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1.
Public Health Nurs ; 39(6): 1271-1279, 2022 11.
Artículo en Inglés | MEDLINE | ID: mdl-35899908

RESUMEN

OBJECTIVE: This study explored race-based differences in disease burden, health care utilization, and mortality for Black and White persons experiencing homelessness (PEH) who were referred to a transitional care program, and health care utilization and program outcomes for program participants. DESIGN: This was a quantitative program evaluation. SAMPLE: Black and White PEH referred to a transitional care program (n = 450). We also analyzed data from the subgroup of program participants (N = 122). Of the 450 referrals, 122 participants enrolled in the program. MEASURES: We included chronic disease burden, mental illness, substance use, health care utilization, and mortality rates for all PEH referred. For program participants, we added 6-month pre/post health care utilization and program outcomes. All results were dichotomized by race. RESULTS: Black PEH who were referred to the program had higher rates of hypertension, diabetes, renal failure, and HIV and similar post-referral mortality rates compared to White PEH. Black and White PEH exhibited similar program outcomes; however, Black PEH revisited the emergency department (ED) less frequently than White PEH at 30 and 90 days after participating in the program. CONCLUSIONS: Health care utilization may be a misleading indicator of medical complexity and morbidity among Black PEH. Interventions that rely on health care utilization as an outcome measure may unintentionally contribute to racial disparities.


Asunto(s)
Personas con Mala Vivienda , Cuidado de Transición , Humanos , Aceptación de la Atención de Salud , Población Blanca , Evaluación de Resultado en la Atención de Salud
2.
Public Health Nurs ; 39(2): 363-371, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-34492122

RESUMEN

OBJECTIVES: This study sought to (1) determine the number of persons evicted from the Durham Housing Authority (DHA) over a 5-year period, (2) explore changes in the number of persons with various medical diagnoses and health care utilization patterns before and after eviction, and (3) examine how many persons evicted from DHA became literally homeless. DESIGN: This was a pre/post cross-sectional quantitative study. SAMPLE: Heads of households evicted from DHA properties from January 1, 2013 through December 31, 2017 were included in the study. MEASUREMENTS: We matched people evicted by the DHA in a university health system electronic health record system to determine changes in diagnoses and health care utilization before and after eviction. We also matched the cohort in the homeless management information system to determine how many persons evicted became literally homeless. RESULTS: Findings indicate statistically significant increases in persons with medical diagnoses in five of ten categories, total hospital admissions, and emergency department visits after eviction. Of the 152 people included in the study, 34 (22%) became literally homeless. CONCLUSIONS: Health and health care utilization patterns were different before and after eviction. Implications for clinicians are explored.


Asunto(s)
Personas con Mala Vivienda , Vivienda Popular , Estudios Transversales , Composición Familiar , Vivienda , Humanos , Aceptación de la Atención de Salud
3.
N C Med J ; 83(6): 454-460, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36344100

RESUMEN

BACKGROUND Transitional care and medical respite programs provide assistance to people experiencing homelessness as they move from acute care into community settings. These programs can address issues that may fall outside the reach of traditional medical care yet have a profound impact on the health of vulnerable populations. This article focuses on the cost-effectiveness of the Durham Homeless Care Transitions (DHCT) program.METHOD This intervention study of the DHCT program uses a comparison group of people experiencing homelessness who were referred but did not participate. Encounter-level data, aggregated by quarterly segments of charges and reimbursements, were abstracted for all persons referred. Descriptive statistics were computed and models of charges and reimbursements were created using ordinary least squares (OLS) regression to compare utilization for 12 months pre- and post-referral.RESULTS Patients referred to the DHCT program (N = 485) were primarily non-Hispanic Black (62.5%), male (68.4%), uninsured (35.5%), and had an average of 5.3 chronic conditions and an average age of 50.0 years (SD = 11.3). There was variability among charges and reimbursement based on health care visit type but a negative association between treatment and charges, indicating that being part of the DHCT program led to lower charges post-referral.LIMITATIONS The study is limited by lack of access to line-item details of charges, reimbursement, and payer mix.CONCLUSION There is evidence of benefit to patients from transitional care and medical respite programs that does not substantially increase the overall societal cost of care; however, health systems commonly require evidence of cost savings and benefit as a return on investment.


