Trent University, Peterborough, Ontario, Canada.
J Prim Care Community Health. 2020 Jan-Dec;11:2150132720910289. doi: 10.1177/2150132720910289.
To determine how accessible health care services are for people who are experiencing homelessness and to understand from their perspectives what impact clinician bias has on the treatment they receive. Narrative interviews were conducted with 53 homeless/vulnerably housed individuals in Ontario, Canada. Visit history records were subsequently reviewed at 2 local hospitals, for 52 of the interview participants. Of the 53 participants only 28% had a primary care provider in town, an additional 40% had a provider in another town, and 32% had no access to a primary care provider at all. A subset of the individuals were frequent emergency department users, with 15% accounting for 75% of the identified hospital visits, primarily seeking treatment for mental illness, pain, and addictions. When seeking primary care for these 3 issues participants felt medication was overprescribed. Conversely, in emergency care settings participants felt prejudged by clinicians as being drug-seekers. Participants believed they received poor quality care or were denied care for mental illness, chronic pain, and addictions when clinicians were aware of their housing status. Mental illness, chronic pain, and addictions issues were believed by participants to be poorly treated due to clinician bias at the primary, emergency, and acute care levels. Increased access to primary care in the community could better serve this marginalized population and decrease emergency department visits but must be implemented in a way that respects the rights and dignity of this patient population.
为了确定无家可归者获得医疗服务的便利性，并从他们的角度了解临床医生的偏见对他们所接受的治疗的影响。 在加拿大安大略省对 53 名无家可归/脆弱住房的个人进行了叙述性访谈。随后在 2 家当地医院对 52 名访谈参与者的就诊记录进行了回顾。在 53 名参与者中，只有 28%的人在镇上有初级保健提供者，另外 40%的人在另一个城镇有提供者，32%的人根本无法获得初级保健提供者。这些人中有一部分是经常使用急诊室的人，其中 15%的人占已确定的医院就诊次数的 75%，主要是为治疗精神疾病、疼痛和成瘾寻求治疗。当这些 3 个问题的参与者寻求初级保健时，他们觉得药物开得过多。相反，在急诊环境中，参与者感到临床医生对他们有偏见，认为他们是寻求药物的人。当临床医生了解他们的住房状况时，参与者认为他们因住房状况而得不到精神疾病、慢性疼痛和成瘾的高质量护理或被拒绝护理。参与者认为，由于初级、急诊和急性护理各级的临床医生的偏见，他们的精神疾病、慢性疼痛和成瘾问题治疗不佳。增加社区初级保健的可及性可以更好地为这一边缘化人群服务，并减少急诊就诊次数，但必须以尊重这一患者群体的权利和尊严的方式实施。
