Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Department of Medicine at the Cpl. Michael Crescenz VA Medical Center, U.S. Department of Veterans Affairs, Philadelphia, PA, USA.
Health Soc Care Community. 2020 Jan;28(1):91-99. doi: 10.1111/hsc.12843. Epub 2019 Sep 2.
In the United States and abroad, health systems have begun to address housing insecurity through programs that adhere to the Housing First model. The model provides permanent supportive housing without disqualification due to current mental health problems or substance use, along with optional case management services. This study used qualitative methods to explore how housing stability affected chronic disease management and social and community relationships among individuals with complex health and social needs and patterns of high hospital utilisation who were housed as part of a scattered-site Housing First program in a mid-size city in the northeastern United States. 26 individual, semi-structured interviews were conducted with Housing First clients in their homes or day program sites between March and July 2017. Interviews were digitally recorded and transcripts were analysed using a qualitative descriptive methodology until thematic saturation was reached. Findings suggest that housing provided the physical location to manage the logistical aspects of care for these clients, and an environment where they were better able to focus on their health and wellness. Study participants reported less frequent use of emergency services and more regular interaction with primary care providers. Additionally, case managers' role in connecting clients to behavioural health services removed barriers to care that clients had previously faced. Housing also facilitated reconnection with family and friends whose relationships with participants had become strained or distant. Changes to physical and social communities sometimes resulted in experiences of stigmatisation and exclusion, especially for clients who moved to areas with less racial and socioeconomic diversity, but participation in the program promoted an increased sense of safety and security for many clients.
在美国和国外，卫生系统已经开始通过遵循“先住后付”模式的项目来解决住房无保障问题。该模式提供永久性的支持性住房，不会因当前的心理健康问题或药物使用问题而取消资格，并提供可选的个案管理服务。本研究采用定性方法，探讨了住房稳定如何影响患有复杂健康和社会需求以及高住院利用模式的个体的慢性病管理以及社会和社区关系，这些个体是作为美国东北部一个中等城市的分散式“先住后付”住房项目的一部分得到安置的。2017 年 3 月至 7 月期间，在住房第一客户的家中或日间项目地点对 26 名客户进行了个人、半结构化访谈。访谈以数字方式记录，使用定性描述性方法对记录和转录进行分析，直到达到主题饱和度。调查结果表明，住房为这些客户提供了管理护理后勤方面的物理位置，并为他们提供了一个更好地关注健康和健康的环境。研究参与者报告说，他们较少使用紧急服务，更多地定期与初级保健提供者互动。此外，个案经理在将客户与行为健康服务联系起来方面的作用消除了客户以前面临的护理障碍。住房还促进了与家人和朋友的重新联系，这些人的关系变得紧张或疏远。物理和社会社区的变化有时会导致污名化和排斥的经历，特别是对于那些搬到种族和社会经济多样性较少的地区的客户，但许多客户参与该计划后，会感到更安全。
