HealthTeam, City of Copenhagen
More than 700 patients have accessed systematic health-care from HealthTeam since the team mounted their bicycles for the first time on may 1st. 2005 and 250 - 300 patients each year seeks help with health, alcohol- and substance-use problems.
Joining up out-reach social and medical care
The City of Copenhagen project “HealthTeam” comprises four nurses and a physician. HealthTeam is a part of the outreach work in Municipality of Copenhagen and offers joint social and health initiatives directed at citizens that want, and need, help for complex problems, but are not able to seek it out.
A project researching the health, and need for health‐care, among people who are homeless in Copenhagen, was implemented in 2000 and evaluated in 2004.
The project integrated social outreach services and outreach healthcare. It was shown that there was a need for both health and social outreach working in close connection, but it also seemed clear that the two kinds of professionalism would have the best synergy from close co‐operation between different teams.
A structured interview of 122, and a thorough medical examination of 75, homeless substance and alcohol misusers showed a large degree of somatic and psychiatric health problems and a large number of drug‐related problems. It was also shown that there was a frequent use of emergency wards for all kinds of problems: acute, as well as infectious, diseases and psychiatric and drug‐related problems.
The project showed a massive alcohol misuse in the opioid‐misusing group and most of the opioid misusing was in a methadone program, though their profile of drug‐use was not different from those who were not in any program. The major somatic illnesses in the group as a whole were alcohol related, with liver diseases and neurological disturbances ranking highest. HIV is, in effect, systematically isolated in Denmark, but Hepatitis C is rampant in the homeless substance using group, with 85% of all opioid misusing infected. Anxiety and depression were found among 60%.
It seemed clear that the contact with the emergency system wasn’t optimal in relation to better general health‐status, because the emergency system wasn’t set up to coordinate care for the many chronic diseases found on closer examination. The result was, in general, a massive degradation of general health. To address these problems a new city‐wide health initiative was implemented in Copenhagen in 2005
Kings square by night
HealthTeam is a part of the outreach work in Copenhagen City which is joint social‐ and health initiatives directed at citizens that want and need help for complex problems but are not able to seek it out.
HealthTeam (HT) is an extensive way of getting in contact with people who do not – for various reasons – get in proper contact with the healthcare system. HT is based in the social system but works within the legal frame of an ordinary GP‐service. This means that HT can access all parts of the hospital system and begin long‐term collaboration with specialist and rehabilitation services, the substance treatment system as well as psychiatric in‐patient and outreach services.
On the other hand, the location inside the social system gives quick access to the whole system of shelter and social services. In addition to the direct outreach work, HT has been assigned to carry out some prevention activities, such as detection of infectious diseases and vaccination for hepatitis, among special groups and among people living in contact with homeless substance users in general.
We have now been working for almost 2 years and our report for the second year has just been finished. It has been a goal from the beginning to try to blend the best from social outreach and contact, such as a broad approach and acceptance; with the best from medical practice, such as evidence base and focus on the best available treatment.
In Copenhagen we’re lucky to have 3 low threshold nurse‐stations, serving many people who are homeless or people who are more or less marginalized every day, so Health‐Team’s primary goal is to help the people who don’t even get access to these clinics.
It could be said that the most marginalized in relation to access to health are the target group of HT, but we have found that many people actually fluctuate in and out of homelessness and related problems. As a consequence, we have defined the target group in relation to the availability of health‐services, so that in fact our target group is homeless citizens with health‐problems, where contact has failed with what would normally be the appropriate health‐system. It can be people who do not have contact with a general practitioner or people who would be uncomfortable in the normal hospital framework.
GP on wheels
As mentioned previously, the work of Health‐Team is similar to the work done in an ordinary primary healthcare service, with some exceptions. The team is organized in the framework of a primary healthcare service. The exceptions are more a matter of degree than a matter of different offers of treatment. There is also a need for x‐rays and anti‐hypertensive treatment, but most problems relate to extensive substance use which needs to be considered over time. The fact that the team works as a general practice means that Health‐Team has the same possibilities as any general practice in Copenhagen, concerning treatment and referral to the secondary health‐system.
Health‐Team bridges the gap between lack of accessible health‐service and the individual. Health‐Team does not work from a stationary clinic, which means that work is done where the patients are. Transportation is by bicycle ‐ the fastest method in modern city traffic – at least in Copenhagen. Health‐Team attempts to attain contact with the citizen as fast as possible, but giving priority to the most urgent needs. The citizen will always be offered contact within 7 days - most often within a few up to 24 hours.
What we do
• Health‐Team has a broad range of possibilities for direct action:
• We take blood‐samples
• We refer to further medical examination.
• We follow up on hospitalization and help with medication if needed.
• We treat mental and physical conditions that do not require hospitalization.
• We prepare the citizen for planned hospitalization.
• We work as liaison between the health‐system and citizens with whom it is difficult to maintain contact.
• Contact with HealthTeam is free of charge for all.
Treatment and referral
All contact, planning and treatment is carried out in close co‐operation with the citizen. Health‐Team can always be contacted concerning advice in health problems. Referral to Health‐Team is extremely simple, as we’re supposed to offer access to health‐service to people who have problems accessing other health‐services. Referral is straightforward: just a contact by telephone from almost anybody, for instance police, hospitals, drop‐in centres, outreach workers etc. These days we also see a rising number of referrals by other homeless patients.
Spring has arrived - Main square, Copenhagen