When street medicine isn't enough: Effective transitions from the street to the clinic

The street medicine movement has delivered health care to places that were previously unattainable and to people who were previously unreachable. Despite its success, the quality of care delivered on the street is limited by the resources available to the street medical providers, and the system supporting the team from a traditional setting. Health care delivered on the street sometimes lacks physical privacy, causing the patient to be guarded in the interview, as well as making it difficult to obtain a quality physical exam. Street medicine teams rarely travel with the support staff one would find in an office such as a case manager, financial counselor or specialty care. Street medicine teams rarely have access to diagnostic testing that would be available in an office such as an electrocardiogram and pulmonary function testing. Only the most advanced street teams perform phlebotomy and joint injections on the street, which would be common in an office setting. While street medicine fills an essential role in taking health care to unsheltered people experiencing homelessness, care is not designed to be given on the street for the life of a patient, or take the place of a primary care physician. As a result, attempts must be made to transition patients to a traditional setting, which can be extremely difficult. The top reasons why unsheltered people experiencing homelessness avoid traditional means of care are the lack of transportation, medical insurance, and trust in the medical community. Street medicine is excellent at gaining trust but transportation and the financial means to pay remains a barrier if the patient remains homeless. Even if patients are willing to come to the office, the impersonal, overly structured and hurried atmosphere deters a repeat visit. During this Think Tank, presenters will share their approach to transitioning patients into traditional care. Each of the presenters come from different supporting and sponsoring institutions such as a large hospital network, a FQHC, and an academic student run program. Algorithmic approaches will be shared with participants and a facilitated discussion will be incorporated into the presentation to allow for sharing of methods, successes and pitfalls. The goal outcome of this session is the creation of a primer for best practices in transitioning unsheltered patients into a traditional health care setting that can be shared with attendees.