Urgent Care Services Research Articles

Urgent palliative care: An effective intervention to improve end-of-life experience and outcomes for patients with advanced cancer.

203 Background: Early integration of palliative care services for advanced oncology patients has a well-documented benefit on quality-of-life measures including symptom management, quality-of-death measures, cost-effectiveness, care-giver burden, and patient satisfaction metrics. However many barriers exist, including delayed referrals and negative perceptions of hospice/palliative care by patients and families. Furthermore, wait times from referral to visit can vary from weeks to months. For patients with late-stage disease, rapidly advancing disease or symptoms, this delay can lead to unnecessary acute care utilization, impoverished quality-of-life, and discordant end-of-life care. Methods: The CU Cancer Center CARE clinic provides advanced symptom management and urgent care services to oncology patients, often seeing patients with high symptom burden and advanced disease. A recent unpublished case-based analysis demonstrated that patients seen in CARE clinic 4 times or more in a month have a high risk of inpatient mortality within 3 months. In response, the CARE clinic created an urgent palliative care program wherein patients have the ability to see a palliative care provider within 1 week of referral who could provide ongoing advanced symptom management/medication titration and facilitate conversations around goal-concordant care in late-stage illness. A 1-year feasibility pilot took place from 2022-2023. Referrals required patients to meet the following criteria: 1) Not already being seen by an ambulatory palliative care professional; and 2) any of the following: prognosis of weeks without an end-of-life care plan; symptoms likely to require hospitalization if not addressed within a week; or seen in CARE clinic 4 or more times in the last month From 09/2022-08/2023, 55 patients were seen. Outcomes were followed for 3 months following final CARE clinic visit and were compared to patients who had received palliative care referrals from the CARE clinic in the preceding year (9/2021-9/2022). Results: In-hospital deaths, hospital days in the last 30 days of life, and palliative care/hospice involvement were all positively affected in our initial pilot. Notably, in-hospital deaths were reduced by 50%. There was also a 14% increase in deaths with hospice care in the pilot group compared to the control group. Conclusions: Data from this feasibility pilot suggest that urgent palliative care can improve key metrics in oncology quality-of-care, and improve cost effectiveness. Further delineation of the outcomes compared in a rigorously controlled population will further define the relative clinical benefit and fiscal implications of such interventions. Urgent palliative care outcomes. Historical Control (2021-2022) Pilot (2022-2023) N 44 55 Hospitalizations 101 52 Deaths 30 (68%) 40 (72%) Deaths in the Hospital 8 (18%) 5 (9%) Deaths With Hospice Care 21 (47%) 34 (61%)

Predicting Mental Health Hospitalizations Among First Nations Adults in Residential Treatment

Indigenous peoples in Canada experience disproportionately higher rates of hospitalization for mental health and substance use concerns than non-Indigenous populations. Ambulatory care sensitive conditions are community-level markers of mental illness which can theoretically be managed through community-based health services, and therefore should not require urgent care services. Previous mental health related ambulatory sensitive conditions have included psychotic and mood disorders; however, limited research has explored these relationships of increased hospitalization among specific health disorders with Indigenous populations. This study analyzed predictors of prior mental health hospitalizations among a predominately First Nations population seeking residential treatment for substance use. We hypothesized that increased co-morbid mental health concerns would predict increased hospitalizations for mental health concerns, and this relationship would be moderated by higher Adverse Childhood Experience (ACE) scores. Logistic regression showed that for every increase in each reported mental health concern, the odds of prior hospitalization was 1.6 times higher among this sample, although ACEs did not moderate this relationship. Participants with depressive, anxiety-related, psychotic, and personality-related disorders reported proportionally more hospitalization. Although study results suggest ACEs are not a useful predictor of hospitalization, their presence has previously shown to exacerbate co-morbid concerns, and thus, may influence prior hospitalization history indirectly. Further research can explore relationships between exposure to childhood trauma and hospitalization, particularly in consideration of access to tertiary mental health services.

