The Role of the Emergency Department in the Care of Homeless and Disadvantaged Populations

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An overview of social deprivation among ED patients

Despite the development of outreach programs such as Health Care for the Homeless, many of the most disadvantaged individuals in our society rely on EDs for medical care [4], [5], [6], [7], [8]. A Los Angeles study of the homeless found that only 57% had any contact with medical care, and 23% of those used the local ED as their primary point of care [9]. In San Francisco, 40% of homeless and “marginally housed” individuals surveyed had used the ED in the past year, a rate three times higher

Epidemiology of homelessness

A homeless person lacks a stable nighttime residence and usually lives in temporary accommodations. Temporary living accommodations include shelters, community institutions, and open places not intended for regular sleeping accommodations [14]. Homelessness is the consequence of a number of factors, including poverty and the lack of low-cost housing, the absence of social plans, and insufficient general health and public services [15], [16].

The Urban Institute estimates that 3.5 million people,

Integrating health and human services in the ED

A 2001 study of mortality among the homeless in Boston discovered that 21% of the homeless had contact with medical care within 1 month before death, and 21% had greater than six contacts [37]. For many of these disadvantaged patients, the ED is their primary or only health care site [13]. Clearly, the isolated provision of medical care in this setting is not enough to interrupt the cycle of poverty and illness.

However, since the ED is a high-cachment area for disadvantaged individuals, it is

Summary

Homelessness and social deprivation is widespread among ED patients. Organized emergency medicine can have a significant impact on total community health by maintaining a universal “safety net” for the delivery of integrated health and human services. Cost-effective approaches to socio-medical integration in the ED are not only feasible, but are critical to promoting the health and welfare of homeless and other disadvantaged populations.

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