title: Unmet need for medical care and safety net accessibility among Birmingham's homeless.
abstract: Although homeless individuals often experience health problems requiring care, there are limitations to available research concerning the scale of their needs and the accessibility of safety net agencies to meet them. Traditional access-to-care surveys calculate unmet need among all persons queried (rather than persons needing care), making it difficult to calculate what percentage of persons requiring care actually obtain it. Additionally, no research has compared the relative accessibility of safety net programs to homeless persons in need. This cross-sectional, community-based survey assessed the prevalence of unmet need for several specific types of health care and compared the accessibility of agencies in Birmingham, AL. Substantial proportions of respondents reported unmet needs for general medical care (46 %), specialty care (51 %), mental health care (51 %), dental care (62 %), medications (57 %), and care of a child (23 %). The most commonly mentioned sites where care was sought included a federally funded Health Care for the Homeless (HCH) program (59 %), a religious free clinic (31 %), and a public hospital emergency department (51 %). The HCH program was most commonly cited as the location where care, once sought, could not be obtained (15 %), followed by the county hospital primary care clinics (13 %). In this survey, unmet need was common for all types of care queried, including primary care. Key components of the safety net, including a federally funded homeless health care program, had suboptimum accessibility.
authors.affiliation: Center for Surgical Medical and Acute Care Research, Birmingham VA Medical Center, Birmingham, AL, USA, skertesz@uabmc.edu.
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Kertesz
authors.forename: Whitney
authors.initials: W
authors.lastname: McNeil
authors.forename: Julie J
authors.initials: JJ
authors.lastname: Cash
authors.forename: Renee
authors.initials: R
authors.lastname: Desmond
authors.forename: Gerald
authors.initials: G
authors.lastname: McGwin
authors.forename: Jason
authors.initials: J
authors.lastname: Kelly
authors.forename: Travis P
authors.initials: TP
authors.lastname: Baggett
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D020380:Needs Assessment / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D014481:United States