1
|
Kopanitsa V, McWilliams S, Leung R, Schischa B, Sarela S, Perelmuter S, Sheeran E, d'Algue LM, Tan GC, Rosenthal DM. A systematic scoping review of primary health care service outreach for homeless populations. Fam Pract 2023; 40:138-151. [PMID: 35809035 DOI: 10.1093/fampra/cmac075] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Homeless populations (HPs) have difficulties obtaining necessary medical care, and primary health care service outreach (PHSO) might be useful to bridge this gap. OBJECTIVE Using the Centre for Evidence-Based Management Critically Appraised Topics framework, to provide systematic evidence of the usefulness of PHSO interventions for HPs. METHODS A systematic search was conducted in 4 electronic databases: PubMed, Web of Science, CINAHL, and Cochrane (publication dates between January 1980 and November 2020). In total, 2,872 articles were identified. Primary research about PHSO for HPs in high-income countries were included. Data were extracted from eligible studies, summarized, and collated into a narrative account. RESULTS Twenty-four studies that described and evaluated PHSO interventions for adults experiencing homelessness were selected in the final synthesis. Most studies had a nonrandomized design. PHSO was found to successfully address some barriers to health care access for HPs through flexible appointments in convenient locations, fostering an understanding relationship between doctor and patients, and provision of additional basic necessities and referrals. Outreach was provided for a range of health care concerns, and several solutions to engage more HPs in primary care, improve continuity of care and to decrease the running costs were identified. Outreach also helped to implement preventative measures and reduced emergency service admissions. CONCLUSION Our review adds to the evidence that PHSO likely improves health care access for HPs. Further studies over longer time periods, involving collaborations with experts with lived experience of homelessness, and utilizing randomized study designs are needed to test outreach efficacy.
Collapse
Affiliation(s)
- Valeriya Kopanitsa
- Faculty of Medical Sciences, University College London Medical School, London, UK
| | - Stephen McWilliams
- Faculty of Medical Sciences, University College London Medical School, London, UK
| | - Richard Leung
- Faculty of Medical Sciences, University College London Medical School, London, UK
| | | | - Shazia Sarela
- Faculty of Medical Sciences, University College London Medical School, London, UK
| | - Sara Perelmuter
- Faculty of Life Sciences, University College London, London, UK
| | - Emma Sheeran
- Health Humanities Centre, University College London, London, UK
| | | | - Guan Chwen Tan
- Arts and Sciences Department, University College London, London, UK
| | - Diana Margot Rosenthal
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK.,UCL Collaborative Centre for Inclusion Health, University College London, London, UK
| |
Collapse
|
2
|
Zeitler M, Williamson AE, Budd J, Spencer R, Queen A, Lowrie R. Comparing the Impact of Primary Care Practice Design in Two Inner City UK Homelessness Services. J Prim Care Community Health 2021; 11:2150132720910568. [PMID: 32129134 PMCID: PMC7057407 DOI: 10.1177/2150132720910568] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Specialist homeless primary health care services in the United Kingdom have arisen from the need for bespoke approaches to providing health care for people experiencing homelessness but descriptions of the design characteristics of homeless health services together with associated long-term condition (LTC) prevalence, health care utilization, and prescribing remain unexplored, thereby limiting our understanding of potential impact of service configuration on outcomes. Aim: Description of specialist homeless general practitioner services in Glasgow and Edinburgh, in terms of practice design (staff, skill mix, practice systems of registration, and follow-up); and exploration of the potential impact of differences on LTC prevalence, health care utilization, and prescribing. Method: Patient data were collected from computerized general practitioner records in Glasgow (2015, n = 133) and Edinburgh (2016, n = 150). Homeless health service configuration and anonymized patient data, including demographics, LTCs service utilization, and prescribing were summarized and compared. Results: Marked differences in infrastructure emerged between 2 practices, including the patient registration process, segmentation versus integration of services, recording systems, and the availability of staff expertise. Patient characteristics differed in terms of LTC diagnoses, health care utilization and prescribing. Higher rates of recorded mental health and addiction problems were found in Edinburgh, as well as higher rates of physical LTCs, for example, cardiovascular and respiratory conditions. There were significantly higher rates of consultations with nurses and other staff in Edinburgh, although more patients had consultations with pharmacists in Glasgow. Medication adherence was low in both cohorts, and attendance at referral appointments was particularly poor in Glasgow. Conclusion: Service design and professional skill mix influence recording of LTCs, service uptake, and identification and management of health conditions. Service configuration, professional skill mix, and resources may profoundly affect diagnoses, utilization of health care, and prescribing. Attention to homeless service design is important when providing care to this disadvantaged patient group.
