Strengths, challenges, and gaps in linkage to primary care among hospitalized individuals who are homeless in Vancouver, British Columbia

ABSTRACT

Individuals who are homeless in the Canadian city of Vancouver, British Columbia have an increasing burden of chronic medical conditions, resulting in rising use of hospital services. Although continued efforts have been made to improve accessibility, barriers to primary care linkage and utilization still exist. Our study explored the strengths, barriers, and gaps in how inpatients who are homeless are connected to primary care through semi-structured qualitative interviews with patients (n = 22) and healthcare providers (n = 7) with experience in caring for patients who are homeless. Patients identified cell phone ownership and use of commitment devices as strengths, while clinics with long wait times, or those proximal to areas of prevalent drug use, were seen as barriers. Providers perceived that low priority was given to primary care linkage within hospitals, and that early and bidirectional communication with hospital staff is vital, particularly around discharge planning. Patients and providers then identified major gaps in service, which included a need for peer health navigation, technology-assisted outreach, and improved service distribution.

KEYWORDS:

• Homeless persons
• primary health care
• health services accessibility
• health care transition
• continuity of patient care

Acknowledgements

Our team would like to extend our heartfelt thanks to Karen Custodio, Dr. Vesna Mihajlovic, Dr. Todd Sakakibara, and the nursing and social work teams from the Medicine Program at St. Paul’s Hospital, who helped us recruit participants for our study. We would also like to thank each of our patient and provider participants for volunteering their time to share their experiences with us.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Alec Yu is a medical student at the University of British Columbia Faculty of Medicine in Vancouver, Canada. A passionate problem-solver, Alec loves combining his interests with his lived experiences to start grassroots initiatives in his community. His current projects span three distinct themes: housing and homelessness, environmental sustainability in the medical system, and student advocacy.

Anne Gadermann is an Assistant Professor at the Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, and Research Scientist at the Centre for Health Evaluation and Outcomes Sciences (CHEOS), Providence Health Care Research Institute. Her research focuses on examining the social determinants of physical and mental health and well-being in populations across the lifespan, including individuals who are homeless or vulnerably housed.

Anita Palepu, MD, MPH, FRCPC, MACP, is a Professor of Medicine and head of the Division of Internal Medicine, University of British Columbia in Vancouver, BC, Canada. She works as a general internist at St. Paul’s Hospital in Vancouver. She conducts her research at the Centre for Health Evaluation and Outcome Sciences (CHEOS) and has a research program that falls under the broad umbrella of urban health research with particular interest in vulnerable populations such as homeless persons and drug users. She is an associate editor for the Annals of Internal Medicine.