Asunto(s)
Personas con Mala Vivienda , Transferencia de Pacientes , Humanos , Masculino , Persona de Mediana Edad , Análisis Costo-Beneficio , Derivación y Consulta , Enfermedad Crónica
4.
Public Health Nurs ; 38(4): 671-674, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33682156

RESUMEN

More than 80 percent of African American women struggle with overweight and obesity. We implemented a 5-week physical activity intervention using Facebook™ and pedometers with African American women. Twenty-seven African American women participated in a single-group pre/post design intervention to promote walking and physical activity. Participants were given access to a private Facebook™ group along with a free Omron Alvita pedometer. The five-week intervention challenged participants to increase weekly daily steps and the number of days they were physically active. At the end of the intervention, participants had significantly increased their weekly steps by 190% as compared to baseline (p = .005). Nearly, 80% of participants reported being active two or more days per week as compared to baseline (35.7%). Technologies such as social media and pedometers can assist in educating individuals and improving physical activity. These findings are relevant to public health nurses when implementing programs to increase physical activity for African American women.


Asunto(s)
Actigrafía , Negro o Afroamericano , Ejercicio Físico , Femenino , Promoción de la Salud , Humanos , Caminata
5.
Public Health Nurs ; 36(3): 296-302, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30746762

RESUMEN

OBJECTIVE: The purpose of this study was to evaluate a homeless medical respite pilot program to determine if program participants had health care utilization pattern changes and improved connection to income, housing, and health care resources post program. DESIGN: This is a quantitative descriptive pre-/post-program evaluation. SAMPLE: A total of 29 patients experiencing homelessness and discharged from an acute care hospital in the southeastern United States were provided with housing and nursing case management. MEASUREMENTS: Demographics including age, sex, race, and ethnicity were collected. Connection to primary care, mental health, substance abuse services, income, insurance, and housing were assessed at program entry and completion. Health care utilization and charge and payment data were collected 1 year prior and 1 year post-respite stay. RESULTS: Participants demonstrated reduced hospital admissions (-36.7%) and when admitted, fewer inpatient days (-70.2%) and increased outpatient provider visits (+192.6%). Health care charges for the cohort decreased by 48.6% from the year prior to the program. Housing and income improved. CONCLUSIONS: The medical respite pilot program was successful in guiding patients to community resources for more appropriate health care at a demonstrated cost savings. Participants also derived benefits in the form of improved housing and income.


Asunto(s)
Personas con Mala Vivienda , Aceptación de la Atención de Salud/estadística & datos numéricos , Cuidados Intermitentes , Adulto , Atención Ambulatoria/estadística & datos numéricos , Estudios de Cohortes , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Personas con Mala Vivienda/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Vivienda/estadística & datos numéricos , Humanos , Renta/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Sudeste de Estados Unidos
6.
J Community Health Nurs ; 34(4): 203-213, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29023160

RESUMEN

This study described the health behaviors and barriers and facilitators of those behaviors in elderly and/or disabled residents of public housing. A mixed-methods design was used. Residents (N = 88) completed a survey with validated measures of health behaviors. A sub-sample (N = 16) participated in three focus groups. Residents scored worse than population norms on the majority of behaviors measured. Qualitative results framed in an ecological model indicated the majority of facilitators and barriers to health behaviors were perceived as occurring at the intrapersonal and interpersonal levels. Interventions to promote health should consider the unique barriers and facilitators to health behaviors among residents.


Asunto(s)
Promoción de la Salud/métodos , Vivienda Popular , Estudios Transversales , Femenino , Grupos Focales , Conductas Relacionadas con la Salud , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
7.
Creat Nurs ; 22(3): 196-203, 2016 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-29195530

RESUMEN

Despite recent decreases, homelessness remains a substantial problem in the United States. Homelessness is associated with poor health, and homeless women experience earlier mortality than their housed counterparts. Understanding the aspirations of homeless women may offer service providers avenues for intervention to increase well-being among this vulnerable population. This study, a secondary analysis of transcribed interviews (n = 20), provides insight into the aspirations of homeless women. Opportunities for service providers to intervene on these aspirations within the context of homelessness are offered.


Asunto(s)
Esperanza , Personas con Mala Vivienda/psicología , Pobreza/psicología , Adolescente , Adulto , Femenino , Humanos , Persona de Mediana Edad , Motivación , Estados Unidos , Adulto Joven
8.
Creat Nurs ; 22(2): 202-208, 2016 05.
Artículo en Inglés | MEDLINE | ID: mdl-27587944

RESUMEN

A public health nurse talks about her career trajectory, her entry into nursing research, and her research career in transgender health. Transgender people encounter many health and social disparities, yet medical and nursing professionals are often ill-prepared to care for this population of individuals. The nursing profession is well known for its contributions to population health and for developing nursing-led interventions to improve the health outcomes of marginalized populations. Hines urges nursing to take a more active stance in transgender health and is leading this effort by example.