Use of emergency departments by children and young people following telephone triage: a large database study

BackgroundAlthough one objective of NHS 111 is to ease the strain on urgent and emergency care services, studies suggest the telephone triage service may be contributing to increased demand. Moreover,...

Scoping review of the effectiveness of 10 high-impact initiatives (HIIs) for recovering urgent and emergency care services

IntroductionProlonged ambulance response times and unacceptable emergency department (ED) wait times are significant challenges in urgent and emergency care systems associated with patient harm. This scoping review aimed to evaluate...

Signposting services in the UK: enhanced support or service diversion for people with health and social care needs: a rapid realist synthesis

PurposeIn the UK signposting services can be developed as enhanced support for people with health and social care needs or service diversion to help primary and urgent care services manage their workload. This review considers these two conflicting purposes.Design/methodology/approachThe review used a realist approach, initial searches to identify theory; we then selected 22 publications and extracted programme theories, from which we developed questions from three viewpoints: the service user, the front-line service provider and the commissioner. A rich sample of studies were found from purposive searching. To optimise the applicability of synthesis findings predominantly UK studies were included.FindingsUsers value signposting service that understand their needs, suggest a range of options and summarise potential actions. People with complex health and social care needs generally require extended time/input from signposting services. Front-line providers require initial and ongoing training, support/supervision, good knowledge of available services/resources and the ability to match users to them and a flexible response. Commissioned signposting services in England are diverse making evaluation difficult.Originality/valueMeaningful evaluation of signposting services requires greater clarity around roles and service expectations. Signposting services alone fulfil the needs of a small number of users due to the unreconciled tension between efficient (transactional) service provision and effective (relational) service provision. This is underpinned by competing narratives of whether signposting represents diversion of inappropriate demand from primary care and other urgent care services or improved quality of care through a joined-up response encompassing health, social care and community/voluntary services.

Brazilian Policies and Programs in Urgent and Emergency Care Services in the Context of Cardiovascular Diseases: A Scoping Review

Brazilian Policies and Programs in Urgent and Emergency Care Services in the Context of Cardiovascular Diseases: A Scoping Review

Synergistic patient factors are driving recent increased pediatric urgent care demand.

We aimed to use the high fidelity urgent care patient data to model the factors that have led to the increased demand at our local pediatric urgent care centre. The dataset for this retrospective cohort study was obtained from our local healthcare centre's national reporting data for pediatric urgent care visits from 2006 to 2022. Variables analyzed included: basic patient demographics, chief complaint, triage urgency, date and time of registration/discharge, discharge diagnosis, and discharge destination. Statistical analysis of non-linear trends was summarized by locally estimated scatterplot smoothing splines. For machine learning, we used the tidymodels R package. Models were validated in training using k-fold cross validation with k = 5. We used univariate linear regression as a baseline model. After the data was standardized, correlation and homoscedasticity were evaluated between all parameter permutations. This dataset consisted of 164,660 unique visits to our academic centre's pediatric urgent care. Over the study period, there was an overall substantial increase in the number of urgent care visits per day, with a rapid increase beyond previous levels in 2021 and further in 2022. The increased length of stay trend was consistent across presenting complaint categories. The proportion of patients without primary care in 2022 was 2.5 times higher than in 2013. A random forest machine learning model revealed the relative importance of features to predicting a visit in 2022 were: longer stay, later registration in the day, diagnosis of an infectious illness, and younger age. This study identified a combination of declining primary care access, circulating viral infections, and shifting chief complaints as factors driving the recent increase in frequency and duration of visits to our urgent care service.

Cost Evaluation of the Ontario Virtual Urgent Care Pilot Program: Population-Based, Matched Cohort Study.

