A cross-sectional observational study of unmet health needs among homeless and vulnerably housed adults in three Canadian cities
A cross-sectional observational study of unmet health needs among homeless and vulnerably housed adults in three Canadian cities
复制标题
DOI：
10.1186/1471-2458-13-577
复制
发表时间：
2013-06-13
影响因子：
4.5
通讯作者：
Hwang, Stephen W.
中科院分区：
文献类型：
--
作者：
Argintaru, Niran;Chambers, Catharine;Hwang, Stephen W.
背景：无家可归者经历了沉重的健康问题负担，但他们在获得医疗保健方面面临重大障碍。对于那些居住在质量差或临时住房中并极有可能成为无家可归者的有适当住房的人的照料需求得不到满足的情况，人们所知甚少。本研究的目的是在全民健康保险体系内的三个主要城市中，以无家可归和居住条件适宜的成年人为样本，研究未满足的医疗保健需求的患病率和相关因素。参与者是在温哥华、多伦多和渥太华的收容所、膳食计划、社区卫生中心、救助中心、公寓和单人房旅馆招募的，加拿大，2009年。基线访谈引出人口统计学特征，健康状况，和障碍，医疗保健。Logistic回归被用来确定与自我报告的未满足的需求，在过去12 months.Results：在分析的1,181名参与者，445（37%）报告未满足的需求相关的因素。在调整后的分析中，与报告未满足需求的可能性较大相关的因素是在过去12个月内有工作（AOR = 1.40，95%CI = 1.03-1.91）和有≥ 3种慢性健康状况（AOR = 2.17，95%CI = 1.24-3.79）。拥有更高的健康相关生活质量（AOR = 0.21，95% CI = 0.09-0.53），心理改善（AOR = 0.97，95% CI = 0.96-0.98）或身体健康（AOR = 0.98，95% CI = 0.96-0.99），并且有初级保健提供者（AOR = 0.63，95%CI = 0.46-0.85）降低了报告未满足需求的几率。无家可归者和有住房的成年人有类似的可能性经历未满足的医疗保健需求。需要制定战略，改善这些人群获得初级保健的机会，减少获得保健的障碍。
Background: Homeless persons experience a high burden of health problems; yet, they face significant barriers in accessing health care. Less is known about unmet needs for care among vulnerably housed persons who live in poor-quality or temporary housing and are at high risk of becoming homeless. The objectives of this study were to examine the prevalence of and factors associated with unmet needs for health care in a population-based sample of homeless and vulnerably housed adults in three major cities within a universal health insurance system.Methods: Participants were recruited at shelters, meal programs, community health centers, drop-in centers, rooming houses, and single room occupancy hotels in Vancouver, Toronto, and Ottawa, Canada, throughout 2009. Baseline interviews elicited demographic characteristics, health status, and barriers to health care. Logistic regression was used to identify factors associated with self-reported unmet needs for health care in the past 12 months.Results: Of the 1,181 participants included in the analysis, 445 (37%) reported unmet needs. In adjusted analyses, factors associated with a greater odds of reporting unmet needs were having employment in the past 12 months (AOR = 1.40, 95% CI = 1.03-1.91) and having >= 3 chronic health conditions (AOR = 2.17, 95% CI = 1.24-3.79). Having higher health-related quality of life (AOR = 0.21, 95% CI = 0.09-0.53), improved mental (AOR = 0.97, 95% CI = 0.96-0.98) or physical health (AOR = 0.98, 95% CI = 0.96-0.99), and having a primary care provider (AOR = 0.63, 95% CI = 0.46-0.85) decreased the odds of reporting unmet needs.Conclusions: Homeless and vulnerably housed adults have a similar likelihood of experiencing unmet health care needs. Strategies to improve access to primary care and reduce barriers to accessing care in these populations are needed.