Barriers to medical care for homeless families compared with housed poor families

Article Abstract:

Although children in homeless families suffer intensely from acute infectious diseases, chronic medical problems, and nutritional inadequacy, they are seriously underserved by health and social services. This study examined the bureaucratic and other barriers that prevent homeless children from receiving such services, and compared their situation with that of poor families who have housing. A survey was carried out of 194 homeless families in the 10 largest shelters in Los Angeles and of 196 housed poor families receiving welfare from the same region. The families (consisting of at least the mother and one minor child) had been homeless an average of six months. One child in each family was randomly chosen as the reference child. Interviews focusing on that child were carried out with the mother concerning housing history, income, family characteristics, health care providers, and barriers to obtaining health care. Health insurance coverage was determined. Results showed that the homeless families were more likely to have both parents and to have more children than the housed families. Although Medicaid was the major source of insurance for all families, more homeless (26 percent) than housed (21 percent) were uninsured, and more had lost their health insurance during the preceding year. Homeless families were less likely to have a regular provider of health care, whether preventive or during illness. Approximately half the families in both groups reported at least one specific barrier to obtaining health care, but more homeless (38 percent) than housed (28 percent) families found that these barriers prevented their obtaining care. The barriers included not having transportation to reach the care; the cost of care; not knowing where to go for care; and having to wait too long for an appointment. Overall, barriers were 70 percent more likely to prevent homeless children than housed children from getting care. A set of strongly worded recommendations for improving the lot of homeless families is presented. (Consumer Summary produced by Reliance Medical Information, Inc.)

Homeless children

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Deleterious effects of criminal victimization on women's health and medical utilization

Article Abstract:

According to the National Crime Survey (NCS), there were more than 20 million personal crimes involving physical contact in 1987. Crime is a major cause of stress and a potential cause of poor health. Being a victim of a crime increases the risk of mental illness, but the long-term effect on physical health has not been studied. In this study of 316 crime victims and 74 nonvictims, the long-term effects on health were documented. The results consistently showed long-lasting ill effects of crime on physical health. The more severely victimized a woman was, the lower her ratings of her health and the greater the number of physician visits. The severity of the crime was a better indicator of physician visits and outpatient costs than either age or unrelated health hazards. A high rate of physician visits was generally not present during the period before the crime took place, and the high rate did not return to normal during the three-year follow-up. The NCS collects data on the cost of emergency room and inpatient hospital care only, suggesting that the true cost of victimization is severely underestimated. Primary care physicians should be aware of the potential psychological difficulties experienced by crime victims, but only half of medical schools include domestic violence in their curricula. Victimization, especially sex crimes, is not included in the standard sexual history in clinical medicine. In addition, diagnostic techniques used in hospitals are virtually useless in identifying domestic violence. Failure to ask the questions implies a lack of permission to discuss such issues, and the opportunity to help these victims is missed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Women, Crimes against, Victims of crimes, Crime victims, National Crime Survey

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Effect of a change in house staff work schedule on resource utilization and patient care

Article Abstract:

Both the medical and lay press have focussed attention in recent years on resident physicians' work schedules, which have often been characterized by sleepless 36-hour shifts. Much concern has been raised that these schedules and the resulting sleep deprivation may seriously compromise patient care. The studies that have been done show that sleep-deprived resident physicians do tend to be more hostile and depressed, but that their motor and cognitive functions seem to be relatively preserved. Subjectively, however, most residents believe that they are less effective when they are fatigued. One residency program that instituted a series of scheduling changes, which greatly reduced the number of consecutive hours a resident worked, did a study to see if any measurable changes in the quality of medical care resulted. Under the new work schedule, the average length of a patient's stay in the hospital was reduced by 15 percent, an unanticipated finding. The average number of laboratory tests per patient dropped under the new schedule. The number of potentially serious medication errors committed by the residents was also significantly reduced under the new schedule. Thus, the new resident physicians' work schedule, which reduced the number and length of on-call shifts produced more well-rested residents, and also reduced the utilization of hospital resources, with no observable reduction in the health of the patients at discharge. (Consumer Summary produced by Reliance Medical Information, Inc.)

Performance, Work hours, Physiological aspects, Residents (Medicine), Hospital utilization, Hospital stays, Job satisfaction, Clinical competence

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