Abstract
BackgroundHomeless individuals frequently experience poor access to healthcare, delayed clinical presentation, and higher disease burden. Providing subspecialty otolaryngology care to this population can be challenging. We previously reported on the prevalence of hearing impairment in Toronto’s homeless community. As a secondary objective of this study, we sought to define otolaryngology specific need for this population.MethodsOne hundred adult homeless individuals were recruited across ten homeless shelters in Toronto, Canada using a stratified random sampling technique. An audiometric evaluation and head and neck physical examination were performed by an audiologist and otolaryngology resident, respectively. Basic demographic and clinical information was captured through verbal administration of a survey. Descriptive statistics were used to estimate frequency of otolaryngology specific diseases for this population.ResultsOf the 132 individuals who were initially approached to participant, 100 (76%) agreed. There were 64 males, with median age of 46 years (IQR 37–58 years). The median life duration of homelessness was 24 months (IQR 6–72 months). Participants had a wide range of medical comorbidities, with the most common being current tobacco smoking (67%), depression (36%), alcohol abuse (32%), and other substance abuse (32%). There were 22 patients with otolaryngology needs as demonstrated by one or more abnormal findings on head and neck examination. The most common finding was nasal fracture with significant nasal obstruction (6%). Eleven patients required referral to a staff otolaryngologist based on concerning or suspicious findings, including two head and neck masses, 6 were later seen in follow-up.ConclusionThere were substantial otolaryngology needs amongst a homeless population within a universal healthcare system. Future research should focus on further elucidating head and neck related issues in this population and expanding the role of the otolaryngologist in providing care to homeless individuals.
Highlights
Homeless individuals frequently experience poor access to healthcare, delayed clinical presentation, and higher disease burden
Wu et al Journal of Otolaryngology - Head and Neck Surgery (2020) 49:47 homeless populations are susceptible to a wide range of medical comorbidities, including higher rates of diabetes, hypertension, cardiovascular disease, vision loss, hearing loss, chronic obstructive pulmonary disease, and human immunodeficiency virus infections [3,4,5,6,7,8,9,10]
All participants were eligible for the Ontario Health Insurance Plan (OHIP) and most participants (78%) had some form of extended health care benefits through social assistance that covers the cost of medication, medical assisted devises and other services not covered through OHIP
Summary
Homeless individuals frequently experience poor access to healthcare, delayed clinical presentation, and higher disease burden. Homeless individuals experience poor access to healthcare, driven by factors that include lack of health insurance coverage, prioritization of other needs (i.e. food and shelter), and previous experiences that were negative or discriminatory within the healthcare system [11]. Together, these circumstances often translate into delayed clinical presentation of diseases, increased rates of hospitalization often for preventable conditions, and higher rates of mortality [12]. Previous experiences of discrimination in the healthcare system, lack of financial resources, high transportation costs, and absence of insurance coverage were identified as barriers for seeking surgical care in the homeless [13]
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