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This will help to establish confidence and mutual trust and encourage the patient to return to the physician's office.
For information about the SORT evidence rating system, go to All homeless patients should receive the influenza vaccine annually and be immunized against pneumococcus according to standard clinical guidelines.Complex, advanced medical problems and psychiatric illnesses, exacerbated by drug and alcohol abuse, in combination with the economic and social issues (such as the lack of housing and proper transportation) make this subset of the population a unique challenge for the health care system, local communities, and the government.An integrated, multidisciplinary health care team with an outreach focus, along with involvement of local and state agencies, seems best suited to address the components needed to ensure quality of care, to help make these patients self-sufficient, and to help them succeed.During the initial clinic visit, the physician and clinic staff should focus on demonstrating genuine interest, empathy, and respect in a warm, nonthreatening, nonjudgmental environment.The goal is to address symptomatic problems first, which can be treated with simple guidance and will have a visible impact on the patient's life.Any of these factors, compounded by alcohol and drug abuse, domestic violence, mental and physical illness, or abuse and neglect, can cause a person to become homeless.5In a homeless person, the association of one or more chronic illnesses with substance abuse or mental illness appears to increase the risk of early death. According to the Housing and Urban Development survey, approximately 37% of the estimated 1.6 million homeless persons living in shelters have a disability compared with 25% of those in poverty and 15.3% of the general population.1016 Homeless children are sick four times more often than children who are not homeless and have an increased incidence of asthma, iron deficiency, lead poisoning, respiratory infections, ear infections, gastrointestinal problems, and emotional and behavioral problems (e.g., anxiety, depression, withdrawal, aggression, hostility).
These children are also four times more likely to demonstrate delayed development, are six times more likely to have stunted growth, and have twice the expected rate of learning disabilities.1725 An outreach visit will most likely be the first contact with the homeless patient.
Risk factors for suicide include age younger than 30 years, Hispanic ethnicity, lower education level, and more days of homelessness.
The two- or nine-item Patient Health Questionnaire is recommended by the Health Care for the Homeless Clinicians' Network for depression screening and the Simple Screening Instrument for Alcohol and Other Drug Abuse is recommended to screen for substance abuse.28 The foundation for treatment is to focus on finding stable housing in combination with access to therapy, supportive services, and, ultimately, employment.33Traumatic brain injury among homeless persons is estimated to be more than five times the rate in the general population.34 There is no cure for the original brain injury; however, a multidisciplinary approach involving family physicians, neuropsychiatric experts, and appropriate community and government resources provides the necessary evaluation, treatment, rehabilitation, and support.
Family physicians are well suited to manage the needs of the homeless patient, provide continuity of care, and lead these multidisciplinary teams.
Homeless persons are individuals without permanent housing who may live on the streets; may stay in a shelter, mission, single room occupancy facility, abandoned building, or vehicle; or who are in any other unstable or nonpermanent situation.
The average life span for a homeless person is between 42 and 52 years.731 To meet standard blood pressure, cholesterol, and diabetes goals, drug therapy should be initiated early, and the physician should work closely with a care manager and liaison to ensure a healthy diet, to reduce stress, and to improve the patient's compliance with the treatment plan. Key elements of integrated care for persons experiencing homelessness: a guide for health care for the homeless providers.