"It Wasn't Just One Thing": A Qualitative Study of Newly Homeless Emergency Department Patients
"It Wasn't Just One Thing": A Qualitative Study of Newly Homeless Emergency Department Patients
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DOI：
10.1111/acem.13677
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发表时间：
2019-09-01
影响因子：
4.4
通讯作者：
Padgett, Deborah K.
中科院分区：
文献类型：
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作者：
Doran, Kelly M.;Ran, Ziwei;Padgett, Deborah K.
目的急诊科（ED）经常照顾无家可归或居住不稳定的病人。无家可归者服务系统采取的一个有希望的办法是提供干预措施，试图在无家可归现象发生之前加以预防。专家们建议，医疗机构可能是识别和干预有无家可归风险的患者的理想场所，但人们甚至对可能受益于这种干预措施的患者的基本特征知之甚少。方法我们对过去6个月内无家可归的艾德患者进行深入的一对一定性访谈。使用半结构化的访谈指南，我们询问患者他们无家可归的途径以及可能阻止他们无家可归的原因。访谈被数字化记录和专业转录。转录本由多名研究者逐行编码，然后作为一个小组开会，以迭代的方式讨论和完善代码。结果共完成访谈31例。平均访谈时间为42分钟。出现了四个主要主题：1）独特的故事，但共同的社会和健康贡献者无家可归，2）个人机构与更大的结构性力量，3）家庭或朋友的帮助有限，4）无家可归是没有预料到的。结论这些发现表明，目前无家可归的预防服务的差距，可以帮助未来的干预措施，为不稳定的住房和无家可归的艾德患者。更直接的是，这些发现为ED中常见的弱势患者群体的生活提供了丰富，独特的背景。
Objectives Emergency departments (EDs) frequently care for patients who are homeless or unstably housed. One promising approach taken by the homeless services system is to provide interventions that attempt to prevent homelessness before it occurs. Experts have suggested that health care settings may be ideal locations to identify and intervene with patients at risk for homelessness, yet little is known even about the basic characteristics of patients who might benefit from such interventions. Methods We conducted in-depth, one-on-one qualitative interviews with ED patients who had become homeless within the past 6 months. Using a semistructured interview guide, we asked patients about their pathways into homelessness and what might have prevented them from becoming homeless. Interviews were digitally recorded and professionally transcribed. Transcripts were coded line by line by multiple investigators who then met as a group to discuss and refine codes in an iterative fashion. Results Interviews were completed with 31 patients. Mean interview length was 42 minutes. Four main themes emerged: 1) unique stories yet common social and health contributors to homelessness, 2) personal agency versus larger structural forces, 3) limitations in help from family or friends, and 4) homelessness was not expected. Conclusions These findings demonstrate gaps in current homeless prevention services and can help inform future interventions for unstably housed and homeless ED patients. More immediately, the findings provide rich, unique context to the lives of a vulnerable patient population commonly seen in EDs.