249 research outputs found

    Toward a New Understanding: The California Statewide Study of People Experiencing Homelessness

    Get PDF
    This report outlines the largest representative study of homelessness in the United States since the mid-1990s. The study provides a comprehensive look at the causes and consequences of homelessness in California and recommends policy changes to shape programs in response.Designed to be representative of all adults 18 years and older experiencing homelessness in California, CASPEH includes nearly 3,200 administered questionnaires and 365 in-depth interviews with adults experiencing homelessness in eight regions of the state, representing urban, rural, and suburban areas. Interviews were conducted in English and Spanish, with interpreters for other languages. In partnership with a wide array of community stakeholders, the UCSF BHHI team collected data between October 2021 and November 2022. CASPEH was funded by UCSF BHHI, the California Health Care Foundation, and Blue Shield of California Foundation

    Barriers and Solutions to Advance Care Planning among Homeless-Experienced Older Adults.

    Get PDF
    Background/Objectives: Older homeless-experienced adults have low rates of advance care planning (ACP) engagement despite high rates of morbidity and mortality. To inform intervention development, we examined potential barriers and solutions to ACP engagement. Design: Cross-sectional qualitative study. Setting: We recruited adults who were homeless in the prior three years and ≥50 years of age in the San Francisco Bay Area, and recruited clinical stakeholders from a national meeting of homeless providers. We analyzed qualitative data using thematic analysis. Measurements: We conducted semistructured interviews with homeless-experienced older adults (n = 20) and focus groups with clinical stakeholders (n = 24) about perceived barriers and solutions to ACP engagement. Results: Participants considered ACP important, reflecting on deaths of people in their networks who had died. Participant-identified barriers to ACP included poor ACP knowledge, lack of familial ties and social isolation, competing priorities, avoidance and lack of readiness, fatalism and mistrust, and lack of ACP training for clinical and nonclinical staff. They identified solutions that included framing ACP as a way to provide meaning and assert choice, providing easy-to-read written documents focused on the populations' unique needs, tailoring content and delivery, initiating ACP in nonclinical settings, such as permanent supportive housing, and providing incentives. Conclusions: Both older homeless-experienced adults and clinical stakeholders believe that ACP is important, but acknowledge multiple barriers that impede engagement. By focusing on potential solutions, including capitalizing on opportunities outside of health care settings, focusing on the period after housing, and tailoring content, there are opportunities to improve ACP uptake

    Primary Care Providers’ Judgments of Opioid Analgesic Misuse in a Community-Based Cohort of HIV-Infected Indigent Adults

    Get PDF
    BackgroundPrimary care providers (PCPs) must balance treatment of chronic non-cancer pain with opioid analgesics with concerns about opioid misuse.ObjectiveWe co-enrolled community-based indigent adults and their PCPs to determine PCPs’ accuracy of estimating opioid analgesic misuse and illicit substance use.DesignPatient-provider dyad study.ParticipantsHIV-infected, community-based indigent adults (‘patients’) and their PCPs.Main measuresUsing structured interviews, we queried patients on use and misuse of opioid analgesics and illicit substances. PCPs completed patient- and provider-specific questionnaires. We calculated the sensitivity, specificity, and measures of agreement between PCPs’ judgments and patients’ reports of opioid misuse and illicit substance use. We examined factors associated with PCPs’ thinking that their patients had misused opioid analgesics and determined factors associated with patients’ misuse.Key resultsWe had 105 patient-provider dyads. Of the patients, 21 had misused opioids and 45 had used illicit substances in the past year. The sensitivity of PCPs’ judgments of opioid analgesic misuse was 61.9% and specificity, 53.6% (Kappa score 0.09, p = 0.10). The sensitivity of PCPs’ judgments of illicit substance use was 71.1% and specificity, 66.7% (Kappa score 0.37, p <0.001). PCPs were more likely to think that younger patients (Adjusted odds ratio (AOR) 0.89, 95% CI 0.84-0.97), African American patients (AOR 2.53, 95% CI 1.05-6.07) and those who had used illicit substances in the past year (AOR 3.33, 95% CI 1.35-8.20) had misused opioids. Younger (AOR 0.94, 95% CI 0.86-1.02) and African American (AOR 0.71, 95% CI 0.25-1.97) patients were not more likely to report misuse, whereas persons who had used illicit substances were (AOR 3.01, 95% CI 1.04-8.76).ConclusionPCPs’ impressions of misuse were discordant with patients’ self-reports of opioid analgesic misuse. PCPs incorrectly used age and race as predictors of misuse in this high-risk cohort

    Is Primary Care Providers’ Trust in Socially Marginalized Patients Affected by Race?

