Canadian journal of surgery. Journal canadien de chirurgie · 2026
Outpatient surgical referrals from primary care providers for people experiencing homelessness: a retrospective review.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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McDonald Madeline, Huan Peter, Hircock Caroline, Pizzola Christina, O'Shea Timothy, Lévis Carolyn, Cadeddu Margherita
Аннотация
BACKGROUND: People experiencing homelessness 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 people experiencing homelessness in Hamilton, Ontario, Canada. The review spanned a 2-year period from 2017 to 2018 and included referrals to all outpatient surgical services (except ophthalmology) and endoscopy.
RESULTS: In total, 167 surgical referrals were sent for 129 patients over the 2-year period. The average age of patients was 46 years, and 95% had provincial health insurance. Among referrals, 93% resulted in a scheduled appointment, and 58% resulted in the patient seeing a surgical provider. Overall, 61 surgical procedures were proposed and 64% of these were completed. Major procedures were completed at a higher rate than minor procedures. Patient, provider, and system factors contributed to patients not receiving care.
CONCLUSION: To our knowledge, this is the first study to describe outpatient surgical referrals by primary care providers for people experiencing homelessness. There were significant gaps in both the accessing of surgical consultation and in the completion of proposed surgical procedures. These represent an ongoing unmet need for surgical care. We divided barriers into systemic, provider, and patient barriers, and those that have direct applications to policy and practice.
METHODS: This is a retrospective review of electronic patient charts from the Shelter Health Network, a health care and social service organization serving people experiencing homelessness in Hamilton, Ontario, Canada. The review spanned a 2-year period from 2017 to 2018 and included referrals to all outpatient surgical services (except ophthalmology) and endoscopy.
RESULTS: In total, 167 surgical referrals were sent for 129 patients over the 2-year period. The average age of patients was 46 years, and 95% had provincial health insurance. Among referrals, 93% resulted in a scheduled appointment, and 58% resulted in the patient seeing a surgical provider. Overall, 61 surgical procedures were proposed and 64% of these were completed. Major procedures were completed at a higher rate than minor procedures. Patient, provider, and system factors contributed to patients not receiving care.
CONCLUSION: To our knowledge, this is the first study to describe outpatient surgical referrals by primary care providers for people experiencing homelessness. There were significant gaps in both the accessing of surgical consultation and in the completion of proposed surgical procedures. These represent an ongoing unmet need for surgical care. We divided barriers into systemic, provider, and patient barriers, and those that have direct applications to policy and practice.