Asunto(s)
Necesidades y Demandas de Servicios de Salud , Disparidades en Atención de Salud , Personas Transgénero , Atención a la Salud , Humanos , Relaciones Profesional-Paciente
9.
J Community Health Nurs ; 32(3): 141-50, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26212466

RESUMEN

Refugees often experience compromised health from both pre- and post-migration stressors. Coalition theory has helped guide the development of targeted programs to address the health care needs of vulnerable populations. Using the Community Coalition Action Theory as a framework, a coalition was formed to implement a community garden with apartment-dwelling refugees. Outcomes included successful coalition formation, a community garden, reported satisfaction from all gardeners with increased vegetable intake, access to culturally meaningful foods, and evidence of increased community engagement. The opportunity for community health nurses to convene a coalition to affect positive health for refugees is demonstrated.


Asunto(s)
Dieta , Jardinería , Federación para Atención de Salud , Promoción de la Salud/organización & administración , Refugiados , Conducta Cooperativa , Femenino , Humanos , Masculino , Proyectos Piloto , Verduras , Virginia
10.
J Community Health Nurs ; 31(1): 34-48, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24528122

RESUMEN

Service providers are gatekeepers to health-sustaining services and resources, although little is known about service encounters from the perspective of homeless women. We conducted in-depth semistructured interviews with 15 homeless women to better understand their experiences of service encounters. Using a phenomenological method, 160 significant statements were extracted from participant transcripts; more positive than negative interactions were reported. The 10 themes that emerged fall along a dehumanizing/humanizing continuum primarily separated by the power participants experienced in the interaction and the trust they felt in the service provider. Implications for nursing practice and research are offered.


Asunto(s)
Personas con Mala Vivienda/psicología , Adulto , Deshumanización , Atención a la Salud , Femenino , Humanos , Entrevistas como Asunto , Relaciones Médico-Paciente , Poder Psicológico , Estereotipo , Confianza
11.
J Community Health Nurs ; 31(3): 145-56, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25051320

RESUMEN

For homeless persons, posthospitalization care is increasingly provided in formal medical respite programs, and their success is now reported in the literature. However, there is a dearth of literature on posthospitalization transitional care for homeless persons in the absence of a respite program. Through this formative study, we sought to understand the process of securing posthospitalization care in the absence of a formal homeless medical respite. Results demonstrated a de facto patchwork respite process that has emerged. We describe both human and monetary costs associated with patchwork respite and demonstrate opportunities for improvement in homeless health care transitions.


Asunto(s)
Personal de Salud/psicología , Accesibilidad a los Servicios de Salud/economía , Necesidades y Demandas de Servicios de Salud , Personas con Mala Vivienda/psicología , Cuidados Intermitentes/economía , Cuidado de Transición/economía , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Estados Unidos
12.
Nurs Clin North Am ; 59(1): 63-74, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38272584

RESUMEN

The number of people experiencing homelessness (PEH) in the United States has increased in the past 5 years. PEH have a higher disease burden and early mortality compared to people who are housed. Stigma adds to the burden of disease and disease management for PEH. In this article the authors review stigma, define housing and homelessness, describe the health and health care disparities PEH experience, and using the socio-ecological model as a framework, offer opportunities for nurses to intervene in efforts to decrease the stigma that PEH and housing instability encounter to improve health outcomes.


Asunto(s)
Inestabilidad de Vivienda , Personas con Mala Vivienda , Humanos , Estados Unidos , Vivienda
13.
PLoS One ; 19(1): e0295543, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38206961

RESUMEN

Medical Respite Programs (MRPs) characterize a care model that has been developed to address the health care and social needs of persons experiencing homelessness by providing post-acute hospital care in a safe environment. Although this model has been shown to reduce hospitalizations, improve health outcomes and increase access to health services, prior studies of MRP programs and outcomes have been limited to individual sites and may not generalize to the population of individuals receiving MRP care. This study protocol describes a mixed method design to collect organizational, provider, and patient-level data from a sample of MRPs.


