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美国为无家可归人群使用流动医疗单元:范围综述。

The Use of Mobile Medical Units for Populations Experiencing Homelessness in the United States: A Scoping Review.

机构信息

Yale University School of Medicine, New Haven, CT, USA.

Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.

出版信息

J Gen Intern Med. 2024 Jun;39(8):1474-1487. doi: 10.1007/s11606-024-08731-9. Epub 2024 Mar 25.

Abstract

With annual point-in-time counts indicating a rise in unsheltered homelessness in the United States, much attention has been paid to how to best provide care to this population. Mobile medical units (MMUs) have been utilized by many programs. However, little is known regarding the evidence behind their effectiveness. A scoping review is conducted of research on MMU provision of medical services for populations experiencing homelessness in the USA to examine the extent and nature of research activity, summarize available evidence, and identify research gaps in the existing literature. Following guidelines for scoping reviews, PubMed and Google Scholar were used to identify an initial 294 papers published from January 1, 1980, to May 1, 2023, using selected keywords, which were distilled to a final set of 50 studies that met eligibility criteria. Eligible articles were defined as those that pertain to the provision of healthcare (inclusive of dental, vision, and specialty services) to populations experiencing homelessness through a MMU in the United States and have been published after peer review. Of the 50 studies in the review, the majority utilized descriptive (40%) or observational methods (36%), with 4 review and 8 controlled studies and no completed randomized controlled trials. Outcome measures utilized by studies include MMU services provided (58%), patient demographics (34%), health outcomes (16%), patient-centered measures (14%), healthcare utilization (10%) and cost analysis (6%). The studies that exist suggest MMUs can facilitate effective treatment of substance use disorders, provision of primary care, and services for severe mental illness among people experiencing homelessness. MMUs have potential to provide community-based healthcare services in settings where homeless populations reside, but the paucity of randomized controlled trials indicates further research is needed to understand if MMUs are more effective than other care delivery models tailored to populations experiencing homelessness.

摘要

随着美国无家可归者人数的年度实时统计数据显示出上升趋势,人们越来越关注如何为这一人群提供最佳护理。许多项目都利用了移动医疗单位 (MMU)。然而,对于它们的有效性背后的证据知之甚少。本研究对美国为无家可归者提供医疗服务的 MMU 供应研究进行了范围综述,以检查研究活动的范围和性质,总结现有证据,并确定现有文献中的研究空白。根据范围综述指南,使用 PubMed 和 Google Scholar 从 1980 年 1 月 1 日至 2023 年 5 月 1 日,使用选定的关键词,共识别出 294 篇初始论文,经过筛选后最终确定了 50 篇符合入选标准的研究。符合条件的文章被定义为通过 MMU 在美国为无家可归者提供医疗保健(包括牙科、视力和专科服务)并经过同行评审后发表的文章。在本综述的 50 项研究中,大多数研究采用描述性(40%)或观察性方法(36%),有 4 项综述和 8 项对照研究,没有完成的随机对照试验。研究中使用的结果衡量标准包括 MMU 提供的服务(58%)、患者人口统计学特征(34%)、健康结果(16%)、以患者为中心的措施(14%)、医疗保健利用情况(10%)和成本分析(6%)。现有的研究表明,MMU 可以有效地治疗药物使用障碍、提供初级保健服务,并为无家可归者中的严重精神疾病患者提供服务。MMU 有可能在无家可归者居住的社区环境中提供基于社区的医疗保健服务,但缺乏随机对照试验表明,需要进一步研究以了解 MMU 是否比针对无家可归者的其他护理模式更有效。

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