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Abstract
Introduction People experiencing homelessness (PEH) suffer from a high burden of surgical conditions and face many barriers to accessing care. Our aim was to describe the unmeasured and unmet need of surgical care through outpatient surgical referrals.
Methods This is a retrospective review of electronic patient charts from the Shelter Health Network, a health care and social service organization serving PEH in Hamilton, Canada. The review spanned a two-year period from 2017-2018 and included referrals to all outpatient surgical services (except ophthalmology) and endoscopy.
Results 167 surgical referrals were sent for 129 patients over the two-year period. The average age of patients was 46 years, and 95% had provincial health insurance. 95% of referrals resulted in a scheduled appointment, and 58% resulted in the patient seeing a surgical provider. Overall, 63 surgical procedures were proposed and 62% of these were completed. This completion rate was similar between minor and major procedures. Patient, provider and system factors contributed to patients not receiving care.
Conclusions The vast majority of referrals resulted in a scheduled appointment, however half of PEH were seen by a surgical provider and just over half received a proposed surgical procedure. Barriers identified were divided into systemic barriers, provider barriers and patient barriers. This project was funded by the MacGlObAs Global Surgical Scholar Research Bursary, McMaster University, Canada.
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