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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.
This will help to establish confidence and mutual trust and encourage the patient to return to the physician's office.
Once trust and rapport are established, visits can focus on identifying an emergency contact and discussing the patient's more challenging social, medical, and mental health problems, and end-of-life issues.
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.
Lifestyle modification usually does not work.2631Approximately 20% to 30% of homeless persons have a mental illness, whereas 30% to 50% have either substance abuse or dual disorders.32 Major depression, bipolar disorder, and schizophrenia are common.
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.
Based on these factors, homeless persons tend to present with advanced disease, and the approach to therapy is different depending on each person's situation.2628Uncontrolled hypertension, coronary artery disease, congestive heart failure, and peripheral vascular disease are common in homeless persons. Understanding the special health care needs of elderly persons who are homeless.
Homeless persons are more likely to become ill, have greater hospitalization rates, and are more likely to die at a younger age than the general population.
The average life span for a homeless person is between 42 and 52 years.
After completing the initial assessment, physicians should take into account the logistical complexities of developing an appropriate treatment plan for these patients.
Making referrals, scheduling follow-up appointments, and monitoring laboratory tests and response to therapy are challenging because of the lack of dependable communication and transportation.The Mini-Mental State Examination, Traumatic Brain Injury Questionnaire, and Repeatable Battery for the Assessment of Neuropsychological Status are useful in evaluating these patients.35 Cognitive rehabilitation is designed to maximize cognitive functioning and reduce functional impairment.36 In addition to performing the initial evaluation and confirming the diagnosis, family physicians can identify and treat specific conditions that commonly occur in these patients (i.e., anxiety, shortened attention span, dementia, depression, headaches, insomnia, and seizures).