Health & Healthcare

Homelessness is detrimental to health, and clinicians can play an essential role in mitigating the deleterious effects of homelessness. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, discusses this and more with JAMA Senior Editor Karen E. Lasser, MD, MPH. Dr. Kushel said, "When you are an individual provider, in a room, you are trying to understand the difficult environmental conditions that your patient has and do things to decrease that part."

People experiencing homelessness have worse mental and physical health than the general population. They also have limited access to primary care for reasons including the absence of health insurance, lack of money for co-payments or transportation, and communication barriers. In this JAMA Insights, researchers examine the adverse effects of homelessness on physical and mental health and suggest strategies to improve access to care.

Unhoused patients have worse surgical outcomes than the general population, resulting in premature mortality. Researchers conducted 26 semi-structured interviews of clinicians who care for patients with surgical disease. The researchers identified 5 themes, including, but not limited to: patients and clinicians face multiple challenges meeting preoperative requirements; although surgeons do not make major operative decisions based on housing status, some take it into consideration for minor care decisions; clinicians perceive that unhoused patients have negative postoperative experiences in the hospital.

In a cohort of over 100,000 patients who received care from the Department of Veterans Affairs (VA) health system, those experiencing homelessness were more likely to be diagnosed with stage IV colorectal cancer compared with those who had housing. The patients who experienced homelessness also had longer hospital stays for all the cancer types studied. However, the findings differed across healthcare settings. In a commentary accompanying the study, Maria C. Raven, MD, MPH, associate Professor and Chief of Emergency Medicine at UCSF, said "Reducing healthcare disparities for people experiencing homelessness is essential, and the [VA] can serve as an example of what it takes to do so."