Cyprus I G, Holleman W L
Department of Family Medicine, Baylor College of Medicine, Houston, TX.
Fam Med. 1994 Apr;26(4):217-20.
With their interest in providing continuous, comprehensive care, family physicians are well-suited to treat persons who are homeless. Yet family practice residents most frequently encounter homeless patients in crowded public hospitals where time constraints and competing philosophies of patient care create suboptimal conditions and encourage the development of cynical attitudes and behavior patterns. EDUCATIONAL INTERVENTION: To address these problems, the Department of Family Medicine at Baylor College of Medicine in Houston developed a homeless visit program in which second-year residents spent one half day at a day center for the homeless. Residents interview the center's homeless clients, address their medical and psychosocial problems, and review each client's case with a faculty physician. Residents have the opportunity to explore the underlying causes of homelessness, the impact of homelessness on clients' health and well-being, and the bureaucratic barriers that homeless individuals must overcome to regain entry into the health care system.
After the first year, the program was evaluated to assess whether its original objectives had been met. Each of the second-year residents reported that the experience had been worthwhile. They recommended that the program expand the number of half days spent with homeless patients and the ancillary personnel, equipment, and supplies available. Each of these changes has been implemented and the program continues to thrive and improve.
The homeless visit serves as a successful model for resident programs willing to devote as little as a half day in a 3-year curriculum toward training residents to better understand the intricate relationship between homelessness, physical and emotional needs, and an environment that simultaneously promotes illness and hinders medical attention.
鉴于家庭医生热衷于提供持续、全面的护理，他们非常适合治疗无家可归者。然而，家庭医学住院医师最常在拥挤的公立医院遇到无家可归的患者，在那里，时间限制和相互冲突的患者护理理念造成了不理想的状况，并助长了愤世嫉俗的态度和行为模式的形成。
为了解决这些问题，休斯顿贝勒医学院家庭医学系开展了一项无家可归者探访计划，二年级住院医师在一家无家可归者日间中心待半天。住院医师会与该中心的无家可归者客户进行面谈，解决他们的医疗和心理社会问题，并与一位教员医生一起回顾每个客户的病例。住院医师有机会探究无家可归的根本原因、无家可归对客户健康和幸福的影响，以及无家可归者为重新进入医疗保健系统必须克服的官僚障碍。
在第一年之后，对该项目进行了评估，以评估其最初目标是否实现。每位二年级住院医师都表示这段经历很有价值。他们建议该项目增加与无家可归患者相处的半天时间，并增加辅助人员、设备和物资。这些改变都已实施，该项目继续蓬勃发展并不断改进。
对于那些愿意在三年课程中抽出短短半天时间来培训住院医师，使其更好地理解无家可归、身体和情感需求以及一个既助长疾病又阻碍医疗关注的环境之间复杂关系的住院医师项目来说，无家可归者探访计划是一个成功的模式。
