title: Reaching out to the forgotten: providing access to medical care for the homeless in Italy.
abstract: BACKGROUND
  A program for outpatient and intermediate inpatient care for the homeless was pioneered by the humanitarian organization Médecins Sans Frontières (MSF) in Milan, Italy, during the winter of 2012-2013. We aimed to document the characteristics and clinical management of inpatients and outpatients seen during this program.
  
  
  METHODS
  A clinic providing outpatient and intermediate inpatient care (24 bed capacity) was set up in an existing homeless hostel. Patients were admitted for post-hospitalization intermediate care or for illnesses not requiring secondary care. This study was a retrospective audit of the routine program data.
  
  
  RESULTS
  Four hundred and fifty four individuals presented for outpatient care and 123 patients were admitted to inpatient intermediary care. On average one outpatient consultation was conducted per patient per month, most for acute respiratory tract infections (39.8%; 522/1311). Eleven percent of all outpatients suffered from an underlying chronic condition and 2.98% (38/1311) needed referral to emergency services or secondary care facilities. Most inpatients were ill patients referred through public reception centers (72.3%; 89/123), while 27.6% (34/123) were post-hospitalization patients requiring intermediate care. Out of all inpatients, 41.4% (51/123) required more than 1 week of care and 6.5% (8/123) needed counter-referral to secondary care.
  
  
  CONCLUSIONS
  The observed service usage, morbidity patterns, relatively long lengths of stay, high referral completion and need for counter-referrals, all reflect the important gap-filling role played by an intermediate care facility for this vulnerable population. We recommend that in similar contexts, medical non-governmental organizations (NGOs) focus on the setup of inpatient intermediary care services; while outpatient services are covered by the public health system.
authors: Médecins Sans Frontières, Operational Centre Brussels, Italy Mission, Rome, Italy.
authors: Gianfranco
authors: G
authors: De Maio
authors: Médecins Sans Frontières, Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Luxembourg, Luxembourg rafael.van.den.bergh@brussels.msf.org.
authors: Rafael
authors: R
authors: Van den Bergh
authors: Médecins Sans Frontières, Operational Centre Brussels, Italy Mission, Rome, Italy.
authors: Silvia
authors: S
authors: Garelli
authors: Médecins Sans Frontières, Operational Centre Brussels, Operations Department, Rome, Italy.
authors: Barbara
authors: B
authors: Maccagno
authors: Médecins Sans Frontières, Operational Centre Brussels, Operations Department, Rome, Italy.
authors: Freja
authors: F
authors: Raddi
authors: Fondazione Progetto Arca onlus, Milan, Italy.
authors: Alice
authors: A
authors: Stefanizzi
authors: Fondazione Progetto Arca onlus, Milan, Italy.
authors: Costantina
authors: C
authors: Regazzo
authors: Médecins Sans Frontières, Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Luxembourg, Luxembourg.
authors: Rony
authors: R
authors: Zachariah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054869:Clinical Audit; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D006703:Ill-Housed Persons; D006801:Humans; D007558:Italy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055815:Young Adult
keywords: Homeless; Intermediary care; Italy; Migrants; Médecins Sans Frontières; Operational research