Katherine Koh. Credit score: Niles Singer/Harvard Employees Photographer
Cellphones are all over the place, together with within the fingers of homeless folks, a inhabitants amongst America’s sickest—common life expectancy is simply 51—and among the many hardest to succeed in by well being care staff.
It is also a inhabitants not usually related to expertise, which comes with utility payments, web service, and cellphone supplier plans. However a pandemic period innovation—telehealth for homeless folks—nonetheless presents a manner for at this time’s suppliers to succeed in homeless sufferers extra ceaselessly and reliably than conventional workplace visits.
Katherine Koh, assistant professor of psychiatry at Harvard Medical College and a psychiatrist at Massachusetts Basic Hospital and its companion Boston Well being Look after the Homeless Program, penned an article within the journal JAMA Inner Medication highlighting the strategy’s success at bettering entry and decreasing obstacles to care.
On this edited dialog with the Gazette, Koh stated she’s seen the impact in her personal follow, and she or he and co-authors from MGH, BHCHP, Boston Medical Middle, and Brown College need to proceed analysis on this strategy and spotlight its success for others helping this hard-to-reach inhabitants.
How did your work on this space get began?
Like most well being care organizations, BHCHP pivoted to telehealth throughout the pandemic in 2020. Initially, lots of people—together with myself—assumed it would not work nicely. However the patient-missed-appointment charge for my telehealth clinic days was decrease than in-person days, which I discovered fascinating and counterintuitive.
Telehealth for unhoused sufferers could sound like an oxymoron, however upon reflection, it truly is sensible. Lots of people are scuffling with substance use, psychological well being signs, and government functioning whereas attempting to fulfill fundamental wants of meals, water, and clothes, making it exhausting for folks to come back to a clinic appointment in a well timed method.
They usually want a T cross or a approach to pay for the T. Telehealth creates a better manner for folks to entry care with out having to take care of these obstacles.
Whereas there’s a excessive missed-appointment charge when sufferers are anticipated to come back in particular person, I discovered that with telehealth, about 80% of individuals would decide up their telephones. For instance, I talked to at least one affected person each single week for about six months straight, whereas in particular person, he would come as soon as a month at greatest. This text was born out of these medical experiences.
We did a preliminary evaluation and located that throughout the first six months of the pandemic, 76% of behavioral well being visits had been completed through telehealth, and 26% of medical visits. Arguably extra fascinating is that telehealth continues to be getting used now, when it does not must be. It is nonetheless a standard follow in BHCHP, and I believe it ought to be optimized as a inventive approach to attain this inhabitants that is usually exhausting to succeed in.
Is it used extra for explicit circumstances?
Behavioral well being visits significantly lend themselves to telehealth, as a bodily examination will not be wanted in lots of instances. We have additionally heard from our doctor colleagues that it is working particularly nicely for diabetes follow-up visits, COVID-19 and different infectious illnesses, and suboxone visits for opioid use dysfunction. It does not work for each situation or affected person, however we discovered that fifty% of behavioral well being sufferers have had one telehealth go to prior to now 12 months.
Throughout telehealth visits, do you are feeling that you just’re connecting with sufferers as a lot as you’d in particular person?
Usually, sure, however I discover there are nuances in how telehealth works for various sufferers. Most individuals can simply do an audio go to as a result of it is actually simply selecting up the telephone. Video visits could be tougher for sufferers as a result of they require a secure web connection and extra tech literacy.
Nevertheless, one other manner we now have made telehealth work is by having a employees member arrange an iPad to go to with a distant supplier whereas sufferers are in our respite heart or clinic, which has facilitated using video expertise.
If it is my first time assembly a brand new affected person, audio visits are tougher for establishing a connection than in particular person or through video. But when I do know the affected person, oftentimes an audio go to works very nicely to fulfill their wants. I usually discover sufferers expressing shock and reduction in regards to the televisits, saying issues like “This works for me.” I believe it empowers them and encourages them to proceed participating in medical care.
What are the most important well being care points dealing with homeless folks at this time?
There are a lot of. Few populations bear a larger psychiatric burden, which is what I am centered on as a psychiatrist. When folks take into consideration homelessness and psychological sickness, they usually take into consideration these affected by schizophrenia, who’re disconnected from actuality. That’s actually prevalent, however a lot of what I deal with is the sequelae of trauma.
Many of those people have been by means of unimaginable trauma from an early age, which impacts their skill to belief, to manage feelings, to tolerate traumatic conditions. Substance use problems are very prevalent: opioid use dysfunction and alcohol use dysfunction are the commonest.
Then there’s an entire vary of acute and power medical illnesses like heart problems, respiratory sickness, and cancers. These circumstances contribute to an abominable mortality charge and a imply age of loss of life that is virtually 30 years decrease than the overall inhabitants.
Are measures of well being outcomes related to this analysis?
Telehealth seems to extend engagement and entry—usually two main challenges—for the unhoused inhabitants, however we do not know but whether or not this interprets into fewer emergency and inpatient stays. That may be a actually vital space of analysis.
This analysis additionally encourages using expertise to deal with homelessness extra broadly. For instance, I am engaged on a examine utilizing AI to measure outcomes for our sufferers, which I believe is an thrilling new space. Traditionally, homeless people have been excluded from advances in expertise, however I believe the telehealth instance exhibits that expertise can and ought to be used to creatively advance analysis and look after unhoused folks.
Homelessness is at a report excessive in America. What components are contributing to this?
Rising housing prices, together with stagnant wages. A rise in migrants with out ample methods to deal with their inflow, and the top of pandemic-era renter protections. Pure disasters are additionally an underappreciated cause for growing homelessness. For instance, within the 2024 rely, folks displaced because of the Maui wildfires had been cited as contributing to the rise in homelessness.
A few years in the past, the Mass and Cass homeless encampment—at Massachusetts Avenue and Melnea Cass Boulevard in Boston—was damaged up, with homeless folks despatched to shelters, non permanent housing, and a few transferring to different components of town. There was media protection that individuals have come again to that space. What’s your evaluation of the state of affairs there?
Tackling this disaster additionally needs to be about prevention, as a result of even when we had been to deal with all people who’s homeless at this time, we cannot resolve the issue.
There’s an entire pipeline of individuals falling into homelessness and never sufficient reasonably priced housing and locations to ship them. My understanding is that the present Mass and Cass inhabitants is not only folks returning, but in addition new folks coming in. The centralization of companies in that space—there are therapy applications, BHCHP, and shelters there—make it a pure place to congregate.
Addressing homelessness, which has many roots in a big metropolis, inside funds constraints, may be very difficult. Each main metropolis is challenged by encampments and a scarcity of funding or help for sustainable options. On the affected person degree, I do suppose it’s vital to acknowledge that many unhoused persons are there due to a long time of trauma, adversity, and hardship.
Their wounds cannot be healed inside weeks and even months. Subsequently, discovering methods to fund non permanent housing websites longer-term till folks can transfer into everlasting supportive housing, in addition to enhance the availability of reasonably priced housing and concentrate on prevention for folks at excessive danger, is essential to fixing this disaster.
Extra info:
Katherine A. Koh et al, Telehealth for Sufferers Experiencing Homelessness—An Surprising Alternative, JAMA Inner Medication (2025). DOI: 10.1001/jamainternmed.2025.3901
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Q&A: Delivering well being care to hard-to-reach inhabitants through telehealth (2025, September 5)
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