Inner City Health

Introduction:

The Inner City Health research program is the newest initiative for the Division of Emergency Medicine. The program is being developed by Dr. Julie Spence in the Department of Medicine. The program focuses on emergency-based health care delivery to disadvantaged populations.  The program maintains strong links to the Centre for Faculty Development and the Arthur Sommer Rotenberg Chair in Suicide Studies and Suicide Studies Unit at St Michael’s Hospital. The program is housed at the Centre for Research on Inner City Health.

Current Studies

Attitudes of Medical Trainees towards Homeless Persons Presenting for Care in the Emergency Department

The homeless are at increased risk for both traumatic injuries and serious health problems.  Due to significant barriers to access to care, a large proportion of homeless persons will present to the Emergency Department (ED) for acute and routine care.  When homeless individuals were asked what the most difficult aspect of being homeless was, negative reactions by shelter workers and health care providers were included as major themes. 

Despite the recognition that many homeless people are treated in the ED, there is little information regarding the attitudes of ED staff and medical trainees towards these patients and their care.  Furthermore, there are no North American curriculum requirements for emergency medicine trainees regarding homelessness or urban health.  In the medical setting, exposure alone to homeless patients may negatively impact the attitudes of trainees.  We propose to study the attitudes towards homelessness of medical trainees before and after emergency department rotations at an inner city hospital and to define whether implementation of a curriculum on homelessness has a positive impact on attitudes. 

This study is sponsored by the PSI Foundation and will be completed over a two year period.  During the first year of the study we will survey trainees’ attitudes before and after clinical emergency department rotations.  We propose to survey the attitudes of medical trainees using the validated questionnaire, the Attitudes Towards Homelessness Inventory (ATHI).   A homeless curriculum will be developed using feedback from house staff, health care providers, community partners, and agencies.  All undergraduate and postgraduate students will be eligible to participate.  In the second year of the study, attitudes will be surveyed before and after completion of the clinical rotation and didactic training. 

The ED research group is working with the Suicide Studies Unit at St. Michael’s Hospital on the following studies. 

Self-poisoning:  The Ins and Outs of Service Use

This CIHR-funded study describes the patterns of health care utilization associated with self-poisonings.  The frequency and severity of poisonings will be determined and the care provided for during the ED/hospital stay will be described. 

Suicidal Men, Emergency and Primary Care Providers:  Access and Continuity of Care Issues

The qualitative study examines the use of emergency based services for suicidal men with problems of substance abuse.  Pathways to care are described and improvements to health care delivery are examined.

 The Caregiver Education Project

For a number of years, educational sessions have been provided for caregivers of people with recurrent suicide attempts.  These evenings create a common understanding of the language and experiences of clients who self injure.  This program has been modified and extended to emergency-base healthcare providers in order to find mechanisms to better serve patients. 

Resuscitation Outcomes Consortium

Recent Publications

Spence J, Notarangelo V, Frank J, Long J, Morrison L, Written Notification for Prehospital Care Trials using Waiver of Consent, Academic Emergency Medicine, Acad Emerg Med. 2005 Nov;12(11):1099-103.

Spence J, Beaton D, Glazier R, Detsky A, Morrison L, Does CTAS Correlate with Admission to Hospital from the Emergency Department?  (thesis), University of Toronto, 2004.

Spence J: Should Emergency Departments Offer Postexposure Prophylaxis for Non-occupational Exposure to HIV? CJEM January 2003; 5(1): 38-45.

Contributors

Julia Spence

Julia Spence MD, MSc is a research scientist at the Centre for Research on Inner City Health at St. Michael’s Hospital and an assistant professor, Division of Emergency Medicine at the University of Toronto.  She was FRCPC(EM) residency director from 1995 until 2000.  Her research has focused on delivery of care in the ED especially to marginalized populations and research ethics. She received her Master’s in Clinical Epidemiology and completed the Collaborative Program in Bioethics at the University of Toronto in 2004.  Dr. Spence is also the current Chair of the Research Ethics Board at St. Michael’s Hospital and works with the ROC Regulatory Committee.

Priya Balasubramaniam-Kakkar