Collapse
Affiliation(s)
| | - Andrea E Williamson
- University of Glasgow, Glasgow, UK.,NHS Greater Glasgow and Clyde, Glasgow, UK
| | - John Budd
- Edinburgh Access Practice, NHS Lothian, Edinburgh, UK
| | | | | | | |
Collapse
|
3
|
Nagy-Borsy E, Vági Z, Skerlecz P, Szeitl B, Kiss I, Rákosy Z. Health status and health behaviour of the Hungarian homeless people. ACTA ACUST UNITED AC 2021; 79:15. [PMID: 33531045 PMCID: PMC7852122 DOI: 10.1186/s13690-021-00534-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/24/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Homelessness has risen recently in Europe, but there is lack of comprehensive health data on this population. Our aim was to characterize the health of the Hungarian homeless population. METHODS We performed a health survey with 453 homeless individuals. The results were compared to the age and sex standardized data of the general Hungarian population and its lowest income quintile from the European Health Interview Survey 2014. The differences by the ETHOS classification within the homeless population were also studied. RESULTS Significantly fewer homeless people reported good health status than in the general population or in its lowest income quintile (p< 0.001). Of the participants 70% had at least one chronic disease, only 41% of them visited a GP and 35% took medication in the previous 12 months. While 59% of the lowest income quintile and 50% of the general population had at least one chronic disease, almost all of them visited a physician and took medication. The highest prevalence of morbidity (80%) and multimorbidity (46%) was reported in the houseless group. The majority of the homeless people were current smokers, the prevalence was much higher than in the two reference populations (p< 0.001). The prevalence of heavy drinkers was the highest among the roofless participants (40%). CONCLUSIONS Homeless people have much poorer health and they utilize health services less than the most disadvantaged quintile of the general population. There is a clear social gradient within the homeless population, as well, which calls for integrated approaches for specific interventions to improve their health.
Collapse
Affiliation(s)
- Emese Nagy-Borsy
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti út 12, Pécs, 7624, Hungary
| | - Zsolt Vági
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti út 12, Pécs, 7624, Hungary
| | - Petra Skerlecz
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti út 12, Pécs, 7624, Hungary
| | | | - István Kiss
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti út 12, Pécs, 7624, Hungary
| | - Zsuzsa Rákosy
- Department of Public Health Medicine, Medical School, University of Pécs, Szigeti út 12, Pécs, 7624, Hungary.
| |
Collapse
|
4
|
Copeland DJ, Johnson P, Moore B. Effects of a service-learning experience on health-related students' attitudes toward the homeless. Nurs Forum 2020; 56:45-51. [PMID: 32964482 DOI: 10.1111/nuf.12510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/04/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES A community engagement service-learning experience was planned to provide health services for the homeless during a local 1-day event. The objectives were to (a) determine the feasibility of a service-learning experience, and to (b) examine the effects on students' attitudes toward persons experiencing homelessness. METHODS A quasi-experimental, institutional review board approved study, including health-related students enrolled in a local university or community college, was planned. The attitudes toward the homeless survey was administered before and after participation in the service-learning experience. Qualitative data were through student reflections of the experience. RESULTS Participants (n = 106) completed a pre and post questionnaire and a self-reflection. A statistically significant t(26) = -2.2, p = .04 change in attitudes toward the homeless were found. Three themes were revealed from the reflections: inherent bias, individualized care, and the societal context of people experiencing homelessness. CONCLUSION Both quantitative and qualitative findings may help students reflect on preconceived stereotypes; therefore, affecting their attitudes toward the homelessness.
