Outpatient services utilization among urban homeless: the role of migrant status

Background The composition of the homeless population in urban areas has been changing, with a large increase of homeless from foreign origin. They represent a new challenge for homeless healthcare. The purpose of this research is to determine the intensity of utilization of ambulatory care within different migrant groups and to compare these to Italian homeless. Methods Data were collected from an Outpatient ‘‘open access’’ Clinic located in Rome, run by a catholic institution who manages health services for deprived urban populations. All homeless adults who had their first medical examination between January 2007 and May 2011 (N=2604 patients) represented the study sample. The follow up period was one year. Poisson regression analyses were conducted in order to assess the number of revisits within a year after first contact in different migrant groups and in the Italian reference group. Results About half (47.6%) of the total population returned to the outpatient service at least once within one year. This percentage was 58.0% among patients with a chronic condition at first visit. Migrants homeless had a higher number of revisits compared with Italian ones. The highest number of visits was found among extra EU undocumented migrants (Rate Ratio 1.22 95% CI 1.08-1.39) and Eastern- European Citizens (Rate Ratio 1.20 95% CI 1.06-1.35) compared to Italian homeless. In the population with chronic condition, the highest number of revisits was found among asylum seekers (RR 1.53 95% CI 1.17-2.01). These differences existed among males but not among females. Conclusions Homeless migrants revisit outpatient services more often than Italian homeless. These differences are observed among men (but not women) and also among those with a chronic condition at first visit. These findings may support focused strategies aimed to respond to the specific needs of these patients. Key message This study provides information on health services use of a vulnerable population that has been poorly researched to date.