Blanca Sckell

Colorectal Cancer Screening Among the Homeless Population of New York City Shelter-Based Clinics

OBJECTIVES We determined colorectal cancer (CRC) screening rates, predictors, and barriers in 2 major New York City shelter-based clinics. METHODS We extracted screening rates, sociodemographic characteristics, and factors associated with homelessness from medical records of domiciled and homeless patients aged 50 years and older (n = 443) with at least 3 clinic visits between 2010 and 2012. RESULTS The majority of patients were African American or Hispanic, 76% were male, and 60.7% were homeless (mean = 2.4 years; SD = 2.8 years). Domiciled patients were more likely than homeless patients to be screened (41.3% vs 19.7%; P < .001). Homeless and domiciled patients received equal provider counseling, but more homeless patients declined screening (P < .001). In logistic regression, gender, race, duration of homelessness, insurance status, substance and alcohol abuse, chronic diseases, and mental health were not associated with screening, but housing, provider counseling, and older age were. CONCLUSIONS Proposed interventions to improve CRC screening include respite shelter rooms for colonoscopy prepping, patient navigators to help navigate the health system and accompany patients to and from the procedure, counseling at all clinical encounters, and tailored patient education to address misconceptions.

Breast Cancer Screening Among Homeless Women of New York City Shelter-Based Clinics

BACKGROUND Millions of Americans experience homelessness annually. Data on breast cancer screening among homeless women is extremely limited. METHODS We performed a retrospective study evaluating 100 female patients 50 to 74 years old with at least three visits to two major New York City shelter-based clinics between 2010 and 2012 to evaluate and compare rates and predictors of mammograms in homeless and low-income domicile patients. RESULTS Of those we included, 44% were homeless with majority Black and Hispanic. Mean age was 59.28 (±5.84) years. The majority were insured, with 44% smokers and 87% with chronic illnesses. Rates of mammogram within past 2 years were 59% in homeless and 57.1% in low-income domicile patients; 53% did not know the results of their mammogram. Homeless and domicile patients received equal provider counseling. Homeless women were more likely to be uninsured (p < .01). Domicile patients were more likely to have a chronic illness (p < .01). A history of mental illness or substance abuse was not different between the two groups. In logistic regression, provider counseling predicted mammogram (odds ratio, 31.69; 95% CI, 3.76-266.8); race, insurance status, housing status, and history of mental illness or substance abuse did not. CONCLUSION The overall low rate of mammogram in this population compared with the national average is alarming. We suggest trained patient navigators to address social barriers and tailored patient education and counseling at any clinical encounter to address misconceptions, along with broader structural approaches to address homelessness.

Perceptions, Attitudes, and Experience Regarding mHealth Among Homeless Persons in New York City Shelters

Mobile health may be an effective means of providing access and education to the millions of homeless Americans. We conducted semi-structured interviews with 50 homeless people from different shelters in New York City to evaluate their perceptions, attitudes, and experiences regarding mobile health. Participants’ average age was 51.66 (SD = 11.34) years; duration of homelessness was 2.0 (SD = 3.10) years. The majority had a mobile phone with the ability to receive and send text messages. Most participants attempted to maintain the same phone number over time. The homeless were welcoming and supportive of text messaging regarding health care issues, including appointment reminders, health education, or management of diseases considering their barriers and mobility, and believed it would help them access necessary health care. Overwhelmingly they preferred text reminders that were short, positively framed, and directive in nature compared to lengthy or motivational texts. The majority believed that free cell phone plans would improve their engagement with, help them navigate, and ultimately improve their access to care. These positive attitudes and experience could be effectively used to improve health care for the homeless. Policies to improve access to mobile health and adapted text messaging strategies regarding the health care needs of this mobile population should be considered.

Rates and predictors of uncontrolled hypertension among hypertensive homeless adults using new york city shelter-based clinics

PURPOSE We undertook a study to determine the rates, predictors, and barriers to blood pressure control among homeless and nonhomeless hypertensive adult patients from 10 New York City shelter-based clinics. METHODS The study was a retrospective chart review of blood pressure measurements, sociodemographic characteristics, and factors associated with homelessness and hypertension extracted from the medical records of a random sample of hypertensive patients (N = 210) in 2014. RESULTS Most patients were African American or Hispanic; 24.8% were female, and 84.3% were homeless for a mean duration of 3.07 years (SD = 5.04 years). Homeless adult patients were younger, had less insurance, and were more likely to be a current smoker and alcohol abuser. Of the 210 hypertensive patients, 40.1% of homeless and 33.3% of nonhomeless patients had uncontrolled blood pressure (P = .29) when compared with US rates for hypertensive adults, which range between 19.6% and 24.8%, respectively; 15.8% of homeless patients had stage 2 hypertension (P = .27). Homeless hypertensive patients with diabetes or multiple chronic diseases had better blood pressure control (P <.01). In logistic regression, lack of insurance was associated with inadequate blood pressure control (P <.05). CONCLUSIONS The high rate of uncontrolled hypertension among hypertensive homeless adults is alarming. We propose comprehensive approaches to improve social support, access to medical insurance, and medication adherence, the lack of which complicate blood pressure control, targeted health education, and life style modifications using mobile health strategies for this mobile population.

Teaching Immigrant and Refugee Health to Residents: Domestic Global Health

Background: Half a million immigrants enter the United States annually. Clinical providers generally lack training in immigrant health. Description: We developed a curriculum with didactic, clinical, and analytic components to advance residents’ skills in immigrant and travel health. The curriculum focused on patients and their countries of origin and encompassed (a) societal, cultural, economical, and human rights profiles; (b) health system/ policies/resources/statistics, and environmental health; and (c) clinical manifestations, tropical and travel health. Residents evaluated sociocultural health beliefs and human rights abuses; performed history and physical examinations while precepted by faculty; developed specific care plans; and discussed patients in a dedicated immigrant health morning report. Evaluation: We assessed resident satisfaction using questionnaires and focus groups. Residents (n = 20) found clinical, sociocultural, and epidemiological components the most helpful. Morning reports reinforced peer education. Conclusion: The immigrant health curriculum was useful for residents. Multiple teaching modules, collaboration with grassroot organizations, and an ongoing clinical component were key features.