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Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'IX: people and places-diverse populations and locations of care', authors address the following themes: 'LGBTQIA+health in family medicine', 'A family medicine approach to substance use disorders', 'Shameless medicine for people experiencing homelessness', '''Difficult" encounters-finding the person behind the patient', 'Attending to patients with medically unexplained symptoms', 'Making house calls and home visits', 'Family physicians in the procedure room', 'Robust rural family medicine' and 'Full-spectrum family medicine'. May readers appreciate the breadth of family medicine in these essays.

Bridging gaps in care coordination for homeless populations is a complex task that requires addressing attitudinal and behavioral changes, as patients hold more control over chronic and preventive care. Despite these challenges, organizations like the Patient Care Intervention Center (PCIC) have made significant strides in improving health equity for vulnerable populations in Houston. PCIC integrates data, fosters collaboration between social services and medical providers, and provides comprehensive and targeted services, positively impacting the health and social outcomes of 98,838 individuals. By addressing diverse needs and integrating medical and social care, PCIC offers a model for developing comprehensive solutions to prevent and reduce homelessness while improving health equity for socially and medically vulnerable populations. PCIC's approach involves data sharing partnerships and care coordination initiatives with various agencies in Harris County and Houston. This cross-sector collaboration, integrating data from multiple sources such as hospital systems, managed care organizations, and government agencies, enables the development of more effective interventions. PCIC demonstrates the limits of fragmented interventions and the importance of integrating medical and social care. PCIC's model serves as an example of how collaboration, targeted services, and data integration can improve health equity and contribute to the prevention and reduction of homelessness. [ABSTRACT FROM AUTHOR]

Homelessness is among the most important problems in social medicine. While traditional studies provide useful answers (albeit for increasingly narrow phenomena), unique perspectives and first-person accounts hold potential to influence broader thinking about the field. Here, we provide a first-person account from physician-activist David Buck, a health policy expert and founder of Healthcare for the Homeless-Houston, on what it takes to tackle the homelessness epidemic, fix the broken aid industry, and challenge the status quo. [ABSTRACT FROM AUTHOR]

Despite a persistent link between homelessness, mental illness, and increased psychiatric hospitalizations, there is a dearth of research examining risk factors for higher utilization of mental health treatment among this vulnerable population. This study utilizes machine learning in electronic health record data to examine admissions from 2010 to 2019 at a regional psychiatric safety-net hospital among individuals experiencing homelessness compared to non-homeless individuals. Of the 64 social, demographic, clinical and treatment predictors examined, 12 were identified as the strongest predictors of homelessness status at psychiatric hospital admission. Admissions for patients identified as homeless were driven by social determinants of health. The strongest predictor was having no income (+267% increase in the odds of being homeless). The study results demonstrate how machine learning can be used to explore electronic health record data collected during psychiatric hospital admission, including social determinants of health, to elucidate the clinical and social needs of homeless individuals seeking psychiatric treatment. These findings have implications for the development of targeted prevention/treatment interventions to address homeless patients' needs during psychiatric hospitalization to improve social and health outcomes. [ABSTRACT FROM AUTHOR]

Across the country, health care professionals are joining forces to improve the health care of populations with complex social, financial, and behavioral health needs. One promising approach relies on community-based integrated health teams (CIHTs), or interprofessional teams that integrate a broad range of medical, behavioral health, and social services, offer intensive case management, and link patients to available community resources. Yet whether CIHTs fulfill their potential depends in part on policymakers enacting policies that support CIHTs delivering comprehensive, high-value care to their patients. Drawing on the insights of CIHT professionals shared with the authors, this Article highlights several factors that contribute to CIHTs’ success, namely utilizing community health workers (CHWs) to provide patients with high-touch care, including behavioral health experts on the care team, and increasing coordination between CIHTs and patients’ primary care providers. The Article then calls for federal and state policies that would promote expansion of the CHW and behavioral health workforce, provide more flexible and sustainable financing to CIHTs, and support primary care providers acquiring the financial resources, data capabilities, and personnel needed to either embedding CIHTs within their practices or coordinate with outside CIHTs. [ABSTRACT FROM AUTHOR]

