A Note from the Editor
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This special issue centers on the theme of transdisciplinary care, a construct at the heart of the Association of Clinicians for the Underserved (ACU). For ACU, caring effectively for medically underserved populations entails transdisciplinary care.
Many ideas are best explained by example, and that is the case for transdisciplinary care. Most of the contributions we received on this theme took the form of reports on existing programs, and so we decided to run them as such, in a temporary new section, Reports on Transdisciplinary Programs, the contents of which run the gamut from the description of a national early childhood literacy initiative to a description of a San Diego refugee health care consortium. We hope that this pastiche of examples, together with Hobbs's conceptual ACU Column on the role of the social worker on a transdisciplinary health care team, will illuminate the emerging concept of transdisciplinary care. Ruddy and Rhee's literature review canvases the published literature on transdisciplinary care from the past decade.
The Letter to the Editor from Christensen and Garces, focused on the care of people who are homeless, succinctly articulates the notion of transdisciplinary care that underlies many of the Reports. Gundlapalli et al.'s Brief Communication describing a Salt Lake City respite care program also underscores the importance of a richly collaborative approach to addressing the health needs of people who are homeless.
This issue's Guest Editorial on Maryland's Special Population Cancer Network, by Claudia Baquet (a member of our Editorial Board and Associate Dean at the University of Maryland School of Medicine) and colleagues documents the importance of targeted initiatives to overcome racial/ethnic disparities in cancer care and health outcomes in the United States. The paper provides specific information about the programs their team has developed in Maryland. Chen's Report, which provides an overview of the success of the transdisciplinary infrastructure of the Asian American Network for Cancer Awareness Research and Training (AANCART), dovetails well with this editorial.
Many of the issue's remaining papers focus on the health and health care of very low-income populations, particularly people who are homeless. We hope that gathering these papers together in one place will lend them a strong combined effect.
Robert Stroebel, of the Mayo Clinic, and colleagues report on an initiative to adapt the chronic care model for use in a free clinic for the low-income uninsured in Minnesota. The clinic population presented special challenges as it consisted largely of migrant workers and their families, whose residence in the area was a matter of months rather than years. The intervention the authors describe, bringing together nurse, patient and physician for the management of chronic disease, effectively improved the condition for at least one chronic disease of a large majority [End Page v] of the patients studied. The importance of such interventions is underscored by Krupski et al.'s findings concerning the quality of life of low-income uninsured men with prostate cancer.
In an innovative exploratory study, Steven Kurtz and colleagues from the University of Delaware's Center for Drug and Alcohol Studies interviewed over 500 street-based sex workers in Miami (as well as conducting focus groups with 25) to learn more about them and their needs for social services and health care. Homelessness, violence, drug abuse and violent victimization (stretching back to childhood in three quarters of the cases) bring about strong, wide-ranging needs for everything from health care for sexually transmitted diseases to a widely expressed need for fresh water for drinking and bathing.
Interestingly, Kurtz et al. note the fluidity of the term homeless and how its meaning shifts from one user to another. This is consistent with the findings of Tsai and colleagues concerning the numbers of homeless patients presenting at San Francisco General Hospital. Tsai et al. demonstrate that the classification of patients as homeless is a shifting, ill-defined matter, and argue that better agreement about the definition of homelessness and more regular record-keeping of housing status is important to tracking the health of this highly vulnerable segment of society.
A team from the Urban Institute's Health...