In 2020, the Ministry of Health (MoH) in Ontario, Canada, introduced a virtual urgent care (VUC) pilot program to provide alternative access to urgent care services and reduce the need for in-person emergency department (ED) visits for patients with low acuity health concerns. This study aims to compare the 30-day costs associated with VUC and in-person ED encounters from an MoH perspective. Using administrative data from Ontario (the most populous province of Canada), a population-based, matched cohort study of Ontarians who used VUC services from December 2020 to September 2021 was conducted. As it was expected that VUC and in-person ED users would be different, two cohorts of VUC users were defined: (1) those who were promptly referred to an ED by a VUC provider and subsequently presented to an ED within 72 hours (these patients were matched to in-person ED users with any discharge disposition) and (2) those seen by a VUC provider with no referral to an in-person ED (these patients were matched to patients who presented in-person to the ED and were discharged home by the ED physician). Bootstrap techniques were used to compare the 30-day mean costs of VUC (operational costs to set up the VUC program plus health care expenditures) versus in-person ED care (health care expenditures) from an MoH perspective. All costs are expressed in Canadian dollars (a currency exchange rate of CAD $1=US $0.76 is applicable). We matched 2129 patients who presented to an ED within 72 hours of VUC referral and 14,179 patients seen by a VUC provider without a referral to an ED. Our matched populations represented 99% (2129/2150) of eligible VUC patients referred to the ED by their VUC provider and 98% (14,179/14,498) of eligible VUC patients not referred to the ED by their VUC provider. Compared to matched in-person ED patients, 30-day costs per patient were significantly higher for the cohort of VUC patients who presented to an ED within 72 hours of VUC referral ($2805 vs $2299; difference of $506, 95% CI $139-$885) and significantly lower for the VUC cohort of patients who did not require ED referral ($907 vs $1270; difference of $362, 95% CI 284-$446). Overall, the absolute 30-day costs associated with the 2 VUC cohorts were $18.9 million (ie, $6.0 million + $12.9 million) versus $22.9 million ($4.9 million + $18.0 million) for the 2 in-person ED cohorts. This costing evaluation supports the use of VUC as most complaints were addressed without referral to ED. Future research should evaluate targeted applications of VUC (eg, VUC models led by nurse practitioners or physician assistants with support from ED physicians) to inform future resource allocation and policy decisions.

An After-Hours Telemedicine Urgent Care Service May Not Improve Access to Care for Underserved Populations.

Background: After-hours telemedicine services for emergency care are thought to offer a solution for patients who live at a distance from traditional face-to-face emergency services. This study evaluates such a service in a Health Maintenance Organization, focusing on the differences between central and peripheral populations. Methods: In this cross-sectional database study, we collected data regarding the encounter and patient characteristics, including prescriptions, referrals for further evaluation in a traditional emergency department (ED), and the distance from a traditional ED. Other outcome measures included health care utilization after the encounter such as primary care physician (PCP) encounters, additional telemedicine encounters, ED visits, and hospitalization. Results: In total, 45,411 patient visits were analyzed. Medication was prescribed in 25% of the encounters, and a referral to an ED was given in 22%. In total, 17.7% of the patients visited an ED within 24 h of the index encounter. In total, 64.8% of patients visited a PCP in the following 30 days. No further care was needed in 32.4% of the encounters. In multivariable logistic regression, the odds of using the service were lower for low socio-economic status groups and inhabitants of the periphery than the central areas. A weak reverse correlation was observed in Jewish sectors regarding distance from traditional ED, whereas no correlation was found in the Arab sector. Conclusion: It is commonly believed that telemedicine overcomes geographical barriers. The results of this research do not support this hypothesis.

EHealth Literacy and the Use of NHS 111 Online Urgent Care Service in England: Cross-Sectional Survey.

