5. A homeless individual is defined in section
330(h)(5)(A) as “an individual who lacks
housing (without regard to whether the
individual is a member of a family), including an
individual whose primary residence during the
night is a supervised public or private facility
that provides temporary living
accommodations, and an individual who is a
resident in transitional housing.”
-Section 330 of the Public Health Service Act (42 U.S.C.,
254b)
6.
7.
8.
9. Photo by Hindrik S - Creative Commons Attribution-NonCommercial-ShareAlike License https://www.flickr.com/photos/63991153@N00 Created with Haiku Deck
19. • Lack of health insurance
• Ineligibility
• Gaps
• Lack of transportation
• Lack of funds
• Competing priorities
• Follow-up/contacting patient my be
challenging
23. • Lack of understanding of disease state
• Lack of understanding of the health care
system
24.
25. • Logistics of medication storage
• Lack of space
• Lack of refrigeration
• Potential for theft
• Disease states more common in patients
in the shelter system
• Lack of restroom facilities during the
daytime
26.
27. • Gaps in care
• Distrust of the healthcare system
• Routine tests/exams may have been missed
• Immunizations
31. • Adherence
• Injections
• Avoid medications that cause sedation
• Chemical Dependency
• Add a B complex vitamin
• Naloxone
• Needle exchange
• Avoid medications with street value
• Benzodiazepines, gabapentin/pregabalin,
quetiapine, clonidine
44. • Titrate metformin carefully if restroom
access is an issue
• Use caution with medications that cause
hypoglycemia
• Use caution with rapid-acting insulin
• Use insulin pens and pen needles
• SMBG may be unrealistic
• Foot care
55. Photo by mikecogh - Creative Commons Attribution-ShareAlike License https://www.flickr.com/photos/89165847@N00 Created with Haiku Deck
56. • Meds in original containers
• Medication list
• Contact information
• Transportation
• Follow-up
57.
58. 1. Notaro SJ, Khan M, Kim C, Nasaruddin M, Desai K. Analysis of the health status of the homeless clients utilizing a free clinic. J. Community Health
2013;38(1):172-177. doi:10.1007/s10900-012-9598-0.
2. Campbell KM, Hayes DS, Wielgos C, Theoktisto K, Taylor JR. Successful reorganization of an interdisciplinary underserved practice. J. Heal. Care
Poor Underserved 2011;22(1):226-231. doi:http://dx.doi.org/10.1353/hpu.2011.0004.
3. Moczygemba LR, Goode J-VR, Gatewood SBS, et al. Integration of collaborative medication therapy management in a safety net patient-centered
medical home. J. Am. Pharm. Assoc. (2003). 2011;51(2):167-72. doi:10.1331/JAPhA.2011.10191.
4. Price-Stevens L, Goode JVR. Shared Care Model in a Federally Qualified Health Care Center for the Homeless. J. Am. Board Fam. Med.
2012;25(2):253-254. doi:10.3122/jabfm.2012.02.110327.
5. Koh KA, Hoy JS, O’Connell JJ, Montgomery P. The hunger-obesity paradox: Obesity in the homeless. J. Urban Heal. 2012;89(6):952-964.
doi:10.1007/s11524-012-9708-4.
6. Hauff AJ, Secor-Turner M. Homeless health needs: shelter and health service provider perspective. J. Community Health Nurs. 2014;31(2):103-17.
doi:10.1080/07370016.2014.901072.
7. Stolte O, Hodgetts D. Being healthy in unhealthy places: health tactics in a homeless lifeworld. J. Health Psychol. 2015;20(2):144-53.
doi:10.1177/1359105313500246.
8. Elder NC, Tubb MR. Diabetes in homeless persons: barriers and enablers to health as perceived by patients, medical, and social service providers.
Soc. Work Public Health 2014;29(3):220-31. doi:10.1080/19371918.2013.776391.
9. Richards R, Smith C. The Impact of Homeless Shelters on Food Access and Choice Among Homeless Families in Minnesota. J. Nutr. Educ. Behav.
2006;38(2):96-105. doi:10.1016/j.jneb.2005.11.031.
10. Programs MR, States U, Health N, Council H. 2015 Medical Respite Program Directory: Descriptions of Medical Respite Programs in the United
States. 2015:1-128. Available at: https://www.nhchc.org/wp-content/uploads/2011/10/2015-medical-respite-program-directory.pdf.
11. Maness DL, Khan M. Care of the homeless: An overview. Am. Fam. Physician 2014;89(8):634-640. doi:10.1016/S1003-6326(14)63234-9.
12. Wilder Research. Homelessness in Minnesota Findings from the 2012 statewide homeless study. Wilder Res. 20103:1-77.
13. Sheet F. Homelessness & Health : What's the Connect Ion ? Natl. Heal. Care Homeless Counc. 2011;(June):11-13.
Editor's Notes
Couch-hopping/doubled up
How homelessness occurs
Poor health leads to homelessness, homelessness leads to poor health
There are clinics at homeless shelters some nights of the week
ASK. It will lead you down an entirely different path.
Century Plaza, Rep payee, Obama phone
Sleeping in a shelter is difficult – loud, doesn’t smell great, bedding is lacking, worried about theft
Personal hygiene struggles
Respiratory illnesses, TB d/t overcrowding
Lice, scabies
Bottom bunk letter
Colonoscopy example
Naloxone even for pts that know people who use opioids – Mpls HCH clinics
Where do I, the pharmacist, fit in?
Once daily dosing
Time, establishment of a relationship
Beta blockers -> rebound HTN if pts miss doses
BP was well-controlled over a few months, DC’d spironolactone
BP crept up, resumed spironolactone
BP difficult to assess -> pt ran out of meds frequently
BP started to increase, had edema d/t increased walking, added HCTZ
Scheduled ultrasounds, pt kept missing appointments, forgetting to ask about results
6 month process
Med list from first slide
Be cautious with drugs metabolized by the liver in homeless patients d/t high rates of hepatitis and alcohol abuse
Lesson learned 5 pharmacists and 2 providers
For this pt, these conditions were interconnected
Harvoni ideal treatment, but is it appropriate for this patient?
Missed appts, missed doses, but successfully completed TB treatment
47% of homeless adults have spent some time in a correctional facility (juvenile detention center, county jail/workhouse or prison)
Men more likely than women (61% vs 31%)
Homeless adults not staying in a shelter have the highest rates of incarceration (70% m/40% f)
