Health Care Needs of Homeless Older Adults:: Examining the Needs of a Senior Center Cohort.

OBJECTIVES: To assess the medical status and health care needs of Wilmington's largest accessible group of homeless elders located at St. Patrick's Center in order to identify areas for improvement of medical screening, preventive health care delivery, and disease management. METHODS: A cross sectional study was conducted between December 2016 and August 2018 at St. Patrick's center in Wilmington, DE. Utilizing a structured health needs assessment, 64 unique individuals aged 50 years and older were interviewed. Descriptive statistics were used to compare data from homeless older adults with data from non-homeless older adults. RESULTS: Of the 64 total subjects, 17 self-reported as homeless at the time of interviewing. High rates of depressive and cognitive impairment symptoms were self-reported in both homeless and non-homeless participants. When compared to the non-homeless group at St. Patrick's Center, the homeless cohort was less likely to have received a non-acute assessment (such as a routine physical exam/well check-up) or a routine dental cleaning/x-ray within the past year. Tobacco and alcohol use and were frequently self-reported by homeless and non-homeless respondents and were more frequent in the homeless group. The homeless individuals were more likely to have engaged in illicit drug use. Overall, more than 90% of the subjects had some form of health insurance coverage. The most frequently cited reasons for lack of healthcare were inability to afford co-payments/deductibles and lack of transportation. CONCLUSIONS: To address the health care needs of this population, new programs to improve care should focus on facilitating access to services which address areas of deficiency. This group of older adults has benefited from a range of available services that reflect the work of a staff aware of their medical needs, as indicated by the high rate of insured individuals. Licit and illicit substance use assessment and treatment and dental screening remain areas of need for the homeless older adults interviewed in this study. The high rates of depression and cognitive impairment in both the homeless and non-homeless older adult groups suggest the need for further services in these areas as well. Access to care may be improved by addressing concerns regarding co-payments, deductibles, and transportation to care.

Statewide Antibiotic Stewardship: : An eBrightHealth Choosing Wisely Initiative.

OBJECTIVE: To implement a collaborative statewide antibiotic stewardship initiative in both the ambulatory and inpatient settings. METHODS: Five participating Delaware health systems each convened internal team(s) to translate the vision set forth by the eBrightHealth LLC Choosing Wisely Work Group into clinical action through process improvement efforts at their institutions. The teams focused on implementing antibiotic time-outs, and on improving antibiotic prescribing for upper respiratory infections in ambulatory settings. The learning network utilized an "all teach, all learn" methodology via monthly conference calls and quarterly face-to-face meetings. RESULTS: All inpatient teams implemented antibiotic time-outs for at least 1 unit. Other interventions included commitment posters; submitting antibiotic utilization data nationally; provider/patient surveys; local stewardship champions; and provider prescribing data feedback. Barriers to implementation included competing priorities, lack of reliable utilization data, and suboptimal provider engagement. Overall antibiotic utilization decreased by 9%, compared to the pre-intervention period. CONCLUSIONS: This initiative has demonstrated the value of multidisciplinary teams, from varying healthcare systems, coming together to work on a single project. While each team's interventions and specific goals differed slightly, all teams implemented new initiatives to promote appropriate use of antibiotics. POLICY IMPLICATIONS: Antibiotic stewardship is a national priority. Acute care hospitals are required to have antibiotic stewardship programs; similar programs are proposed for ambulatory settings.