Abstract Background Recent literature has called for humanistic care of patients and for medical schools to begin incorporating humanism into medical education. To assess the attitudes of health-care professionals toward homeless patients and to demonstrate how those attitudes might impact optimal care, we developed and validated a new survey instrument, the Health Professional Attitudes Toward the Homeless Inventory (HPATHI). An instrument that measures providers' attitudes toward the homeless could offer meaningful information for the design and implementation of educational activities that foster more compassionate homeless health care. Our intention was to describe the process of designing and validating the new instrument and to discuss the usefulness of the instrument for assessing the impact of educational experiences that involve working directly with the homeless on the attitudes, interest, and confidence of medical students and other health-care professionals. Methods The study consisted of three phases: identifying items for the instrument; pilot testing the initial instrument with a group of 72 third-year medical students; and modifying and administering the instrument in its revised form to 160 health-care professionals and third-year medical students. The instrument was analyzed for reliability and validity throughout the process. Results A 19-item version of the HPATHI had good internal consistency with a Cronbach's alpha of 0.88 and a test-retest reliability coefficient of 0.69. The HPATHI showed good concurrent validity, and respondents with more than one year of experience with homeless patients scored significantly higher than did those with less experience. Factor analysis yielded three subscales: Personal Advocacy, Social Advocacy, and Cynicism. Conclusions The HPATHI demonstrated strong reliability for the total scale and satisfactory test-retest reliability. Extreme group comparisons suggested that experience with the homeless rather than medical training itself could affect health-care professionals' attitudes toward the homeless. This could have implications for the evaluation of medical school curricula.

The Jail Inreach Project is a health care-based intensive case management "inreach" program that engages incarcerated persons from the homeless population who have behavioral health disorders (mental illness, substance use disorder, or both) in establishing a plan for specific postrelease services. The Jail Inreach Project aims to provide continuity of care and integrate this highly marginalized subpopulation of homeless persons into primary and behavioral health care systems by establishing patient-centered health homes. The use of integrated primary and behavioral health models in conjunction with provisions for immediate access to and continuity of care upon release is emerging as a best practice in combating the rapid cycling of this vulnerable population between streets and shelters, emergency centers, and the county jail. Preliminary results indicate that more than half of the persons referred to the program remained successfully linked with services postrelease, whereas slightly less than one-third who engaged in services while incarcerated did not retain linkage on release. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Medical Malapropisms (or a Stitch in Time Gathers No Moss)," by S. W. Davis and T. M. Kenyon in the 1995 issue.

Carrying hundreds of patient files in a suitcase makes medical street outreach to the homeless clumsy and difficult. Healthcare for the Homeless--Houston (HHH) began a case study under the assumption that tracking patient information with a personal digital assistant (PDA) would greatly simplify the process. Equipping clinicians with custom-designed software loaded onto Palm V Handheld Computers (palmOne, Inc, Milpitas, CA), Healthcare for the Homeless--Houston assessed how this type of technology augmented medical care during street outreach to the homeless in a major metropolitan area. Preliminary evidence suggests that personal digital assistants free clinicians to focus on building relationships instead of recreating documentation during patient encounters. However, the limits of the PDA for storing and retrieving data made it impractical long-term. This outcome precipitated a new study to test the feasibility of tablet personal computers loaded with a custom-designed software application specific to the needs of homeless street patients.

Background and Objectives: Houston Outreach Medicine Education and Social Services teaches students, in multidisciplinary teams, using the learner-centered model, to provide primary health care to the homeless., Description: The founding and operational aspects of this educational intervention are presented., Evaluation: Student response to this service-learning program is assessed in terms of educational value using a survey and an analysis of student reflections. Clinical service activities are measured to demonstrate program efficacy., Conclusions: Student participants, especially basic science medical students, value the program due to its contributions to their professional and personal education, as well as their increased understanding of biopsychosocial issues. Learners develop empathy, compassion, and heightened social awareness.