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. 2011;5(2):e94-e103.
Epub 2011 May 24.

Access to primary health care among homeless adults in Toronto, Canada: results from the Street Health survey

Erika Khandor  1 , Kate Mason, Catharine Chambers, Kate Rossiter, Laura Cowan, Stephen W Hwang
Affiliations

Access to primary health care among homeless adults in Toronto, Canada: results from the Street Health survey

Erika Khandor et al. Open Med. 2011.

Abstract

Background: Despite experiencing a disproportionate burden of acute and chronic health issues, many homeless people face barriers to primary health care. Most studies on health care access among homeless populations have been conducted in the United States, and relatively few are available from countries such as Canada that have a system of universal health insurance. We investigated access to primary health care among a representative sample of homeless adults in Toronto, Canada.

Methods: Homeless adults were recruited from shelter and meal programs in downtown Toronto between November 2006 and February 2007. Cross-sectional data were collected on demographic characteristics, health status, health determinants and access to health care. We used multivariable logistic regression analysis to investigate the association between having a family doctor as the usual source of health care (an indicator of access to primary care) and health status, proof of health insurance, and substance use after adjustment for demographic characteristics.

Results: Of the 366 participants included in our study, 156 (43%) reported having a family doctor. After adjustment for potential confounders and covariates, we found that the odds of having a family doctor significantly decreased with every additional year spent homeless in the participant's lifetime (adjusted odds ratio [OR] 0.91, 95% confidence interval [CI] 0.86-0.97). Having a family doctor was significantly associated with being lesbian, gay, bisexual or transgendered (adjusted OR 2.70, 95% CI 1.04-7.00), having a health card (proof of health insurance coverage in the province of Ontario) (adjusted OR 2.80, 95% CI 1.61-4.89) and having a chronic medical condition (adjusted OR 1.91, 95% CI 1.03-3.53).

Interpretation: Less than half of the homeless people in Toronto who participated in our study reported having a family doctor. Not having a family doctor was associated with key indicators of health care access and health status, including increasing duration of homelessness, lack of proof of health insurance coverage and having a chronic medical condition. Increased efforts are needed to address the barriers to appropriate health care and good health that persist in this population despite the provision of health insurance.

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Conflict of interest statement

Competing interests: None declared.

Figures

Table 1
Table 1
Characteristics of homeless adults who participated in the survey, by usual source of health care
Table 2
Table 2
Usual sources of health care and sources of health care in past 12 months reported by participants
Table 3
Table 3
Reasons for not having a usual source of health care
Table 4
Table 4
Factors associated with having a family doctor
See this image and copyright information in PMC

References

    1. Frankish C J, Hwang Stephen W, Quantz Darryl. Homelessness and health in Canada: research lessons and priorities. Can J Public Health. 2005;96 Suppl 2:23–29. - PMC - PubMed
    1. Hwang Stephen W. Homelessness and health. CMAJ. 2001 Jan 23;164(2):229–233. http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/11332321 - PMC - PubMed
    1. Goering Paula, Tolomiczenko George, Sheldon Tess, Boydell Katherine, Wasylenki Donald. Characteristics of persons who are homeless for the first time. Psychiatr Serv. 2002;53(11):1472–1474. - PubMed
    1. Cheung Angela M, Hwang Stephen W. Risk of death among homeless women: a cohort study and review of the literature. CMAJ. 2004 Apr 13;170(8):1243–1247. http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/15078846 - PMC - PubMed
    1. Hwang Stephen W. Mortality among men using homeless shelters in Toronto, Ontario. JAMA. 2000 Apr 26;283(16):2152–2157. http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=10791509 - PubMed

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