Many health care systems have used digital technologies to support care delivery, a trend amplified by the COVID-19 pandemic. "Digital first" may exacerbate health inequalities due to variations in eHealth literacy. The relationship between eHealth literacy and web-based urgent care service use is unknown. This study aims to measure the association between eHealth literacy and the use of NHS (National Health Service) 111 online urgent care service. A cross-sectional sequential convenience sample survey was conducted with 2754 adults (October 2020-July 2021) from primary, urgent, or emergency care; third sector organizations; and the NHS 111 online website. The survey included the eHealth Literacy Questionnaire (eHLQ), questions about use, preferences for using NHS 111 online, and sociodemographic characteristics. Across almost all dimensions of the eHLQ, NHS 111 online users had higher mean digital literacy scores than nonusers (P<.001). Four eHLQ dimensions were significant predictors of use, and the most highly significant dimensions were eHLQ1 (using technology to process health information) and eHLQ3 (ability to actively engage with digital services), with odds ratios (ORs) of 1.86 (95% CI 1.46-2.38) and 1.51 (95% CI 1.22-1.88), respectively. Respondents reporting a long-term health condition had lower eHLQ scores. People younger than 25 years (OR 3.24, 95% CI 1.87-5.62) and those with formal qualifications (OR 0.74, 95% CI 0.55-0.99) were more likely to use NHS 111 online. Users and nonusers were likely to use NHS 111 online for a range of symptoms, including chest pain symptoms (n=1743, 70.4%) or for illness in children (n=1117, 79%). The users of NHS 111 online were more likely to have also used other health services, particularly the 111 telephone service (χ12=138.57; P<.001). These differences in eHealth literacy scores amplify perennial concerns about digital exclusion and access to care for those impacted by intersecting forms of disadvantage, including long-term illness. Although many appear willing to use NHS 111 online for a range of health scenarios, indicating broad acceptability, not all are able or likely to do this. Despite a policy ambition for NHS 111 online to substitute for other services, it appears to be used alongside other urgent care services and thus may not reduce demand.

Impact of a Distress Brief Intervention on Suicidal Ideation, Suicide Attempts and Self-harm in the immediate, short and longer term: a mixed method evaluation study protocol

Background The Distress Brief Intervention (DBI) is a new approach aimed at reducing distress and is embedded in Scotland’s suicide prevention and mental health strategies. People in distress can be referred to DBI by front-line healthcare and emergency service staff. DBI promises to make contact within 24 hours and offers people in distress 14 days of compassionate, community-based, and person-centred support. The development of NHS 24, a new specialist National Health Service Mental Health Hub (MHH) embedded in Scotland’s urgent care service created a new national route to access DBI. Protocol This study is a mixed-method evaluation of the impact of DBI on suicidal ideation, suicide attempts and self-harm in the immediate, short and longer term among people presenting in distress. Evaluation participants include adults who access DBI, DBI staff, individuals who have used NHS 24 MHH, and GPs. A combination of analysis of quantitative survey and linked administrative data, including a comparator group analysis, qualitative interview and focus group data will support understanding of whether and how DBI can reduce suicidal ideation, suicidal behaviour and self-harm among those presenting to front-line services in distress. A survey of General Practitioners and a review of existing literature will be used to model typical care pathways for individuals in distress and at risk of self-harm. Modelled resource use and costs will be explored. All data collected will be triangulated through a summative evidence synthesis to develop evidence-based insights and conclusions to inform policy and practice development. Discussion Understanding whether, how and why DBI has helped prevent future suicidal thoughts and behaviour in those with a history of suicidal risk will provide important insights into how the intervention can be further developed and optimised as a suicide prevention intervention.

Referral pathways to early intervention services for psychosis and their influence on perceptions of care: An interpretive phenomenological analysis.

