Street Medicine: How It Can Have a Positive Impact and Curtail the Misuse of the Emergency Department

Jillian Blalock
OMS-III WVSOM

When I made the decision to return to my hometown of Wheeling, West Virginia to complete my clinical requirements for medical school, I did so because I already knew the area; I would not have the “transition period” or feel the need to “get settled” like many of my classmates, and after seven years away from home, and two new cities, that was very comforting. What I failed to realize, however, was that a lot had changed during those seven years that I was away – both for the city of Wheeling, and for myself.

For those unfamiliar with the geographic location of Wheeling, it is in the northern panhandle of the state, with the city center located less than five miles from the Ohio state border and approximately fifteen miles from the Pennsylvania state border. In 2016, the state of West Virginia led the entire nation in rate of deaths due to drug-related overdoses at 52 per 100,000. Two other states listed in the top five include Ohio (39.1 per 100,000) and Pennsylvania (37.9 per 100,000) (1). Although the opioid epidemic began prior to my seven-year hiatus from the Friendly City, its ravenous effects were undeniable upon my return. On top of the drug crisis, the population, which has been on a steady decline for more than ten years, now stands at only 27,375 people, 17.8% of which fall under the federal poverty line, currently defined as $24,600/year for a family of four (2).

Not surprisingly, among the most common characteristics leading to homelessness are inadequate income and substance use disorder. In the US, an astounding up to 3.5 million people are living without permanent shelter on any given night. Although the rate of homelessness is declining in the US, statistics in West Virginia show a very different story. From 2005 to 2007, there was a 36% increase in the number of individuals who are chronically homeless (3). What saddens me most about this statistic is the vast majority of  non-homeless Wheeling residents that I have spoken with are largely unaware of how pervasive the problem is here, or that the problem exists at all. I know I did not.

Everyone who lives in Wheeling knows there is one stoplight in particular that is more frustrating than the rest: “The Perkins Red Light.” It is especially annoying on the after-work commute. What most do not realize while sitting at that light, is that several men live right beneath where their cars sit stagnant, sheltered only by the bridge above their heads. All those times I have sat at that red light, upset that it might take me a few extra minutes to get home after work, and yet there were people literally right beneath me who had no home to which they could return to at the end of the day.

Although it is true that these people are seemingly invisible to most others in town, there is one small group of community members who are going above and beyond the call of duty in order to make a difference in the lives of those less fortunate. It is thanks to them that my eyes have been opened to the reality of our community and its very serious needs.

Project HOPE (Homeless Outreach Partnership Effort) is a local street medicine program, staffed by a diversified team of volunteer healthcare providers, including: physicians, nurses, medical students, and pre-medicine undergraduates. Street medicine is the delivery of medical care to those living and sleeping in the street (4). If you are unfamiliar with street medicine, it is a concept that began in the 1990s, when Dr. Jim Withers, of Pittsburgh, PA, began frequenting the city streets after hours, providing a type of new-aged “house call” to homeless men and women who required basic medical care, but were unable to obtain it otherwise (5). This medical movement has grown tremendously over the years, with programs now spanning the country from San Francisco to Boston, including Detroit and even little old Wheeling, West Virginia.

Although each street medicine program is set up uniquely based on the specific needs of their community, here in Wheeling, Project HOPE takes to the streets one, even two nights a week in times of higher need (i.e. winter), to provide social and medical support to the Valley’s impoverished population. Project HOPE not only provides both acute and preventative care with close follow up on a weekly basis, they also provide patients with long-term follow up options through Wheeling Health Right, the Ohio County Health Department, or various local primary care physicians depending on the patient’s health insurance designation.

It is no secret that overcrowding has become a paramount problem in emergency departments (EDs) across the country (5). When compared with the general population, homeless individuals are 3 times as likely to visit the ED at least once in a given year and are more likely to have repeated ED visits (7-9). There are numerous factors that leave the homeless more susceptible to ED misuse, including a lack of health insurance, poor access to primary care, and chronic, medical problems that make them difficult patients to manage. Therefore, for our homeless patients, the ED is often the only option (7).

Ultimately, what Project HOPE and other programs like it aim to do is bridge the gap between the homeless and healthcare system to provide more accessible primary care options for those who need it. In turn, this should both lessen the burden on taxpayers who are funding these repeated ED visits for those patrons unable to pay, as well as ease the strain felt by the healthcare providers themselves who are forced to try and manage an unrealistic number of patients in the department every day. Studies have shown that implementation of these types of community access programs, which assist in providing housing options and medical/social case management to those in need, have been very successful in helping to minimize unnecessary ED usage (8,10).

By working with Project HOPE, I have experienced the very real impact that street medicine programs can have on a community. As a prospective future emergency medicine physician, I support street medicine, because I believe that collaborations between street medicine programs and local EDs results in better care for these historically unreachable patients and improves the overall health of the community. That is the type of legacy that I am very proud to be a part of.

References:

    1. CDC Staff. Drug Overdose Death Data. The Center for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/data/statedeaths.html. Updated December 19, 2017. Accessed January 20, 2018.
    2. United States Census Bureau Staff. QuickFacts: Wheeling, West Virginia. United States Census Bureau. https://www.census.gov/quickfacts/fact/table/wheelingcitywestvirginia/PST045216. Accessed January 20, 2018.
    3. Greater Wheeling Coalition for the Homeless Staff. West Virginia vs. US Statistics. Greater Wheeling Coalition for the Homeless. http://www.wheelinghomeless.org/statistics-and-definitions.php. Accessed January 20, 2018.
    4. About The Institute. Street Medicine Institute. http://streetmedicine.org/wordpress/about-the-institute/. Accessed March 24, 2018.
    5. Withers, J. Street medicine: an example of realty-based health care. Journal of health care for the Poor and Underserved. 2011;22(1):1-4. doi:10.1353/hpu.2011.0025
    6. Derlet RW, Richards JR, Kravitz RL. Frequent Overcrowding in U.S. Emergency Departments. Academic Emergency Medicine. 2001; 8(2):151-155.
    7. Kushel MB, Perry S, Clark R, Moss AR, Bansberg D. Emergency Department Use Among the Homeless and Marginally Housed: Results From a Community Based Study. American Journal of Public Health. 2002;92:778.
    8. Pope D, Fernandes CMB, Bouthillette F, Etherington J. Frequent users of the emergency department: a program to improve care and reduce visits. CMAJ. 2000;162(7):1017–1020.
    9. D’Amore J, Hung O, Chiang W, et al. The epidemiology of the homeless population and its impact on an urban emergency department. Academic Emergency Medicine. 2001;8:1051-1055.
    10. Sadowski LS, Kee RA, VanderWeele TJ, Buchannan D. Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: A randomized trial. Journal of the American Medical Association. 2009;301:1771-1778.
2018-06-04T20:42:58+00:00April 5th, 2018|Current Events, Spring 2018, The Fast Track Issues|

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