Asunto(s)
Personas con Mala Vivienda , Proyectos de Investigación , Humanos , Problemas Sociales , Hospitalización
14.
Acad Med ; 2024 Mar 28.
Artículo en Inglés | MEDLINE | ID: mdl-38551945

RESUMEN

PROBLEM: Being unhoused and facing housing insecurity contribute to poor health outcomes. Medical school curricula may include social determinants of health (SDOH) topics. However, experiential learning opportunities allow students to better contextualize how SDOH impact patients. The WellNest Housing Support Program (WellNest) was conceived and developed by Duke University medical students to learn from and support community members with a history of housing insecurity. APPROACH: Under the supervision of community organizations providing housing assistance services, WellNest was created in April 2020. Medical student-volunteers (MSVs) call clients, who are referred to WellNest by the community organizations, to plan move-ins. Local experts provide trainings on topics relevant to health care for individuals experiencing loss of housing. MSVs source and move furniture and clients' belongings into the new homes. Following move-in, MSVs are paired with clients to provide longitudinal tenancy support for at least one year. Student-volunteers contemplate their experiences and learning takeaways through debriefing sessions and an optional online survey. OUTCOMES: From fall 2021 to spring 2023, 83 student-volunteers from across the university participated in WellNest. Student-volunteers were generally medical students (37, 45%), and 16 MSVs served on the leadership team. WellNest facilitated 29 move-ins, and 26 clients requested to be paired with MSVs for longitudinal tenancy support. Following participation in WellNest, student-volunteers reported increased comfort, awareness, knowledge, and motivation related to caring for, discussing, and advocating for individuals experiencing housing insecurity. NEXT STEPS: As students from other programs are also interested in WellNest, there is potential for interprofessional education. Student-volunteers will be encouraged to participate in additional opportunities for reflection and advocacy activities. The impact of WellNest on clients will be explored through a questionnaire and narrative interviews. Long-term financial support was secured from community donations and partnering community organizations.

15.
Health Promot Pract ; 13(1): 63-70, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-20439470

RESUMEN

Acute stroke is often a treatable condition; however, intervention is time dependent and typically should ensue within 3 hr from onset of symptoms. The ability of individuals to understand stroke risk factors to reduce individual risk and to recognize warning signs and symptoms of stroke as signals to initiate medical care is paramount to decreasing stroke-related morbidity and mortality. This descriptive study presents ethnic and racial differences of baseline stroke knowledge among residents (n = 1,904) of two North Carolina counties situated in the Stroke Belt. Findings suggest a global stroke knowledge deficit that is more pronounced among Hispanics. Future community stroke education campaigns need to consider various educational mediums and outlets to ensure inclusion of persons at highest risk for stroke. Suggestions are provided for possible content of future stroke knowledge and prevention campaigns.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Accidente Cerebrovascular/etnología , Adulto , Anciano , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , North Carolina , Grupos Raciales
16.
J Health Care Poor Underserved ; 33(3): 1337-1352, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36245167

RESUMEN

People experiencing homelessness (PEH) have a high prevalence of mental illness and substance use disorder (SUD) and substantial acute and chronic disease burden. Transitional care and medical respite programs facilitate a safe transfer for PEH from the acute care to community setting. Many medical respite programs practice harm reduction strategies that can increase the opportunity for positive program outcomes for PEH with SUD. This transitional care and medical respite program evaluation explored program outcomes, health care utilization patterns, and comorbid conditions of persons with and without SUD. People experiencing homelessness with SUD had similar program outcomes and both groups had decreased acute care utilization after program engagement. A high prevalence of trimorbidity, which is associated with early mortality, was noted. Opportunities for harm reduction strategies to promote both social and clinical outcomes are offered.


Asunto(s)
Personas con Mala Vivienda , Trastornos Relacionados con Sustancias , Cuidado de Transición , Humanos , Aceptación de la Atención de Salud , Cuidados Intermitentes , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/terapia
17.
J Addict Nurs ; 32(2): 152-158, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34060767

RESUMEN

BACKGROUND: Drug use, specifically opioid use, is a public health crisis in the United States. Harm reduction programs, including syringe service programs, show efficacy in improving individual and public health outcomes. Healthcare provider perceptions are an important initial assessment when considering implementing a syringe service program. OBJECTIVE: The objective of this quality improvement project, completed in a Northeastern Veterans Affairs Medical Center (NEVAMC), was to lay the groundwork for implementation of a syringe service program. METHODS: This multiphase project included an initial needs assessment with stakeholders to determine the scope of substance use disorder within the facility and initiated the change process needed for syringe service program implementation. We administered an online survey, the Drug and Drug Problems Perceptions Questionnaire (DDPPQ), to better understand staff perspectives of and comfort in working with people who use drugs. Two educational modules were developed and conducted for staff to increase their knowledge, skills, and trauma-informed practices when working with people who use drugs. Standardized document templates for program implementation in federal systems were also developed. RESULTS: The needs assessment identified 266 patients who could benefit from expanded harm reduction services and a recognition that staff perception be assessed within the facility. The DDPPQ, completed by 153 staff members, indicated positive perceptions of people who use drugs and ability to counsel/treat people who use drugs. The median DDPPQ total score was 73, indicative of an overall positive perception. Sixty-eight staff members attended the initial education session, and 35 attended the second session designed specifically for mental health service line professionals. CONCLUSION: The findings indicate NEVAMC staff members have a high level of comfort working with people who use drugs. The staff educational programs were well received and have become a part of routine staff training at the NEVAMC. The standardized document templates are available for persons developing a syringe service program within a federal system.


