Healthcare utilization among urban homeless followed by an outpatient clinic: more intensive use by migrant groups

Introduction: The increasing share of homeless represents a challenge for the healthcare system. In Rome, Italy, a large ambulatory care centre for the homeless had adopted several measures to improve access to health care facilities by migrants. We aimed to determine the rate of utilization among migrants as compared to the Italian homeless. Methods: We collected data on 2604 homeless adults who had their first medical examination between 2007 and 2011. We conducted Poisson regression to analyse the association of medical and demographic variables with the number of revisits within 1 year after the first contact. Results: As compared to the Italian-born homeless, the number of revisits among the migrants which included undocumented migrants, homeless EU citizens, forced migrants and refugees, was increased. These differences were also noted among those with chronic conditions detected on the first contact. The differences were substantial among males but not among females. A greater frequency of revisits was also observed among the uneducated and those who were not registered with the National Health Service. Conclusion: The specialised services in this clinic were able to achieve relatively high rates of revisits among the homeless of foreign background. This suggests that the utilization of health care services by these people may be effectively increased by the implementation of a series of migrant-oriented practices.