    Get PDF
    Interpersonal trust plays an important role in the clinic visit. Clinician trust in the patient may be especially important when prescribing opioid analgesics because of concerns about misuse. Previous studies have found that non-white patients are perceived negatively by clinicians.To examine whether clinicians' trust in patients differed by patients' race/ethnicity in a socially marginalized cohort.Cross-sectional study of patient-clinician dyads.169 HIV infected indigent patients recruited from the community and their 61 primary care providers (PCPs.)The Physician Trust in Patients Scale (PTPS), a validated scale that measures PCPs' trust in patients.The mean PTPS score was 43.2 (SD 10.8) out of a possible 60. Reported current illicit drug use and prescription opioid misuse were similar across patients' race or ethnicity. However, both patient illicit drug use and patient non-white race/ethnicity were associated with lower PTPS scores. In a multivariate model, non-white race/ethnicity was independently associated with PTPS scores 6.3 points lower than whites (95% CI: -9.9, -2.7). Current illicit drug use was associated with PTSP scores 5.5 lower than no drug use (95% CI -8.5, -2.5).In a socially marginalized cohort, non-white patients were trusted less than white patients by their PCPs, despite similar rates of illicit drug use and opioid analgesic misuse. The effect was independent of illicit drug use. This finding may reflect unconscious stereotypes by PCPs and may underlie disparities in chronic pain management

    Coming Home: Health Status and Homelessness Risk of Older Pre-release Prisoners

    Get PDF
    Older adults comprise an increasing proportion of the prison and homeless populations. While older age is associated with adverse post-release health events and incarceration is a risk factor for homelessness, the health status and homelessness risk of older pre-release prisoners are unknown. Moreover, most post-release services are geared towards veterans; it is unknown whether the needs of non-veterans differ from those of veterans. To assess health status and risk of homelessness of older pre-release prisoners, and to compare veterans with non-veterans. Cross-sectional study of 360 prisoners (≥55 years of age) within 2 years of release from prison using data from the 2004 Survey of Inmates in State and Federal Correctional Facilities. Veteran status, health status (based on self-report), and risk of homelessness (homelessness before arrest). Mean age was 61 years; 93.8% were men and 56.5% were white. Nearly 40% were veterans, of whom 77.2% reported likely VA service eligibility. Veterans were more likely to be white and to have obtained a high school diploma or GED. Overall, 79.1% reported a medical condition and 13.6% reported a serious mental illness. There was little difference in health status between veterans and non-veterans. Although 1 in 12 prisoners reported a risk factor for homelessness, the risk factors did not differ according to veteran status. Older pre-release prisoners had a high burden of medical and mental illness and were at risk for post-release homelessness regardless of veteran status. Reentry programs linking pre-release older prisoners to medical and psychiatric services and to homelessness prevention programs are needed for both veterans and non-veterans

    Housing as Health Care During and After the COVID-19 Crisis

    Full text link
    The COVID-19 crisis has illustrated clearly that “housing is health care.” The 567,000 people experiencing homelessness in the U.S. face heightened risk for contracting COVID-19 due to the circumstances surrounding their lack of housing. Simultaneously, an outbreak of COVID-19 among people who are homeless could threaten already burdened health systems, showing the critical interconnections between housing and health care. We describe strategies to mitigate the impact of COVID-19 for homeless populations and for the health care system. Looking forward, we suggest that guaranteeing housing for all is an essential step toward reducing the societal burden of the next pandemic.https://deepblue.lib.umich.edu/bitstream/2027.42/154767/1/Doran main article.pdfDescription of Doran main article.pdf : Main articl
    corecore