Hands-on telemedicine; Hope Services Street Medicine program assists homeless with health care during pandemic

At every level of society, people experience barriers to accessing health care.

For people experiencing homelessness, each barrier is amplified by the daily struggle to survive. Having to make choices between going to the doctor or risking their possessions being stolen, spending money on food or medicine or simply having lost faith in health care because of previous negative experiences, these challenges seem insurmountable.

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According to the American Medical Association, “marginalized and minoritized patients have and will suffer disproportionately during the COVID-19 crisis due to the inequities in society perpetuated by systematic practices.”

Telemedicine has proven to be a viable, cost-effective solution that improves access to health care. And telemedicine use has skyrocketed during the pandemic.

Prior to COVID-19, there were an average of 13,000 Medicare beneficiaries receiving telemedicine per month. To date, more than 10 million Medicare beneficiaries have received telemedicine during this public health emergency.

Hope Services Hawaii’s Street Medicine was developed in May 2019 with the objective of reducing inequities and barriers.

Each Wednesday night, a team of dedicated active and retired health care professionals canvass the streets, encampments and emergency shelters of Hilo to connect with people.

Outreach specialists, registered nurses, medical doctors, nurse practitioners, physician’s assistants and paramedics provide emergency nutrition, hygiene, first-aid kits, masks, hand sanitizer and health care education. They clean and bandage festering wounds, remove sutures, provide comprehensive medical assessments, conduct COVID-19 screening and testing, schedule medical appointments and transportation, facilitate emergency case management, facilitate entry to detox and rehab and assist in emergency shelter placement.

When a medical doctor, nurse practitioner or physician’s assistant is present, prescriptions are called in, picked up, paid for and delivered to the patient — sometimes all in the course of an hour.

On the nights when the team is without one of those providers, they’ve used telemedicine, and realized the world of potential it offers to those on the street.

In partnership with Premier Medical Group, the team can connect with a physician on a smartphone and facilitate a patient assessment right there on the street. The patient can benefit from this by having a prescription called in, receiving a specialty referral, obtaining a note to their primary doctor or scheduling a face-to-face follow-up visit by the telemedicine physician the next day.

During a time when the homeless face monumental barriers, street telemedicine is an innovative technological solution helping address health disparities exacerbated by the pandemic.

To date, the team has been on 67 missions, seen more than 400 patients and helped avoid countless emergency room visits by treating preventable maladies before they become emergencies.

Unfortunately, the team does not have the funding or manpower to deliver care beyond Wednesday nights, but members hope these encounters are the first step toward nurturing meaningful relationships between the health care and houseless communities.

The Street Medicine team is excited about the power of telemedicine and is working with Community First and the Pacific Basin Telehealth Resource Center in pursuit of funding for dedicated telehealth access points for the Big Island’s homeless.

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When programs such as these are funded, barriers become surmountable, inequities become less stark and patients become healthier.

The Street Medicine program is made up of Hope Services staff and community volunteers and works under the medical direction of Premier Medical Group, with support from Bay Clinic, Clinical Labs of Hawaii and HMSA.

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