Most young adults experiencing psychosis enter early intervention services (EIS) via inpatient and emergency departments. These experiences are suggested to negatively impact their views of treatment and engagement in EIS. However, limited research has examined the impact of young adults' prior help-seeking experiences on these outcomes. The present study aimed to explore how young adults engaged in EIS have experienced initial help-seeking and make sense of these experiences in the context of their current treatment. Using an interpretative phenomenological analysis approach, semi-structured interviews were conducted with 12 young adults (mean age = 24.83) within their first 3-12 months of treatment in EIS. Interviews aimed to examine their experiences of help-seeking and referral to EIS as well as the impact of these experiences on their subsequent perception of, and engagement with EIS. 3 superordinate themes emerged: (1) Navigating the Maze of Healthcare (2) Dignity and (3) Impact of Help-Seeking and Referral Experiences. Participants with referral pathways involving urgent care services described more adversity during their referral pathway and tended to describe help-seeking experiences as contributing to negative views towards EIS and diminished engagement in treatment. The impact of early negative experiences with healthcare on views towards EIS and engagement is evident in participants' accounts. Sense making was further contextualized by participants' illness insight, degree of recovery, and social support throughout experiences. Emergent themes highlight the need for psychiatric services to emphasize service users' dignity and for EIS to provide opportunities for patients to process past negative mental healthcare experiences to strengthen engagement.

The Multidisciplinary Mobile Unit (MMU) Program Bringing Hospital Specialist Geriatric Competencies at Home: A Feasible Alternative to Admission in Older Patients with Urgent Complaints.

Background/Objectives: Older patients are subject to a high number of Emergency Department (ED) visits and hospitalizations. Innovative strategies to manage geriatric urgencies in the community are thus needed. Methods: In this prospective observational study, we examined the case mix of a hospital-based domiciliary urgent care service tailored to older patients, called Multidisciplinary Mobile Unit (MMU), from January to September 2023. The service, activated by general practitioners or territorial specialists during workdays, provided domiciliary geriatric assessment, point-of-care diagnostics, including multi-site ultrasound and lab tests, and therapeutical measures, including intravenous treatment and insertion of invasive devices, with the goal of reaching on-site stabilization and avoiding ED referral. We collected data regarding multimorbidity, polypharmacy, and frailty according to the Clinical Frailty Scale (CFS), reasons for MMU activation, and diagnostic and therapeutical services provided. The assessed outcomes were immediate hospitalization after a visit, 30-day admission, and 30-day mortality. Results: Participants (n = 205, 102 M) were mostly aged (median age 83 years old), with multimorbidity and frailty (CFS median 6). The most frequent reasons for MMU activation were dyspnea (49%), cough (34%), and musculoskeletal pain (17%), while the commonest diagnostic test provided was thoracic ultrasound (81%). Only five patients (2.4%) were hospitalized immediately after MMU visit. The 30-day rate of hospitalization was 10.2%, with age, cancer, and abdominal pain as independent predictors on a stepwise binary logistic regression model. 30-day mortality was 4.9%. Conclusions: The MMU model is a feasible strategy to manage geriatric urgencies, especially involving the cardiorespiratory system, is associated with good outcomes and may prevent ED visits.

Access to Urgent Care Practices Improves Understanding and Management of Endemic Coccidioidomycosis: Maricopa County, Arizona, 2018-2023

BackgroundCoccidioidomycosis within endemic regions is often undiagnosed because appropriate testing is not performed. A dashboard was developed to provide information about the prevalence of coccidioidomycosis throughout the year. MethodsBanner Urgent Care Service has many clinics within Maricopa County, Arizona, a highly endemic region for coccidioidomycosis. All clinic visits and subset analyses for patients with International Classification of Diseases, Tenth Revision codes for pneumonia (J18.*) or erythema nodosum (L52) during 2018-2024 were included. Tabulated were daily frequencies of visits, pneumonia and erythema nodosum coding, coccidioidal testing, and test results. Banner Urgent Care Services’ counts of monthly coccidioidomycosis diagnoses were compared with those of confirmed coccidioidomycosis cases reported to Maricopa County Department of Public Health. ResultsMonthly frequencies of urgent care coccidioidomycosis diagnoses strongly correlated with public health coccidioidomycosis case counts (r = 0.86). Testing frequency for coccidioidomycosis correlated with overall pneumonia frequency (r = 0.52). The proportion of pneumonia due to coccidioidomycosis varied between <5% and >45% within and between years. Coccidioidomycosis was a common cause of erythema nodosum (65%; 95% confidence interval, 45%-67%) and independent of pneumonia. Over half of Banner Urgent Care Services’ coccidioidomycosis diagnoses were coded for neither pneumonia nor erythema nodosum. ConclusionData provided by the coccidioidomycosis dashboard can assist urgent care practitioners in knowing when coccidioidomycosis is prevalent in the community. Patients with exposure to endemic coccidioidomycosis who develop erythema nodosum or pneumonia should routinely be tested for coccidioidomycosis. Data from private health care organizations can augment surveillance of diseases important to public health.

