Reaching out to the forgotten: providing access to medical care for the homeless in Italy

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 outpa...

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Bibliographic Details
Published in:International health 2014-06, Vol.6 (2), p.93-98
Main Authors: De Maio, Gianfranco, Van den Bergh, Rafael, Garelli, Silvia, Maccagno, Barbara, Raddi, Freja, Stefanizzi, Alice, Regazzo, Costantina, Zachariah, Rony
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Clinical Audit
Delivery of Health Care - organization & administration
Female
Health Services Accessibility - standards
Homeless Persons
Humans
Italy
Length of Stay
Male
Middle Aged
Original
Referral and Consultation - statistics & numerical data
Retrospective Studies
Young Adult
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Summary: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.
ISSN:1876-3413
1876-3405
DOI:10.1093/inthealth/ihu002