| Risk factors | Concepts | Outcomes | Pearls & peeves | Interventions |
|---|---|---|---|---|
|
What is substance use, low back pain, bipolar disorder?
If screen positive, then know where to refer (e.g. soc work, MH, addiction tx services,) or address (HEP, supportive, PT/maint;) low back pain prob b/c employment difficulty
Screening for these conditions (name 1) reduces risk of homelessness e.g. when inpt or in clinic
|
What is population health?
Kindig & Stoddard 2003, aka everything that affects health outside the clinical encounter/hosp/clinic
This is the health outcomes of a group of individuals, and the distribution of such health outcomes within that group.
|
What is c?
Each event, if >3wks, is more likely to result in successfully quitting, with physical dependence reduced at 3wks. However, address triggers for smoking to reduce risk e.g. stress mgmt options, habits, redirection, etc.
Multiple Choice:
Most individuals will attempt to quit smoking this many times before successfully quitting. a. 1, b. 2, c. 7, d. 16, e. 27 |
What is "do you have access to a toilet, place to prepare day before the colo?"
At VA, can request admission 1d to campus housing prior to many procedures or appts for vets who may have hardships (e.g. travel, homelessness)
This is important to ask before ordering a colo for a homeless person (hint: logistics)
|
What is T?
Highest risk of overdose, CV, violence/suicide in first 14d after re-entry compared to general Seattle population (Binswager et al) Barriers to re-instating medicaid, access to clinics/care, MH/cognitive, behaviors likely contribute. VJO for certain vets can help vets go to Vet Court at S Clara county court for non-violent offenses, including mandated resid rehab.
T or F
Former inmates have 13x higher odds of death in first 2wks of release from correctional system than the general population. VA has VJO (vets justice outreach) to help transition for court/parole/probation w case mgmt |
|
What is True?
11% of US veterans are black, but represent 33% of homeless veterans. Extrapolating from Baggett et al's 2013 data on mortality among homeless individuals in MA, structural factors (e.g. poverty, discrimination) likely contributes to poor health outcomes including homelessness, CA, CHD, and chronic dz deaths in Afr Am men.
T or F:
Due to structural barriers, African-American vets have 3x higher odds of being homeless than non-African-American veterans. |
What is T?
Behavior is one of 5 determinants of health, i.e. social, economic or other factors affecting health outcome; it encompasses obesity, smoking, substance use, violence/suicide.
T or F
Behavior accounted for 40% of premature mortality in the US (ie. all deaths before age 76) per McGinnis et al |
What is e?
Screening for these conditions will help reduce risk of homelessness:
a. social isolation, b. low back pain, c. SUD, d. bipolar, e. all of the above |
What is e?
Multiple choice:
When asking about discharge plans, this condition is considered homelessness: a. couch-surfing, b. living in a storage space, c. doubling-up (sharing housing w mult indiv) d. moving freq in last 2m, e. all of the above |
What is supportive housing? i.e. housing + case management, MH, or nursing support co-located in housing can reduce LOS/ED/mortality in multiple studies (NY, Chicago) among urban homeless populations.
This intervention has improved ED utilization, MH hospitalization, and mortality (in HIV+ populations) among chronically homeless indiv compared to usual discharge
|
|
What is smoking/tobacco use?
NRT (patches, gum, lozenges) and tobacco cessation classes start on admission to resid rehab at 1 of the VA programs, to reduce risk of relapse on substances.
This habit is associated with higher rates of relapse on substance use, so replacement therapy and cessation counseling often start on admission to resid rehab.
|
What is T?
health outcomes across the world are tied to education levels (e.g. proportion of pop with hs degree or higher; better outcomes if proportion is higher) and income of the neighborhood is a stronger predictor of health than individual income, per VA study 2018
T or F
"Your zip code may be more important than your genetic code." |
What is teach-back technique? EC: good examples?
Also acceptable: mult modes of communication (e.g. written, verbal, drawings) and use of ratios rather than %, advanced directives written at younger-grade level (vs 12th)
Individuals with lower health literacy i.e. ability to understand health info to make decisions may have worse outcomes e.g. ED, re-admission, LOS. This intervention helps clarify communication without taking more time.
|
What is c?
This is how often you may let your friends in business/law school or at start-ups think they are suffering more than you did as a med student:
a. always, b. sometimes, c. never |
What are (any 3:) SUD, Heart (e.g. DM/lipid), IPV, MH, Infxn (e.g. HCV, TB, HIV, STI GC/CT) E.C.: SHIMI
(ref: HC for homeless clinicians' network, 2011)
These are 3 examples (of 5) of which screening recommendations differ for homeless vs housed individuals. (Extra credit: ?acronym...rhymes w TIMI)
|