Closing the Gap in Health Care Services for Homeless Persons on Maui

Petith-Zbiciak, Carol
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[Honolulu] : [University of Hawaii at Manoa], [December 2016]
Background: Homeless persons are at risk for unmet health needs and carry a higher burden of chronic disease than the population at large, which results in unnecessary emergency department visits, and increased acute care hospital lengths of stay. Hawaii has the highest per capita rate of homeless persons of any state in the United States. Homeless persons on Maui lack health care services that are available in other geographic areas, and appear to have unmet needs for health care services. The goals of this DNP Project are to provide equity in the provision of health care services for homeless persons on Maui, and improve how well health care needs are met for homeless persons on Maui. Method: Phase 1 of the DNP Project included a needs assessment. A literature search was conducted to identify ways to meet homeless persons’ health care needs. The Iowa Model was used as a conceptual framework. Institutional Review Board exempt status was granted. Semi- structured interviews with 32 individual homeless persons (IHPs), 12 individual key stakeholder service providers (IKSs), and one group of hospital social workers (GS) were conducted over a 5 month period on Maui. Interviews were transcribed, coded, and analyzed for themes for source of health care service, unmet health care service needs, barriers to health care service access, and ideas for solutions. Outcomes: The IHPs reported no primary care service (n = 22), and use of the emergency department for services (n = 28). Frequently identified unmet needs were services for wound care, prescription medications, dental care, mental health, substance abuse treatment, vision and others needs such as hygiene and housing. Barriers included lack of basic requirements for health care services, lack of enabling services, stigma, attitudes and behaviors. Ideas for solutions included promoting attitude and behavioral change, opening access to primary care, health outreach, enabling services, and medical respite. Conclusions: Strategies to reduce barriers and meet unmet needs for homeless persons on Maui during Phase 2 planning and Phase 3 implementation are suggested.
D.N.P. University of Hawaii at Manoa 2016.
Includes bibliographical references.
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