AAFP Proposals Address 'Housing First' Care, Workplace Violence

Marcia Frellick

September 13, 2017

SAN ANTONIO, Texas — Proposals to address housing-first healthcare and workplace violence were recommended September 12 by the American Academy of Family Physicians (AAFP) 2017 Congress of Delegates.

The housing resolutions recommended that AAFP advocate for "housing first" approaches, including permanent housing with community-based, integrated treatment, rehabilitation, and support services. The approach includes encouraging Medicaid agencies and Medicaid to pay for such services.

James Gill, MD, MPH, from Newark, Delaware, told Medscape Medical News that housing is "a human right, probably even more basic than healthcare."

"I feel that housing is too important to rely mainly on the volunteer organizations that try to provide it, and to the woefully inadequate governmental programs that provide subsidized housing, with very long wait lists."

Housing should be available to all who cannot afford it, just as food stamps are available to Americans who cannot afford food, he said.

It would make sense to fund housing first programs through Medicaid, he said, "since without housing, paying for healthcare through Medicaid will have much less positive impact on health."

Russell Maier, MD, with the Washington delegation, which sponsored one of the resolutions, notes that their resolution explicitly asked the AAFP to work with Medicaid to fund housing-first programs through managed care organizations and other Medicaid insurers.

"Several third-party private insurers, including [managed care organizations], have recognized that placing homeless individuals into housing first decreases overall costs and improves health outcomes, two of the triple aim principles. In spite of this evidence-based practice and policy, some states still don't provide funds for housing first," he told Medscape Medical News.

AAFP has recognized homelessness' link to health, speakers acknowledged, but they said the current resolutions urge more specific and urgent action to address it.

Keisha Harvey, MD, an alternate delegate with the new physician constituency, said, "We all know that homelessness is one of the social determinants of health. [Homeless people] have poorer outcomes and poorer access to health. One of the resounding themes here is that healthcare should be a right. We believe that this resolution is headed in the right direction towards making healthcare a right."

Tools to Address Workplace Violence

The congress also recommended two resolutions regarding workplace violence that urged the AAFP to survey family physicians to quantify the incidence of violence against family physicians in the workplace and to create a toolkit to provide students, residents, practicing physicians, nurses, and staff with resources such as active-shooter and de-escalation training.

As reported recently by Medscape Medical News, the number of active shooter events in any US setting increased from an average of 6.4 events from 2000 through 2006 to 16.4 events per year from 2007 to 2013.

David Hoelting, MD, a Nebraska delegate, told Medscape Medical News he applauds the toolkit, given the growing numbers of violent events over the years in healthcare settings. He added that a patient recently threatened to shoot him over care of a family member.

"Violence in physicians' offices is surprisingly common," he said. "In fact, clinics are one of the most common targets of violence. Most commonly, it is disgruntled patients, mentally ill patients, drug seekers, and occasionally, employees."

Dr Maier said that even though the training would take more of providers' time, it is a burden worth taking on. He said the de-escalation training is particularly relevant, considering family medicine's focus on prevention.

The speakers have disclosed no relevant financial relationships.

American Academy of Family Physicians (AAFP) 2017 Congress of Delegates. Presented September 12, 2017.

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