SATISFACTION WITH HEALTH CARE IN A SAMPLE OF INDIGENTS:
WOULD THEY RATHER BE TREATED BY PHYSICIANS OR NURSE PRACTIONERS?
In the United States, health care is often unavailable for the homeless. This heterogeneous group of men and women, includes longterm street dwellers, residents of shelters, the chronically mentally ill, the economically debased, and alienated youth---all of whom are subject to a broad range of acute and chronic diseases, intensified by unsuitable living conditions, stress and sociopathic behavior.
Trauma, pulmonary tuberculosis, infestations, and peripheral vascular disease are common problems among the homeless, and often incomplete and/or fragmentary medical care permits exacerbation of chronic disorders (Sebastian, 1994). Outreach health care programs, commonly consisting of teams of physicians, nurses, and social workers are used to reestablish and maintain health services for these disenfranchised persons.
Despite differences in community demographics, Carter, Green, Green, and Dufour (1994) have noted that most indigents encounter the roughly the same obstacles in seeking health care: bureaucracy, transportation, accessibility, present-time orientation, limited resources, frustration, and anxiety.
The authors feel that the best answer to the health care needs of indigents are nurse-managed free clinics.
It is pointed out that in outreach programs while a physician essentially deals only with clients' immediate physical problem, the nurse practioner (public health nurse with additional skills in the areas of health promotion and health education) in these programs attempts to serve all of the needs of indigent populations. Through the services provided by nurse practioners, homeless clients can receive continuity of care, proper follow-up, referrals, and teaching to aid in the prevention of illness. Similar sentiments have been voiced by Sebastian (1994) who reports that in many situ...