Understanding the surgical care needs and use of outpatient surgical care services among homeless patients at the Ottawa Hospital

Understanding the surgical care needs and use of outpatient surgical care services among homeless patients at the Ottawa Hospital

Can J Surg 2018;61(6):424-429 | PDF

Laura Zuccaro, MD; Caitlin Champion, MD, MSc; Sean Bennett, MD, MSc; Yvonne Ying, MD, MSE, MEd

Abstract

Background: The use of outpatient health care services by homeless people is low compared to their high level of need; however, it is unclear whether this applies to surgical care. We sought to describe surgical care access among homeless patients in a Canadian tertiary care setting.

Methods: We reviewed the medical records of adult (age > 18 yr) patients with no fixed address or a shelter address who presented to The Ottawa Hospital Emergency Department from Jan. 1, 2013, to Dec. 31, 2014, and required surgical referral. We analyzed the data using descriptive statistics.

Results: A surgical referral was initiated in 129 emergency department visits for 97 patients (77 men [79%], mean age 46.7 yr). Most patients lived in shelters (77 [79%]) and had provincial health insurance (82 [84%]), but only 35 (36%) had a primary care physician. The mean number visits for any reason was 7.9 (standard deviation 13.7) (range 1–106). The majority of surgical referrals (83 [64.3%]) were for traumatic injuries, and the most frequently consulted service (52 [40.3%]) was orthopedic surgery. Just under half (48 [49%]) of referred patients attended at least 1 outpatient appointment, and only a third (33 [34%]) completed full follow-up.

Conclusion: Homeless patients presenting to an emergency department and requiring surgical care were predominantly men living in shelters, most frequently seeking care for traumatic injuries. Current outpatient services may not meet the surgical care needs of these patients, as many do not access them. Alternative approaches to outpatient care must be considered, particularly among high-need services such as orthopedics, to support surgical care access among this population.

Résumé

Contexte : L’utilisation des services de santé ambulatoires par les sans-abri est faible si on la compare à leurs besoins qui sont élevés; on ignore par contre s’il en va de même pour les soins chirurgicaux. Nous avons voulu décrire l’accès aux soins chirurgicaux chez les patients sans domicile fixe dans un hôpital de soins tertiaires au Canada.

Méthodes : Nous avons passé en revue les dossiers médicaux de patients adultes (âge > 18 ans) sans domicile fixe ayant consulté aux urgences de l’Hôpital d’Ottawa entre le 1er janvier 2013 et le 31 décembre 2014, et pour qui une consultation en chirurgie avait été demandée. Nous avons analysé les données au moyen de statistiques descriptives.

Résultats : Une consultation en chirurgie a été demandée lors de 129 visites aux urgences, pour 97 patients (77 hommes [79 %], âge moyen 46,7 ans). La plupart de ces patients vivaient dans des refuges (77 [79 %]) et bénéficiaient d’un régime d’assurance maladie provincial (82 [84 %]), mais seulement 35 (36 %) avaient un médecin de famille. Le nombre moyen de visites, toutes raisons confondues, a été de 7,9 (écart-type 13,7) (entre 1 et 106). La majorité des demandes de consultations en chirurgie (83 [64,3 %]) concernaient des lésions traumatiques et le service le plus souvent appelé en consultation (52 [40,3 %]) était la chirurgie orthopédique. Un peu moins de la moitié (48 [49 %]) des patients envoyés en consultation se sont présentés à au moins un rendez-vous en clinique externe, et seulement le tiers d’entre eux (33 [34 %]) se sont soumis au suivi complet.

Conclusion : Les patients sans domicile fixe qui consultent aux urgences et ont besoin de soins chirurgicaux étaient principalement des hommes hébergés dans des refuges ayant le plus souvent consulté pour des blessures traumatiques. Les services ambulatoires actuels ne répondent peut-être pas aux besoins chirurgicaux de ces patients, car plusieurs n’y accèdent pas. Il faudrait envisager d’autres approches, particulièrement en ce qui concerne les services très en demande, comme l’orthopédie, pour faciliter l’accès aux soins chez cette population.


Accepted for publication Feb. 15, 2018

Acknowledgements: The authors acknowledge The Ottawa Hospital Health Records Department for its assistance in obtaining patient charts and creating an initial database.

Affiliations: From the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Zuccaro, Champion, Bennett, Ying); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Champion, Bennett, Ying); and the Children’s Hospital of Eastern Ontario and The Ottawa Hospital, Ottawa, Ont. (Ying).

Competing interests: None declared.

Funding: This research was supported by a 2014 Phoenix Fellowship from Associated Medical Services, which was used to obtain patient charts from The Ottawa Hospital health records database.

Contributors: All authors designed the study and acquired and analyzed the data. L. Zuccaro, C. Champion and S. Bennett wrote the article, which all authors reviewed and approved for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of Associated Medical Services.

DOI: 10.1503/cjs.001317

Correspondence to: Y. Ying, Division of Plastic Surgery, Children’s Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa ON K1H 8L1, yying@cheo.on.ca