Preferences for sites of care among urban homeless and housed poor adults.
OBJECTIVE
To describe sources of health care used by homeless and housed poor adults.


METHODS
In a cross-sectional survey, face-to-face interviews were conducted to assess source of usual care, preferred site of care for specific problems, perceived need for health insurance at different sites of care, and satisfaction with care received. Polychotomous logistic regression analysis was used to identify the factors associated with selecting non-ambulatory-care sites for usual care.


METHODS
Twenty-four community-based sites (i.e., soup kitchens, drop-in centers, and emergency shelters) frequented by the homeless and housed poor in Allegheny County, Pa.


METHODS
Of the 388 survey respondents, 85.6% were male, 78.1% African American, 76.9% between 30 and 49 years of age, 59.3% were homeless less than 1 year, and 70.6% had health insurance.


RESULTS
Overall, 350 (90.2%) of the respondents were able to identify a source of usual medical care. Of those, 51.3% identified traditional ambulatory care sites (i.e., hospital-based clinics, community and VA clinics, and private physicians offices); 28.9% chose emergency departments; 8.0%, clinics based in shelters or drop-in centers; and 2.1%, other sites. Factors associated with identifying nonambulatory sites for usual care included lack of health insurance (relative risk range for all sites [RR] = 3.1-4.0), homelessness for more than 2 years (RR = 1. 4-3.0), receiving no medical care in the previous 6 months (RR = 1. 6-7.5), nonveteran status (RR = 1.0-2.5), being unmarried (RR = 1. 2-3.1), and white race (RR = 1.0-3.3).


CONCLUSIONS
Having no health insurance or need for care in the past 6 months increased the use of a non-ambulatory-care site as a place for usual care. Programs designed to decrease emergency department use may need to be directed at those not currently accessing any care.
O'Toole
T P
TP
Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh, PA, USA.
Gibbon
J L
JL
Hanusa
B H
BH
Fine
M J
MJ
D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008489:Medical Indigency / Q000706:statistics & numerical data; D011203:Poverty / Q000706:statistics & numerical data; D019037:Urban Health Services / Q000706:statistics & numerical data*