References
Experiences of homeless individuals using ambulance services: a narrative review
Abstract
Background:
Homeless individuals are vulnerable and have a higher burden of illness. Barriers to care exist and experiences can be negative, contributing to increased morbidity and mortality. The experiences of homeless individuals accessing healthcare through ambulance services is underexplored.
Aims:
The study aims to describe why homeless individuals access healthcare through ambulance services and identify lived experiences.
Methods:
A narrative literature review was undertaken using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology, with Critical Appraisal Skills Programme tools used to assess quality before thematic synthesis.
Results:
Twenty-three studies were included. Six themes were identified including frequency of ambulance use and clinical characteristics, why healthcare is accessed through ambulance services and the experiences of homeless individuals and paramedics.
Conclusions:
Evidence relating to homeless individuals accessing healthcare through ambulance services is limited. However, it is clear this group uses these services more often than non-homeless individuals, likely because of their higher chronic illness burden. Services should be developed to meet the needs of homeless individuals and to help ensure demand on ambulance services is manageable and affordable.
Homelessness presents in many forms throughout society. While rough sleeping is the most visible, living in insecure housing, using temporary shelters/hostels, sofa surfing and squatting are all recognised presentations (Heaslip et al, 2022; Watts et al, 2022). Determining the extent of homelessness is difficult because of the different definitions and reporting methods along with the transient nature of this group (Heaslip et al, 2022).
Homeless individuals experience health inequalities and inequities resulting in disproportionate reliance on healthcare services compared to the general population (Marmot and Bell, 2012). Difficulty in accessing these services is often reported (Gunner et al, 2019) and over-reliance on emergency departments (EDs) may result (Moore et al, 2011; Feldman et al, 2017; Gunner et al, 2019). It is often not recognised that most of these ED presentations are appropriate and relate to acute emergencies from living in a hostile environment and acute exacerbations or complications from chronic illness (Moskop et al, 2009; Berkowitz et al, 2018). Discrimination and negative experiences are often reported when accessing healthcare services (Johnstone et al, 2015; Purkey and MacKenzie, 2019; Ramsay et al, 2019) and longer ED wait times are experienced by homeless compared to non-homeless individuals (Ayala et al, 2021).
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