Asunto(s)
Trastornos Relacionados con Sustancias , Jeringas , Personal de Salud/educación , Humanos , Programas de Intercambio de Agujas , Evaluación de Necesidades , Encuestas y Cuestionarios , Estados Unidos
18.
Front Psychiatry ; 12: 780366, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34987429

RESUMEN

Background: People experiencing homelessness face significant medical and psychiatric illness, yet few studies have characterized the effects of multimorbidity within this population. This study aimed to (a) delineate unique groups of individuals based on medical, psychiatric, and substance use disorder profiles, and (b) compare clinical outcomes across groups. Methods: We extracted administrative data from a health system electronic health record for adults referred to the Durham Homeless Care Transitions program from July 2016 to June 2020. We used latent class analysis to estimate classes in this cohort based on clinically important medical, psychiatric and substance use disorder diagnoses and compared health care utilization, overdose, and mortality at 12 months after referral. Results: We included 497 patients in the study and found 5 distinct groups: "low morbidity" (referent), "high comorbidity," "high tri-morbidity," "high alcohol use," and "high medical illness." All groups had greater number of admissions, longer mean duration of admissions, and more ED visits in the 12 months after referral compared to the "low morbidity" group. The "high medical illness" group had greater mortality 12 months after referral compared to the "low morbidity" group (OR, 2.53, 1.03-6.16; 95% CI, 1.03-6.16; p = 0.04). The "high comorbidity" group (OR, 5.23; 95% CI, 1.57-17.39; p < 0.007) and "high tri-morbidity" group (OR, 4.20; 95% CI, 1.26-14.01; p < 0.02) had greater 12-month drug overdose risk after referral compared to the referent group. Conclusions: These data suggest that distinct groups of people experiencing homelessness are affected differently by comorbidities, thus health care programs for this population should address their risk factors accordingly.

19.
Creat Nurs ; 27(4): 278-284, 2021 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-34903635

RESUMEN

PURPOSE: To better understand clinic attendees' perceptions of nonsterile glove (NSG) use during vaccination and their concern for the environment. DESIGN: This was a cross-sectional, self-administered, in-person survey. METHODS: A nonrandom volunteer sample of vaccination clinic attendees (n = 789) completed a survey assessing their perception of NSG use during influenza vaccination administration and their concern for the environment. FINDINGS: Nearly all respondents equated NSG use with increased safety and professionalism. More than half of respondents reported feeling concerned about environmental waste associated with NSG use. CONCLUSIONS: NSG are not indicated for routine vaccination. Adherence to evidence-based practices on NSG use during vaccination can substantially reduce associated medical waste. Nurses can lead by example by only using NSG when indicated.


Asunto(s)
Gripe Humana , Vacunación , Estudios Transversales , Conocimientos, Actitudes y Práctica en Salud , Humanos , Encuestas y Cuestionarios
20.
Prog Community Health Partnersh ; 15(1): 59-64, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33775961

RESUMEN

The connection between health and housing is well-established. People who are precariously housed have worse health than those who have stable housing arrangements.- Persons moving into public housing have a higher illness burden than the general population, and public housing residents engage in less healthy behaviors, which contribute to public housing residents having poorer health than persons living in other housing situations. Public housing authorities and residents can benefit from authentic and constructive relationships with academic partners; academicians and students can benefit from engaging in partnerships with housing authorities and residents to better understand the connection between housing and health. This article describes the well-established relationship between the Duke University School of Nursing (DUSON) and the Durham Housing Authority (DHA), the evolution of that relationship, our collaborative work in improving the health of DHA residents while advancing nursing education and science, and lessons learned.


Asunto(s)
Vivienda Popular , Facultades de Enfermería , Investigación Participativa Basada en la Comunidad , Humanos
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