A systematic scoping review of primary health care service outreach for homeless populations

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.

Characteristics of Veterans Experiencing Homelessness using Telehealth for Primary Care Before and After COVID-19 Pandemic Onset

“…Findings were stable when we adjusted for patient factors that may affect telehealth use and show potential for virtual primary care use among a population severely affected by digital and other access barriers. 11 , 13 Secure messaging rates also increased to albeit a much lesser extent—only used by 2% of homeless-experienced veterans. Consistent with prior research, 28 low secure messaging use may suggest that this primary care modality may not be preferred by persons experiencing homelessness or may have more barriers to adoption.…”

“…Historically, persons experiencing homelessness have faced technological barriers (e.g., lack of mobile telephones) in accessing services and require supportive outreach to engage in primary care. 11 – 13 Small-scale studies have documented attempts to engage homeless-experienced persons using telehealth care, as well as their perspectives regarding this care modality. 14 , 15 At the same time, telehealth has shown promise and is a tool that may reduce racial-ethnic and other disparities in chronic disease care over time.…”

Health literacy and its association with mental and spiritual well-being among women experiencing homelessness

“…Aligning with insights from earlier research ( Luchenski et al ., 2018 ; Kopanitsa et al ., 2023 ), the Women’s Advisory Board for Inclusion Health recommended a different approach. They suggested that HL interventions should be integrated into outreach health promotion initiatives—services provided outside traditional healthcare settings and closer to locations frequented by the target population.…”

Exploring the impact of integrated health and social care services on child health and wellbeing in underserved populations: a systematic review

“…The lack of more definitive evidence of such health and social care interventions designed to impact the underserved might be attributed in part to broader systemic difficulties in engaging with these groups due to their frequent changes of address; lack of trust in centralised authorities, and language and cultural barriers (57). To overcome some of these pervasive socio-cultural barriers to accessing health and social care there is a need to recognise the value of using alternative means of improving the outreach to the most vulnerable such as housing associations (58), (59) or homelessness charities (60). Having done so, co-design initiatives of health and social care interventions can become more meaningful and genuinely increase ownership of the intervention whilst reducing the stigma of accessing support (61).…”