Factors associated with access to care and healthcare utilization in the homeless population of England
Factors associated with access to care and healthcare utilization in the homeless population of England
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DOI：
10.1093/pubmed/fdw008
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发表时间：
2017-03-01
影响因子：
4.4
通讯作者：
Holland, Richard
中科院分区：
文献类型：
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作者：
Elwell-Sutton, Tim;Fok, Jonathan;Holland, Richard
背景经历无家可归的人众所周知有复杂的健康需求，这些需求往往因难以获得医疗保健而变得更加复杂。方法采用横断面抽样方法，对英国19个地区2505名流浪者进行调查。结果露宿流浪者向全科医生登记的可能性较低(优势比(OR)0.45，95%可信区间(CI)0.30~0.66)，而住在住处的流浪者(参照组)和隐性流浪者(OR1.48，95%CI 0.88~2.50)的风险较小。最近被全科医生或牙医拒绝登记的人入院(OR 0.67，95%CI 0.49~0.91)或使用救护车(OR 0.73，95%CI 0.54~0.99)的几率也较低。露宿者的全科医生登记率特别低，这似乎对入院产生了连锁反应。改善无家可归者获得初级保健的机会可以确保社会上一些最脆弱的人能够获得他们目前错失的重要医院服务。
Background People experiencing homelessness are known to have complex health needs, which are often compounded by poor access to healthcare. This study investigates the individual-level factors associated with access to care and healthcare utilization among homeless people in England.Methods A cross-sectional sample of 2505 homeless people from 19 areas of England was used to investigate associations with access to care and healthcare utilization.Results Rough sleepers were much less likely to be registered with a general practitioner (GP) (odds ratio (OR) 0.45, 95% confidence interval (CI) 0.30-0.66) than single homeless in accommodation (reference group) or the hidden homeless (OR 1.48, 95% CI 0.88-2.50). Those who had recently been refused registration by a GP or dentist also had lower odds of being admitted to hospital (OR 0.67, 95% CI 0.49-0.91) or using an ambulance (OR 0.73, 95% CI 0.54-0.99).Conclusions The most vulnerable homeless people face the greatest barriers to utilizing healthcare. Rough sleepers have particularly low rates of GP registration and this appears to have a knock-on effect on admission to hospital. Improving primary care access for the homeless population could ensure that some of the most vulnerable people in society are able to access vital hospital services which they are currently missing out on.