Zuccaro Laura, Champion Caitlin, Bennett Sean, Ying Yvonne
From the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Zuccaro, Champion, Bennett, Ying); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Champion, Bennett, Ying); and the Children’s Hospital of Eastern Ontario and The Ottawa Hospital, Ottawa, Ont. (Ying).
Can J Surg. 2018 Dec 1;61(6):424-429. doi: 10.1503/cjs.001317.
The use of outpatient health care services by homeless people is low compared to their high level of need; however, it is unclear whether this applies to surgical care. We sought to describe surgical care access among homeless patients in a Canadian tertiary care setting.
We reviewed the medical records of adult (age > 18 yr) patients with no fixed address or a shelter address who presented to The Ottawa Hospital Emergency Department from Jan. 1, 2013, to Dec. 31, 2014, and required surgical referral. We analyzed the data using descriptive statistics.
A surgical referral was initiated in 129 emergency department visits for 97 patients (77 men [79%], mean age 46.7 yr). Most patients lived in shelters (77 [79%]) and had provincial health insurance (82 [84%]), but only 35 (36%) had a primary care physician. The mean number visits for any reason was 7.9 (standard deviation 13.7) (range 1–106). The majority of surgical referrals (83 [64.3%]) were for traumatic injuries, and the most frequently consulted service (52 [40.3%]) was orthopedic surgery. Just under half (48 [49%]) of referred patients attended at least 1 outpatient appointment, and only a third (33 [34%]) completed full follow-up.
Homeless patients presenting to an emergency department and requiring surgical care were predominantly men living in shelters, most frequently seeking care for traumatic injuries. Current outpatient services may not meet the surgical care needs of these patients, as many do not access them. Alternative approaches to outpatient care must be considered, particularly among high-need services such as orthopedics, to support surgical care access among this population.
与无家可归者的高需求相比，他们对门诊医疗服务的利用率较低；然而，这是否适用于外科护理尚不清楚。我们试图描述加拿大三级医疗环境中无家可归患者的外科护理可及性。
我们回顾了2013年1月1日至2014年12月31日期间前往渥太华医院急诊科、无固定住址或居住在收容所且需要外科转诊的成年（年龄>18岁）患者的病历。我们使用描述性统计分析数据。
97名患者（77名男性[79%]，平均年龄46.7岁）的129次急诊科就诊启动了外科转诊。大多数患者居住在收容所（77名[79%]）并拥有省级医疗保险（82名[84%]），但只有35名（36%）有初级保健医生。因任何原因的平均就诊次数为7.9次（标准差13.7）（范围1 - 106次）。大多数外科转诊（83名[64.3%]）是因创伤性损伤，最常咨询的科室（52名[40.3%]）是骨科手术。近一半（48名[49%]）的转诊患者至少参加了1次门诊预约，只有三分之一（33名[34%]）完成了全程随访。
前往急诊科且需要外科护理的无家可归患者主要是居住在收容所的男性，最常因创伤性损伤寻求治疗。当前的门诊服务可能无法满足这些患者的外科护理需求，因为许多患者无法获得这些服务。必须考虑门诊护理的替代方法，特别是在骨科等高需求科室，以支持该人群获得外科护理。
