National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, 20892, USA.
Hawaii Health & Harm Reduction Center, Honolulu, HI, USA.
J Epidemiol Glob Health. 2023 Dec;13(4):604-614. doi: 10.1007/s44197-023-00157-6. Epub 2023 Oct 17.
Wound care management for unhoused individuals is challenging due to the lack of healthcare infrastructure to handle the unique needs of this population. Therefore, we aimed to obtain insights for best practices and to establish a care clinic that is low threshold, community-based and meets the needs of unhoused people. We employed two approaches: (1) conduct a targeted narrative review of the literature of existing or proposed community-based program models that can address the wound care needs of unhoused individuals, and (2) assess cost-effectiveness and describe the results of a survey administered to unhoused clients and their health care providers at a community-based wound care program in Honolulu, Hawai'i. The literature search and screening yielded 11 articles relevant to the topic. Per the literature, existing community-based healthcare programs were successful when: (1) wound care services were incorporated into a broader social/health program, (2) cost-effective, and (3) comprehensive services were provided. Survey results in Honolulu found that the wound care program matched the needs of the targeted population and was cost-effective. Difficulty in following clients until wound closure and the sustainability of the program, particularly the lack of insurance reimbursement for street-based services, were perceived challenges. Additionally, the lack of insurance reimbursement for street-based wound care services continues to impact sustainability. Community-based programs can be successful in addressing the wound care needs of unhoused individuals if they address complex fundamental issues. This paper highlights existing gaps in logistics and policies that must be addressed to meet the specific medical needs of these vulnerable individuals.
由于缺乏医疗基础设施来满足这一人群的独特需求，无家可归者的伤口护理管理具有挑战性。因此，我们旨在获得最佳实践的见解，并建立一个低门槛、以社区为基础且满足无家可归者需求的护理诊所。我们采用了两种方法：（1）对现有的或拟议的以社区为基础的项目模式进行有针对性的叙事文献综述，这些模式可以满足无家可归者的伤口护理需求；（2）评估成本效益，并描述在夏威夷火奴鲁鲁的一个以社区为基础的伤口护理计划中对无家可归者客户及其医疗保健提供者进行的调查结果。文献检索和筛选产生了 11 篇与主题相关的文章。根据文献，现有的以社区为基础的医疗保健项目在以下情况下取得了成功：（1）将伤口护理服务纳入更广泛的社会/健康项目；（2）具有成本效益；（3）提供全面的服务。在火奴鲁鲁的调查结果发现，伤口护理计划符合目标人群的需求，并且具有成本效益。直到伤口愈合为止，跟踪客户的困难以及该计划的可持续性，特别是缺乏对街头服务的保险报销，被认为是挑战。此外，缺乏对街头伤口护理服务的保险报销继续影响可持续性。如果以社区为基础的项目能够解决无家可归者的伤口护理需求，那么它们就能解决复杂的基本问题。本文强调了物流和政策方面存在的差距，必须解决这些差距，以满足这些脆弱人群的特定医疗需求。
