Inanspruchnahme medizinischer Versorgung durch Wohnungslose Menschen – der Einfluss von zugangsförderlichen Faktoren, Schmerzen und Gender untersucht anhand des Gelberg-Andersen-Modells

ZusammenfassungZiel der vorliegenden Arbeit war es, Einflussfaktoren auf die Inanspruchnahme medizinischer Versorgungsangebote durch wohnungslose Menschen zu ermitteln. Im Rahmen einer Feldstudie wurden 51 wohnungslose Männer und 47 wohnungslose Frauen in Baden-Württemberg mit einem für diese Studie konzipierten Fragebogen in face-to-face-Interviews befragt. Anhand multipler logistischer Regressionsmodelle in Anlehnung an das Gelberg-Andersen Behavioral Model for Vulnerable Populations wurden Einflussfaktoren auf die Inanspruchnahme medizinischer Versorgungsangebote ermittelt. Erfüllte alltägliche Grundbedürfnisse (OR 1,33, 95%-KI [1,03–1,72] bzgl. Wahrnehmung von Impfungen), eine feste primärmedizinische Anlaufstelle (OR 12,2 [1,81–82] bzgl. Wahrnehmung von Früherkennungsuntersuchungen; quasi-vollständige Trennung bzgl. Inanspruchnahme hausärztlicher Versorgung), soziale Unterstützungssysteme (OR 2,9 [1,13–7,5] bzgl. Wahrnehmung von Früherkennungsuntersuchungen; OR 0,63 [0,41–0,98] bzgl. Aufsuchen von Notaufnahmen) und technische Unterstützungssysteme (OR 2,2 [1,13–4,4] bzgl. Inanspruchnahme hausärztlicher Versorgung) hatten einen günstigen Einfluss auf das Inanspruchnahmemuster. Schmerzen führten zu einer häufigeren Inanspruchnahme von Notaufnahmen (OR 1,72 [1,22–2,4]) und stationärer Versorgung (OR 1,66 [1,19–2,3]). Es zeigten sich Unterschiede zwischen den Geschlechtergruppen. Die genannten Einflussfaktoren sind in der Versorgung wohnungsloser Menschen gezielt zu adressieren. Zur Früherkennung und Bearbeitung komplexer sozialer und gesundheitlicher Problemlagen vulnerabler Bevölkerungsgruppen ist eine Integration sozialer Versorgungsangebote in die medizinische Regelversorgung notwendig. Dies erfordert interprofessionelle Ansätze in der medizinischen Aus-und Weiterbildung, die die Lebenslagen vulnerabler Bevölkerungsgruppen und soziale Determinanten von Gesundheit in den Blick rücken.

Factors Influencing Patients Using Long-Term Care Service of Discharge Planning by Andersen Behavioral Model: A Hospital-Based Cross-Sectional Study in Eastern Taiwan

Taiwan has been an aged society since March 2018, and the elderly population suffer from multiple comorbidities and long duration of disability. Therefore, the service of discharge planning of long-term care 2.0 is an important stage before patients go back to the community. Strengthening the sensitivity when identifying predisabled patients is a principal development of discharge planning. In the current study, we analyzed the characteristics and predictive factors of patients who used the service of long-term care 2.0 from the perspective of discharge planning. In this retrospective study, we included patients who received the discharge planning service in a hospital located in southern Hualien during November 2017 to October 2018. The data were collected and classified as predisposing factors, enabling factors, and need factors according to the analysis architecture of the Andersen Behavioral Model. There were 280 valid patients included in this current study; age, medical accessibility, possession of a disability card, and cerebrovascular diseases, cardiovascular diseases, and diabetes mellitus were the vital factors which influenced the coherence and cohesion between discharge planning and the service of long-term care 2.0. Among them, the most influencing factor was age. We hope that the current study will make policymakers in hospitals pay attention to the usage of the discharge planning service to link long-term care 2.0 and effectively promote the usage of long-term care 2.0.

Use of Informal Support as a Predictor of Home- and Community-Based Services Utilization

Objectives Home- and community-based services (HCBS) help older adults remain living safely in their homes by delaying or preventing the need for institutionalization. This analysis is guided by the Andersen Behavioral Model of Health Services Use to examine the association between informal support and use of HCBS. Method Health and Retirement Study data from 2011 and 2012 are used in the bivariate analyses and multivariate logistic regression models to examine differences in HCBS utilization among extremely vulnerable older adults who have informal caregivers and those who do not. Results For extremely vulnerable older adults who report difficulties with any instrumental or basic activities of daily living, use of HCBS is not strongly associated with access to informal caregivers. However, for this same population of extremely vulnerable older adults, those who live alone have roughly 3 times the odds of using any HCBS compared to those who do not live alone. Discussion Among already vulnerable older adults, this study revealed that living alone is an important enabling factor of the Andersen Behavioral Model as applied in HCBS research. Further investigation is needed to see if more resources should be allocated to senior centers and local providers to identify vulnerable older adults who live alone and may have unmet needs.

Conceptualizations of help-seeking for mental health concerns in First Nations communities in Canada: A comparison of fit with the Andersen Behavioral Model

This qualitative study explored the fit between on-reserve First Nations community members’ conceptualizations of help-seeking for mental health concerns and the Andersen Behavioral Model of Health Services Use. Youth, adults and elders (N = 115) living and or working in eight distinct First Nations communities within a tribal council area in Canada participated in focus groups or individual interviews that were transcribed, coded and then analyzed using a thematic analysis approach informed by grounded theory methodology. Resulting themes were then mapped onto the Andersen Behavioral Model of Health Services Use. Participants’ conceptualizations of predisposing characteristics including social structures, health beliefs and mental illness, enabling and impeding resources had a high degree of fit with the model. While perspectives on perceived need for mental health care, and spirituality as a health and lifestyle practice had only moderate fit with the model, these domains could be modified to fit First Nations’ interpretations of help-seeking. Participants’ perceptions of avoidant strategies and non-use of mental health services, however did not map onto the model. These findings suggest conceptualizations of help-seeking for mental health issues in these First Nations communities are only partially characterized by the Andersen Behavioral Model, suggesting there are a number of considerations to Indigenize the model. Findings also highlight potential explanations for why some members of this population may not access or receive appropriate mental health treatment. Multi-pronged efforts are warranted to link culturally normed pathways of help-seeking with effective mental health supports for First Nations community members in Canada.

Predictors of Emergency Department Use among Individuals with Current or Previous Experience of Homelessness

This study assessed the contributions of predisposing, enabling, and needs factors in predicting emergency department (ED) use among 270 individuals with current or previous experience of homelessness. Participants were recruited from three different types of housing (shelter, temporary housing and permanent housing) in Montreal, Quebec (Canada). They were interviewed at baseline (T0), and again 12 months after recruitment (T1). Longitudinal data analyses were conducted on associations between a set of baseline predictors (T0) with the dependent variable (ED users vs. non-users) from T1. Predictors were identified according to the Gelberg–Andersen Behavioral Model. Findings revealed two needs factors associated with ED use: having a substance use disorder (SUD) and low perceived physical health. Two enabling factors, use of ambulatory specialized services and stigma, were also related to ED use. No predisposing factors were retained in the model, and ED use was not associated with type of housing. Improvements are needed in SUD and physical health management in order to reduce ED use, as well as interventions aimed at stigma prevention for this vulnerable population.