homeless adults seeking care at a free clinic for the uninsured, a community-based health center, and local soup kitchens. All respondents were surveyed concerning socio-demographics, chronic disease risk factors and healthcare utilization patterns.

Results: Findings include mean age of 41.5 years, 87% African-American, 58% completed high school, 77% unemployed, and only 21% had health insurance. In terms of health status, 76% were smokers, 64% had elevated blood pressure (BP>120/80), 31% reported a current or past STD, and 46% reported a substance abuse problem. Overall, 60% saw a healthcare provider while 44% delayed seeking medical care at least one time in the past 12 months, usually due to lack of insurance and/or money. Regarding the site of service, 44% went to an ER, 26% to a private doctor, and 37% to a clinic.

Conclusion: This data suggests that although many urban homeless clients lack health insurance, most actually have accessed some kind of healthcare service in the past year. Furthermore, this access is not limited to the Emergency Room. However, health status remained poor suggesting that future progress is needed to ensure appropriate utilization and not just improved access to care.

Learning Objectives:

• 1. Discuss the relative contribution of insurance status vs. appropriateness of utilization among homeless adults living in the inner city.
• 2. Understand the importance of interventions to improve appropriate utilization as well as access to healthcare services among urban homeless adults

Presenting author's disclosure statement:

Any relevant financial relationships? No