Associations between adverse childhood experiences and trust in health and other information from public services, professionals and wider sources: national cross sectional survey

IntroductionTrust in health and other systems can affect uptake of public health advice and engagement with health services. Individuals who had adverse childhood experiences (ACEs) are more likely to experience...

Awareness of Urgent Care Services Among Primary Healthcare Center Patients in Al-Ahsa, Saudi Arabia.

Background Urgent care clinics (UCCs) provide services for patients without the need to book an appointment in advance to treat acute diseases and injuries that do not need ED service and provide care for chronic conditions. This study aimed to assess the patients's level of awareness regarding UCCs in the Al-Ahsa region and provide information contributing to decision-makers' support about the urgent care services and their patterns of use within primary healthcare. Methods A descriptive cross-sectional study was conducted in the Al-Ahsa region from August 2023 to December 2023. A validated questionnaire was used. Cluster sampling was used to select three primary healthcare centers from four health sectors (southern cluster, middle cluster, northern cluster, and eastern cluster), and then simple random sampling was used to select participants. sample size calculated by Cochran'ssample size formula, which estimated 377 participants. However, to accommodate a non-response rate of 10.0% and stronger statistical power and effect size, the final sample size was 469 participants. Data were analyzed by SPSS Statistics version 28 (IBM Corp. Released 2021. IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp.). Both descriptive and inferential statistics were used. A p-value ≤0.05 is considered statistically significant. Results Of the 469 participants in the study, more than half (54.8%) were aged between 18 and 38 years old, and more than half (54.8%) were male. More than half (67.4%) reported having no chronic diseases, whereas the most common chronic diseases reported were diabetes mellitus (11.9%) and hypertension (14.3%). Most of the participants (84.9%) weren't aware of UCCs. Among the participants who were aware of UCCs (n=71), 53.5% of them had visited a UCC in the last three months. The most common reasons for their visits were the common cold (40.8%), headaches (5.6%), and abdominal pain (5.6%). More than one-third of participants (38.6%) believed that UCCs provide services like those of the emergency center. According to patients' sex, there was a significant (0.031) difference in the awareness level; the highest was among females at 20.1% vs. 12.6%. Conclusion The study revealed that the majority of the participants were unaware of UCCs. Increasing patients' awareness of UCCs is necessary through different media to improve access to healthcare services and reduce overcrowding in the ED that is caused by non-urgent problems.

Virtual urgent care is here to stay: driving toward safe, equitable, and sustainable integration within emergency medicine.

Virtual care in Canada rapidly expanded during the COVID-19 pandemic in a low-rules environment in response to pressing needs for ongoing access to care amid public health restrictions. Emergency medicine specialists now face the challenge of advising on which virtual urgent care services ought to remain as part of comprehensive emergency care. Consideration must be given to safe, quality, and appropriate care as well as issues of equitable access, public demand, and sustainability (financial and otherwise). The aim of this project was to summarize current literature and expert opinion and formulate recommendations on the path forward for virtual care in emergency medicine. We formed a working group of emergency medicine physicians from across Canada working in a variety of practice settings. The virtual care working group conducted a scoping review of the literature and met monthly to discuss themes and develop recommendations. The final recommendations were circulated to stakeholders for input and subsequently presented at the 2023 Canadian Association of Emergency Physicians (CAEP) Academic Symposium for discussion, feedback, and refinement. The working group developed and reached unanimity on nine recommendations addressing the themes of system design, equity and accessibility, quality and patient safety, education and curriculum, financial models, and sustainability of virtual urgent care services in Canada. Virtual urgent care has become an established service in the Canadian health care system. Emergency medicine specialists are uniquely suited to provide leadership and guidance on the optimal delivery of these services to enhance and complement emergency care in Canada.