Collapse
Affiliation(s)
- Donna J Copeland
- Adult Health Department, College of Nursing, University of South Alabama, Mobile, Alabama, USA
| | - Pam Johnson
- Adult Health Department, College of Nursing, University of South Alabama, Mobile, Alabama, USA
| | - Bridget Moore
- Neonatal Intensive Care Unit, USA Health Children's and Women's Hospital, Mobile, Alabama, USA
| |
Collapse
|
5
|
Fajardo-Bullón F, Esnaola I, Anderson I, Benjaminsen L. Homelessness and self-rated health: evidence from a national survey of homeless people in Spain. BMC Public Health 2019; 19:1081. [PMID: 31399028 PMCID: PMC6688283 DOI: 10.1186/s12889-019-7380-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 07/26/2019] [Indexed: 11/29/2022] Open
Abstract
Background Internationally, acute homelessness is commonly associated with complex health and social care needs. While homelessness can be understood as an outcome of structural housing exclusion requiring housing led solutions, the health care issues faced by homeless people equally require attention. A substantive evidence base on the health needs of homeless people exists, but relatively little is known about what influences the self-rated health of homeless people. This article presents new evidence on whether drug use (alcohol consumption, ever having used drugs), health variables (visiting a hospital once in the last year, visiting the doctor in the last month, having a health card, sleeping difficulties, and having a disabling impairment) and sociodemographic characteristics are significantly associated with Self-Rated Health (SRH) among Spanish homeless people. Method The approach applies secondary analysis to cross-sectional data from a sample of 2437 homeless adults in Spain (83.8% were male). Multinomial logistic regression modelling was used to analyse the relationships between drug use, other health variables and SRH. Results Being male, an abstainer, having a health card and being in the youngest age groups were significant factors associated with perceived good health. On the other hand, ever having used drugs, having been a night in hospital, having gone to the doctor in the last month, having sleeping difficulties, having a disabling impairment and being in the older age group were all significant risk factors associated with perceived poor health. Conclusions These results help to improve understanding of the key factors that influence the SRH among homeless people. The findings can contribute to development and delivery of preventive policies, suggesting that interventions to reduce drug consumption and ensure access to a health card/health services, as well as enhancing services for older, female and disabled homeless people are all measures which could improve health and well-being for those who face homelessness. Effective housing interventions (e.g. Housing First or Permanent Supported Housing programmes) are equally important to underpin the effectiveness of measures to improve the self-rated health of homeless people.
Collapse
Affiliation(s)
- Fernando Fajardo-Bullón
- Department of Development and Educational Psychology. Faculty of Education, University of Extremadura, Badajoz, Spain
| | - Igor Esnaola
- Department of Development and Educational Psychology. Faculty of Education (Avenida de Tolosa, 20018, San Sebastián), University of the Basque Country, UPV/EHU, Leioa, Spain.
| | - Isobel Anderson
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Lars Benjaminsen
- The Danish Center for Social Science Research, København, Denmark
| |
Collapse
|
6
|
Lowrie F, Gibson L, Towle I, Lowrie R. A descriptive study of a novel pharmacist led health outreach service for those experiencing homelessness. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 27:355-361. [PMID: 30847995 DOI: 10.1111/ijpp.12520] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 01/09/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To illustrate and review this new service and to describe the demographics of the patient group and the typology of interventions made by the pharmacist prescribers. METHODS Pharmacists provided pop-up, drop-in (no appointment needed) health clinics to various homeless support venues in Glasgow City Centre. Data from pharmacists' interventions (n = 52) and patient demographics were gathered from clinical records. Data were then extracted, transcribed and analysed. KEY FINDINGS The demographics of the homeless patient group consisted mainly of white middle-aged males (mean age 39.8 years), of Scottish ethnicity and living in homeless hostels. Medications were prescribed by pharmacists in 62% of all patients. New medications were initiated in 69% of these patients; repeat/re-issues of lapsed medications were issued in 66% of these patients; changes were made to existing medication in 16%. The most commonly prescribed items were as follows: wound dressings; antihypertensives; antidiabetics; analgesics; inhalers; antidepressants; and nutritional supplements. Pharmacists diagnosed a new clinical issue in 69% of patients, most commonly with infections (skin or respiratory) in 36% of patients. Sixty-two per cent of patients had their presenting symptoms managed by the pharmacist alone. Patient engagement was good with 85% subsequently attending either a follow-up with the pharmacist or onward referral (to specialist services, secondary care, general practitioner appointment etc). CONCLUSIONS Assertive outreach by pharmacist independent prescribers for people who are homeless is feasible and leads to increased access to medicines for acute and chronic health problems. Further work is needed to evaluate the impact of this new service on key clinical outcomes.
