Primary health care services for single homeless people: defects and opportunities.
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BACKGROUND: An innovative residential centre in west London during 1997-1998 helped older rough sleepers leave the streets and resettle in conventional homes. Many clients presented with multiple physical illnesses complicated by chronicity and poor management. The centre initially experienced difficulties in obtaining health care for the residents, briefly relied on an A&E department for treatment of serious and minor ailments, and latterly was served by a GP practice supported by special funding. OBJECTIVE: The aims of this study were to describe the problems of providing at short notice primary health care services to a high-need group, and the prospective opportunities for the delivery of the required care. METHOD: A monitoring study collected routine operational data, life histories from 88 residents using a semi-structured questionnaire and information from 61 residents about their contacts with GPs before residence in the centre. Interviews were also conducted with the centre's staff, a Health Authority officer and a GP who treated the residents. RESULTS: The medical care of the residents was a major concern. Many had physical illnesses yet three-fifths had not seen a GP for more than 5 years. Many were not registered, even among those who recently had become homeless. It was difficult to organize the residents' medical care and to access special funding at short notice. When funding was secured, there were difficulties in contracting the service. CONCLUSION: Current registration and commissioning procedures are ill fitted to provide primary care services to a high-needs group at short notice. Primary Care Groups, special funding and contractual arrangements provide opportunities for GPs and primary health care workers to provide an improved service to marginalized and special needs groups. The responsibility to identify and respond to exceptional needs should be clearly defined and allocated. (+info)
The effects of respite care for homeless patients: a cohort study.
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OBJECTIVES: Homeless individuals experience high rates of physical and mental illness, increased mortality, and frequent hospitalizations. Respite care provides homeless individuals with housing and services allowing more complete recovery from illnesses and stabilization of chronic conditions. METHODS: We investigated respite care's impact on 225 hospitalized homeless adults consecutively referred from an urban public hospital during a 26-month period. The cohort was separated into 2 groups: (1) patients referred and accepted into the respite center and (2) patients referred but denied admission because beds were unavailable. All patients met the center's predefined eligibility criteria. Main outcome measures were inpatient days, emergency department visits, and outpatient clinic visits. RESULTS: The 2 groups had similar demographic characteristics, admitting diagnoses, and patterns of medical care use at baseline. During 12 months of follow-up, the respite care group required fewer hospital days than the usual care group (3.7 vs 8.3 days; P=.002), with no differences in emergency department or outpatient clinic visits. Individuals with HIV/AIDS experienced the greatest reduction in hospital days. CONCLUSIONS: Respite care after hospital discharge reduces homeless patients' future hospitalizations. (+info)
Substance abuse treatment and receipt of liver specialty care among persons coinfected with HIV/HCV who have alcohol problems.
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We examined the association of substance abuse treatment with access to liver specialty care among 231 persons coinfected with HIV and hepatitis C virus (HCV) with a history of alcohol problems who were recruited and followed up in the HIV-Longitudinal Interrelationships of Viruses and Ethanol cohort study from 2001 to 2004. Variables regarding demographics, substance use, health service use, clinical variables, and substance abuse treatment were from a standardized research questionnaire administered biannually. We defined substance abuse treatment services as any of the following in the previous 6 months: 12 weeks in a halfway house or residential facility, 12 visits to a substance abuse counselor or mental health professional, day treatment for at least 30 days, or any participation in a methadone maintenance program. Liver specialty care was defined as a visit to a liver doctor, a hepatologist, or a specialist in treating hepatitis C in the past 6 months. At study entry, most of the 231 subjects (89%, n = 205) had seen a primary care physician, 50% had been exposed to substance abuse treatment, and 50 subjects (22%) had received liver specialty care. An additional 33 subjects (14%) reported receiving liver specialty care during the follow-up period. In the multivariable model, we observed a clinically important although not statistically significant association between having been in substance abuse treatment and receiving liver specialty care (adjusted odds ratio = 1.38; 95% confidence interval = 0.9-2.11). Substance abuse treatment systems should give attention to the need of patients to receive care for prevalent treatable diseases such as HIV/HCV coinfection and facilitate its medical care to improve the quality of care for individuals with substance use disorders. The data illustrate the need for clinical care models that give explicit attention to the coordination of primary health care with addiction and hepatitis C specialty care while providing ongoing support to engage and retain these patients with complex health needs. (+info)
An examination of main and interactive effects of substance abuse recovery housing on multiple indicators of adjustment.
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AIMS: To assess the effectiveness of community-based supports in promoting abstinence from substance use and related problems. DESIGN AND PARTICIPANTS: Individuals (n = 150) discharged from residential substance abuse treatment facilities were assigned randomly to either an Oxford House recovery home or usual after-care condition and then interviewed every 6 months for a 24-month period. INTERVENTION: Oxford Houses are democratic, self-run recovery homes. MEASUREMENTS: Hierarchical linear modeling was used to examine the effect of predictive variables on wave trajectories of substance use, employment, self-regulation and recent criminal charges. Regressions first examined whether predictor variables modeled wave trajectories by condition (Oxford House versus usual after-care), psychiatric comorbidity, age and interactions. FINDINGS: At the 24-month follow-up, there was less substance abuse for residents living in Oxford Houses for 6 or more months (15.6%), compared both to participants with less than 6 months (45.7%) or to participants assigned to the usual after-care condition (64.8%). Results also indicated that older residents and younger members living in a house for 6 or more months experienced better outcomes in terms of substance use, employment and self-regulation. CONCLUSIONS: Oxford Houses, a type of self-governed recovery setting, appear to stabilize many individuals who have substance abuse histories. (+info)
A clean and sober place to live: philosophy, structure, and purported therapeutic factors in sober living houses.
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The call for evidence-based practices (EBPs) in addiction treatment is nearly universal. It is a noteworthy movement in the field because treatment innovations have not always been implemented in community programs. However, other types of community-based services that may be essential to sustained recovery have received less attention. This article suggests that sober living houses (SLHs) are a good example of services that have been neglected in the addiction literature that might help individuals who need an alcohol- and drug-free living environment to succeed in their recovery. It begins with an overview of the history and philosophy of this modality and then describes our five-year longitudinal study titled, "An Analysis of Sober Living Houses." Particular attention is paid to the structure and philosophy of SLHs and purported therapeutic factors. It ends with the presentation of baseline data describing the residents who enter SLHs and six-month outcomes on 130 residents. (+info)
Halfway houses for alcohol dependents: from theoretical bases to implications for the organization of facilities.
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A model for sober housing during outpatient treatment.
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Finding a living environment that supports recovery is a major challenge for many clients attending outpatient treatment. Yet it is important because family, friends, and roommates who encourage substance use or discourage recovery can undermine the progress made in treatment. Destructive living environments are most problematic for clients who have limited incomes and reside in urban areas where housing markets are tight. Individuals who are homeless face constant threats to their sobriety and often lack the stability necessary to attend treatment consistently. Options Recovery Services is an outpatient program in Berkeley, California that uses sober living houses (SLHs) to provide an alcohol- and drug-free living environment to clients while they attend the outpatient program. This article describes the structure and processes of the houses along with six month outcome data on 46 residents. Improvements were seen in the number of months using substances, maximum number of days of substance use per month, arrests, and employment. Seventy six percent of the residents remained in the house at least five months and 39% reported being employed at some point during the past 30 days. Outpatient programs should consider establishing SLHs for clients who lack a living environment supportive of sobriety. (+info)