‘Genuine doctor care’: Perspectives on general practice and community‐based care of Australian men experiencing homelessness

Abstract

People with complex health and social needs, including tri-morbidity and homelessness, are challenging for modern healthcare systems. These clients have poor health and social outcomes. They tend to use available health resources inefficiently, with fragmented, uncoordinated use of multiple health and social care services. Increasing access for these clients to well-supported general practice care may be an effective response to these challenges. The aim of this study was to explore client experiences of, and attitudes to, community-based healthcare, and general practice in particular, to identify opportunities to improve healthcare provision. Five focus groups with a total of 20 men currently experiencing homelessness were facilitated by the corresponding author in an inner-city homeless hostel. Discussions were transcribed, coded and analysed thematically. The analysis was informed by earlier focus group discussions with community-based homeless healthcare providers. Participants reported reluctance to engage with healthcare providers outside times of perceived crisis, and experiences of stigma and dismissive care. Some participants were sceptical of the motivations of health and social care providers, including general practitioners. Presentations with physical and psychological pain featured prominently in participant accounts. Three key themes identified important aspects of client experiences of community-based healthcare which indicate potential areas for improvement. These themes were as follows: the relative invisibility and low salience of general practice compared to hospital-based emergency and inpatient services; discontinuity within community-based healthcare and across transitions between community-based and other healthcare; and inconsistent and unsatisfactory general practitioner responses to physical and psychological pain. These responses included apparent over-prescribing, under-prescribing and short-term 'band-aid' responses.Generalist medical expertise was valued in general practitioners, but not consistently experienced. A number of challenges and opportunities exist, at both individual and system levels, for general practice to realise its potential to deliver effective, compassionate and efficient care to clients experiencing homelessness. K E Y W O R D Sgeneral practice, healthcare organisation, homelessness, pain management, vulnerable populations

A systematic review of the effect of stigma on the health of people experiencing homelessness

“…Several papers referenced that regardless of actual poor treatment and discrimination in many instances this was a significant expectation of PEH (Gunner et al, 2019; Sturman & Matheson, 2020) making them highly sensitive to any hint of disparaging treatment. There was no objective evidence offered of treatment disparities for PEH but it was notable that many PEH believed they had not received appropriate care or treatment for their health.…”

A scoping review examining patient experience and what matters to people experiencing homelessness when seeking healthcare

“…In circumstances where PEH accessed 'navigational aids', greater usage and higher levels of satisfaction with health services were reported 47 . Although in a paper by Steward (2016), coordination ranked as one of the four most important characteristics of homeless healthcare service provision 44 , multiple negative accounts were reported describing episodes of fragmented care 35,36 , wasted time 33 , service gaps 31 , a lack of coordination between services 28 and problematic relationships with interdisciplinary teams 33 . In one study, 44% of PEH delaying healthcare attributed this to previous experiences and concerns that they would not receive appropriate healthcare 28 .…”

“…The 'effective' domain that pertains to care following evidence-based guidelines and standard operating procedures was the least frequently articulated domain in the qualitative papers reviewed (10 citations), with Steward et al (2016), independently reporting that PEH highly prioritised 'evidence-based decision making' 44 . On the few occasions the effective domain was highlighted in the literature, it involved treatment based on individual biases and stereotypes 33,57 , inconsistent discharge practices 51 and pain management regimens 35,36 .…”

“…Yet there were occasions where PEH perceived health professionals as uncaring 31 , demeaning 46 , dismissive 35,36,57 and judgemental 31,35,46,47,52,57 . Many PEH reported experiences of stigmatisation when accessing healthcare 29,31,48,[51][52][53][54] .…”

Staying safe, feeling welcome, being seen: How spatio‐temporal configurations affect relations of care at an inclusive health and wellness centre

“…Conceptualising primary health care as delivered within social relations, throws into relief how spatial and temporal practice standards, such as appointment length, modalities in delivery, attendance, and behavioural policies promote or hinder greater health equity. A lack of consultation time has been reported by general practitioners (GPs) as a barrier to developing trusted relationships with patients 22 . Luchenski et al, 23 observed that taking time for appointments to allow for listening to patients is important for inclusive healthcare.…”