Provider perceptions of challenges and facilitators to surgical care in unhoused patients: A qualitative analysis.

Humans Patient Discharge Hospitals Surgeons Communication Qualitative Research

Journal

Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347

Informations de publication

Date de publication:
Apr 2024
Historique:
received: 29 06 2023
revised: 19 10 2023
accepted: 07 11 2023
medline: 18 3 2024
pubmed: 24 12 2023
entrez: 23 12 2023
Statut: ppublish

Résumé

Unhoused patients have worse surgical outcomes than the general population. However, the drivers of this inequity have not been studied. We conducted 26 semi-structured interviews of clinicians who care for patients with surgical disease, using a purposive sampling strategy to intentionally recruit participants with significant experience caring for unhoused patients across different roles. We used thematic analysis to analyze the resulting data. We conducted 26 interviews: 11 with surgeons (42%), 8 with internal medicine physicians (30%), 2 with surgical advanced practice providers (8%), 3 with social workers or case managers (11%), and 2 with registered nurses (8%). One-third of the participants worked in either medical respite or street medicine programs. We identified 5 themes, each of which was most relevant at a distinct point along the spectrum of surgical care: (1) patients and clinicians face multiple challenges meeting preoperative requirements, (2) although surgeons do not make major operative decisions based on housing status, some take it into consideration for minor care decisions, (3) clinicians perceive that unhoused patients have negative postoperative experiences in the hospital, (4) discharge options for unhoused patients are commonly imperfect, which can lead to inadequate postoperative care, (5) challenges with formal communication between surgeons and non-surgeons are amplified when caring for unhoused patients. Clinicians who care for unhoused patients with surgical disease relayed multiple challenges throughout all phases of surgical care and relied on both formal and informal mechanisms to mitigate these challenges. There may be opportunities to intervene and improve access to surgical care for this vulnerable group.

Sections du résumé

BACKGROUND BACKGROUND
Unhoused patients have worse surgical outcomes than the general population. However, the drivers of this inequity have not been studied.
METHODS METHODS
We conducted 26 semi-structured interviews of clinicians who care for patients with surgical disease, using a purposive sampling strategy to intentionally recruit participants with significant experience caring for unhoused patients across different roles. We used thematic analysis to analyze the resulting data.
RESULTS RESULTS
We conducted 26 interviews: 11 with surgeons (42%), 8 with internal medicine physicians (30%), 2 with surgical advanced practice providers (8%), 3 with social workers or case managers (11%), and 2 with registered nurses (8%). One-third of the participants worked in either medical respite or street medicine programs. We identified 5 themes, each of which was most relevant at a distinct point along the spectrum of surgical care: (1) patients and clinicians face multiple challenges meeting preoperative requirements, (2) although surgeons do not make major operative decisions based on housing status, some take it into consideration for minor care decisions, (3) clinicians perceive that unhoused patients have negative postoperative experiences in the hospital, (4) discharge options for unhoused patients are commonly imperfect, which can lead to inadequate postoperative care, (5) challenges with formal communication between surgeons and non-surgeons are amplified when caring for unhoused patients.
CONCLUSION CONCLUSIONS
Clinicians who care for unhoused patients with surgical disease relayed multiple challenges throughout all phases of surgical care and relied on both formal and informal mechanisms to mitigate these challenges. There may be opportunities to intervene and improve access to surgical care for this vulnerable group.

Identifiants

DOI: 10.1016/j.surg.2023.11.009 PMID: 38142144
pubmed: 38142144
pii: S0039-6060(23)00850-4
doi: 10.1016/j.surg.2023.11.009
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1095-1102

Informations de copyright

Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

Auteurs

Hannah Decker (H)

Department of Surgery, University of California at San Francisco, San Francisco, CA. Electronic address: Hannah.decker@ucsf.edu.

Mukund Raguram (M)

School of Medicine, University of California at San Francisco, San Francisco, CA.

Hemal K Kanzaria (HK)

Department of Emergency Medicine, University of California at San Francisco, Benioff Homelessness and Housing Initiative, University of California at San Francisco, San Francisco, CA. Electronic address: https://twitter.com/hkanzaria.

Michael Duke (M)

Benioff Homelessness and Housing Initiative, University of California at San Francisco, San Francisco, CA.

Elizabeth Wick (E)

Department of Surgery, University of California at San Francisco, San Francisco, CA.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Provider perceptions of challenges and...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Soins de santé primaires › Continuité des soins › Sortie du patient › Provider perceptions of challenges and...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Hôpitaux › Provider perceptions of challenges and...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Personnel de santé › Médecins › Chirurgiens › Provider perceptions of challenges and...
questionsmedicales.fr › Sciences de l'information › Communication › Provider perceptions of challenges and...
questionsmedicales.fr › Disciplines des sciences naturelles › Science › Recherche › Recherche empirique › Recherche qualitative › Provider perceptions of challenges and...