Assessing the reach and safety of an innovative urgent care service tailored to older adults.

Traditional emergency departments (EDs) are overcrowded and sometimes not suitable for older adults with complex needs. Specialised geriatric urgent care pathways for selected patients can alleviate ED demand and improve patient experience. To address urgent care needs for older adults in Southern Adelaide, the Complex And RestorativE (CARE) service was established. CARE offers alternative, geriatrician-led treatment pathways consisting of a ward-based treatment centre and an in-home visiting team called Eyes on Scene (EoS). Both pathways offer medical, nursing and allied health treatment. Routinely collected clinical data were analysed to explore the reach of the service and the incidence and nature of adverse events. Between September 2021 and March 2023, the CARE service attended to 5324 older adults requiring urgent care. A significant proportion of patients were discharged to or remained in their regular place of residence, with few requiring inpatient admissions or referrals to other facilities. A total of 7% of patients required transfer to ED and adverse events were rare. The CARE service demonstrates a feasible and safe alternative model of urgent care for older Australians.

Homelessness Among Acute Care Patients Within a Large Health Care System in Northern California.

The impacts of homelessness on health and health care access are detrimental. Intervention and efforts to improve outcomes and increase availability of affordable housing have mainly originated from the public health sector and government. The role that large community-based health systems may play has yet to be established. This study characterizes patients self-identified as homeless in acute care facilities in a large integrated health care system in Northern California to inform the development of collaborative interventions addressing unmet needs of this vulnerable population. The authors compared sociodemographic characteristics, clinical conditions, and health care utilization of individuals who did and did not self-identify as homeless and characterized their geographical distribution in relation to Sutter hospitals and homeless resources. Between July 1, 2019 and June 30, 2020, 5% (N = 20,259) of the acute care settings patients had evidence of homelessness, among which 51.1% age <45 years, 66.4% males, and 24% non-Hispanic Black. Patients experiencing homelessness had higher emergency department utilization and lower utilization of outpatient and urgent care services. Mental health conditions were more common among patients experiencing homelessness. More than half of the hospitals had >5% of patients who identified as homeless. Some hospitals with higher proportions of patients experiencing homelessness are not located near many shelter resources. By understanding patients who self-identify as homeless, it is possible to assess the role of the health system in addressing their unmet needs. Accurate identification is the first step for the health systems to develop and deliver better solutions through collaborations with nonprofit organizations, community partners, and government agencies.

Women Abused: Analysis of Assistance Provided by Urgency Mobile Service.

Considering that reports of violence against women must come after a victim seeks help, the subject matter transcends health-related issues. In Brazil, mobile urgency services (SAMU/SIATE) frequently provide first aid to these women and, to the best of our knowledge, no other research has specifically examined the first reaction given to these women. The present study aimed to analyze SAMU/SIATE assistance to abused women in a cross-sectional study of the assistance to assaulted women provided by SIATE and SAMU Maringá/Norte Novo between 2011 and 2020. Women between 20 and 39 years old, non-pregnant, were the main victims, and 19.52% of them have used drugs of some kind. The (ex) partner figured as the perpetrator in 17.35%, but there was no information about this variable in 73.75% of the records. The Chi-square test shows a mortality rate superior to 70% among the severely traumatized victims. This is the first research work to examine the kind of care that SAMU/SIATE offers, and it identifies several weaknesses in its "modus operandi" that may prevent the results from being applied to larger contexts. In addition, further studies on mobile urgent care services in other provinces are required in order to suggest ways to lessen this epidemic.