Collapse
Affiliation(s)
| | - Lauren Gibson
- PPSU- Homeless Healthcare, West Ambulatory Care Hospital Yorkhill, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Ian Towle
- University of Strathclyde, Glasgow, UK
| | - Richard Lowrie
- PPSU- Homeless Healthcare, West Ambulatory Care Hospital Yorkhill, NHS Greater Glasgow & Clyde, Glasgow, UK
| |
Collapse
|
7
|
Hanlon P, Yeoman L, Gibson L, Esiovwa R, Williamson AE, Mair FS, Lowrie R. A systematic review of interventions by healthcare professionals to improve management of non-communicable diseases and communicable diseases requiring long-term care in adults who are homeless. BMJ Open 2018; 8:e020161. [PMID: 29627814 PMCID: PMC5892758 DOI: 10.1136/bmjopen-2017-020161] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Identify, describe and appraise trials of interventions delivered by healthcare professionals to manage non-communicable diseases (NCDs) and communicable diseases that require long-term care or treatment (LT-CDs), excluding mental health and substance use disorders, in homeless adults. DESIGN Systematic review of randomised controlled trials (RCTs), non-RCTs and controlled before-after studies. Interventions characterised using Effective Practice and Organisation of Care (EPOC) taxonomy. Quality assessed using EPOC risk of bias criteria. DATA SOURCES Database searches (MEDLINE, Embase, PsycINFO, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA) and Cochrane Central Register of Controlled Trials), hand searching reference lists, citation searches, grey literature and contact with study authors. SETTING Community. PARTICIPANTS Adults (≥18 years) fulfilling European Typology of Homelessness criteria. INTERVENTION Delivered by healthcare professionals managing NCD and LT-CDs. OUTCOMES Primary outcome: unscheduled healthcare utilisation. SECONDARY OUTCOMES mortality, biological markers of disease control, adherence to treatment, engagement in care, patient satisfaction, knowledge, self-efficacy, quality of life and cost-effectiveness. RESULTS 11 studies were included (8 RCTs, 2 quasi-experimental and 1 feasibility) involving 9-520 participants (67%-94% male, median age 37-49 years). Ten from USA and one from UK. Studies included various NCDs (n=3); or focused on latent tuberculosis (n=4); HIV (n=2); hepatitis C (n=1) or type 2 diabetes (n=1). All interventions were complex with multiple components. Four described theories underpinning intervention. Three assessed unscheduled healthcare utilisation: none showed consistent reduction in hospitalisation or emergency department attendance. Six assessed adherence to specific treatments, of which four showed improved adherence to latent tuberculosis therapy. Three concerned education case management, all of which improved disease-specific knowledge. No improvements in biological markers of disease (two studies) and none assessed mortality. CONCLUSIONS Evidence for management of NCD and LT-CDs in homeless adults is sparse. Educational case-management interventions may improve knowledge and medication adherence. Large trials of theory-based interventions are needed, assessing healthcare utilisation and outcomes as well as assessment of biological outcomes and cost-effectiveness.
Collapse
Affiliation(s)
- Peter Hanlon
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lynsey Yeoman
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lauren Gibson
- Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Care Unit, Glasgow, UK
| | - Regina Esiovwa
- Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Care Unit, Glasgow, UK
| | - Andrea E Williamson
- General Practice and Primary Care, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Richard Lowrie
- Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Care Unit, Glasgow, UK
| |
Collapse
|
8
|
Jego M, Abcaya J, Ștefan DE, Calvet-Montredon C, Gentile S. Improving Health Care Management in Primary Care for Homeless People: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E309. [PMID: 29439403 PMCID: PMC5858378 DOI: 10.3390/ijerph15020309] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 02/04/2018] [Accepted: 02/07/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. We aimed to describe the main characteristics of the primary care programs that take care of homeless people, and to identify which could be most relevant. METHODS We performed a literature review that included articles which described and evaluated primary care programs for homeless people. RESULTS Most of the programs presented a team-based approach, multidisciplinary and/or integrated care. They often proposed co-located services between somatic health services, mental health services and social support services. They also tried to answer to the specific needs of homeless people. Some characteristics of these programs were associated with significant positive outcomes: tailored primary care organizations, clinic orientation, multidisciplinary team-based models which included primary care physicians and clinic nurses, integration of social support, and engagement in the community's health. CONCLUSIONS Primary health care programs that aimed at taking care of the homeless people should emphasize a multidisciplinary approach and should consider an integrated (mental, somatic and social) care model.
Collapse
Affiliation(s)
- Maeva Jego
- EA 3279 Research Unit-Public Health, Chronic Diseases and Quality of Life, Faculty of Medicine, Aix-Marseille University, 27 Bd Jean Moulin, 13385 Marseille CEDEX 5, France.
- Department of General Practice, Faculty of Medicine, Aix-Marseille University, 27 Bd Jean Moulin, 13385 Marseille CEDEX 5, France.
| | - Julien Abcaya
- Department of General Practice, Faculty of Medicine, Aix-Marseille University, 27 Bd Jean Moulin, 13385 Marseille CEDEX 5, France.
| | - Diana-Elena Ștefan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 37 Street Dionisie Lupu, Sector 1, 030167 Bucharest, Romania.
| | - Céline Calvet-Montredon
- Department of General Practice, Faculty of Medicine, Aix-Marseille University, 27 Bd Jean Moulin, 13385 Marseille CEDEX 5, France.
| | - Stéphanie Gentile
- EA 3279 Research Unit-Public Health, Chronic Diseases and Quality of Life, Faculty of Medicine, Aix-Marseille University, 27 Bd Jean Moulin, 13385 Marseille CEDEX 5, France.
| |
Collapse
|