Nurse‐led primary health care for homeless men: a multimethods descriptive study

Roche, Michael; Duffield, Christine; Smith, Judith; Kelly, D.; Cook, Robyn; Bichel-Findlay, Jen; Saunders, Carla; Carter, David J.

doi:10.1111/inr.12419

Cited by 28 publications

(54 citation statements)

References 32 publications

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“…[1][2][3] One such inequity linked to poor health is having low socioeconomic status, such as the estimated 235 000 Canadians who experience homelessness each year. 4 Homelessness is associated with poor health outcomes, [5][6][7] including higher incidence of traumatic brain injury, 8 bodily injury, 9 and increased mortality. 10 Canadian studies with homeless populations indicate 75% have untreated dental conditions, 11 85% have at least 1 chronic health condition, and over 50% report a diagnosed mental illness.…”

Section: Introductionmentioning

confidence: 99%

Homeless Patients Associate Clinician Bias With Suboptimal Care for Mental Illness, Addictions, and Chronic Pain

Gilmer

Buccieri

2020

J Prim Care Community Health

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Objective: To determine how accessible health care services are for people who are experiencing homelessness and to understand from their perspectives what impact clinician bias has on the treatment they receive. Methods: Narrative interviews were conducted with 53 homeless/vulnerably housed individuals in Ontario, Canada. Visit history records were subsequently reviewed at 2 local hospitals, for 52 of the interview participants. Results: Of the 53 participants only 28% had a primary care provider in town, an additional 40% had a provider in another town, and 32% had no access to a primary care provider at all. A subset of the individuals were frequent emergency department users, with 15% accounting for 75% of the identified hospital visits, primarily seeking treatment for mental illness, pain, and addictions. When seeking primary care for these 3 issues participants felt medication was overprescribed. Conversely, in emergency care settings participants felt prejudged by clinicians as being drug-seekers. Participants believed they received poor quality care or were denied care for mental illness, chronic pain, and addictions when clinicians were aware of their housing status. Conclusion: Mental illness, chronic pain, and addictions issues were believed by participants to be poorly treated due to clinician bias at the primary, emergency, and acute care levels. Increased access to primary care in the community could better serve this marginalized population and decrease emergency department visits but must be implemented in a way that respects the rights and dignity of this patient population.

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Section: Introductionmentioning

confidence: 99%

Homeless Patients Associate Clinician Bias With Suboptimal Care for Mental Illness, Addictions, and Chronic Pain

Gilmer

Buccieri

2020

J Prim Care Community Health

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“…While previous research demonstrates how health and psychosocial services can be adapted to enhance the healthcare of people who are homeless (Canham et al, ; Cornes et al, ; Hewett et al, ; Lamanna et al, ), our analysis demonstrates how a Multidisciplinary Model can create the conditions for people living on the streets to exit homelessness and access stable housing, and thus assisting some of society's most marginalised and underserved citizens (Lettner et al, ) to demonstrably change the conditions of their lives. Further, the Team's delivery of services in public places adds to the existing literature demonstrating how primary healthcare can be delivered to overcome barriers that homeless people experience accessing health clinics (Roche et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…With the benefit of trust and rapport, people sleeping rough experienced the Multidisciplinary Team as a resource they were willing to engage with, unlike mainstream health and housing providers. Even though the Model comprises integrated health and psychosocial services, it does not aim to, nor in practice does it, duplicate the mainstream service system, but rather – consistent with a clinic‐based model of primary healthcare (Roche et al, ) – it provides a supported conduit into the system so that mainstream systems are accessible to people living on the streets. Indeed, the tailored health and psychosocial support, for example, provided assistance with transport to mainstream health providers and then the outreach service providers accompanied people during medical consultations.…”

Section: Discussionmentioning

confidence: 99%

“…Integrating a General Practitioner and nurse within a hospital increases care received by homeless people and the functioning of the hospital and the secondary care system (Hewett, Halligan, & Boyce, ). Roche et al () demonstrated how a clinic‐based nurse‐led model of primary health enabled homeless men to overcome barriers to healthcare access.…”

Section: Introductionmentioning

confidence: 99%

“…Building on the evidence for nurse‐led clinic‐based primary healthcare (Roche et al, ), this article contributes to the literature by examining a Multidisciplinary Model that integrates healthcare and psychosocial support into an outreach approach that provides services both on the streets and in housing after people exit homelessness. First, we present descriptive statistics to illustrate that the model supports people sleeping rough to access and sustain affordable housing.…”

Section: Introductionmentioning

confidence: 99%

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Evidence for an integrated healthcare and psychosocial multidisciplinary model to address rough sleeping

Parsell

Clarke

Vorsina

2019

Health Soc Care Community

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People who sleep rough/experience unsheltered homelessness face barriers accessing mainstream healthcare and psychosocial services. The barriers to service access exacerbate poor health, which in turn create additional challenges for rough sleepers to access health and psychosocial services, including stable housing. The study presents descriptive statistics to identify housing outcomes of people working with a Multidisciplinary Model that comprises integrated healthcare and psychosocial support, and qualitative data with clients and service providers to investigate how the Model is experienced and delivered in practice. Fieldwork was conducted between December 2016 and March 2018 with the Multidisciplinary Team operating in Cairns, in the far north of Australia. Qualitative data are drawn from in‐depth interviews with 26 rough sleepers and 33 health and psychosocial service providers from the Multidisciplinary Team and the wider service system. Descriptive statistics show that 67% of clients who were sleeping rough were supported to immediately access stable housing, and at the end of the program, all clients remained housed. The qualitative findings illustrated how integrated healthcare and psychosocial outreach enabled people sleeping rough to overcome barriers they experienced accessing mainstream healthcare and other services. With the benefit of healthcare, people felt sufficiently well to engage with the psychosocial service providers to have their housing and other psychosocial needs addressed. This article demonstrates how individual responsibility for and control over healthcare is not only a matter of the individual, but also a matter requiring systems change and the active provision of resources to cater for the constraints and opportunities present in people's immediate environments.

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Nurses’ perceptions of the skills, knowledge and attributes required to optimise scope of practice and improve access to care for people experiencing homelessness in Australia: A cross-sectional study

et al. 2023

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Nurse‐led primary health care for homeless men: a multimethods descriptive study

Abstract: A greater number of primary health services that collaborate with specialist services, including nurse-led clinics, may facilitate health care for persons who are homeless, reducing the burden on acute services.

Cited by 28 publications

References 32 publications

Homeless Patients Associate Clinician Bias With Suboptimal Care for Mental Illness, Addictions, and Chronic Pain

Homeless Patients Associate Clinician Bias With Suboptimal Care for Mental Illness, Addictions, and Chronic Pain

Evidence for an integrated healthcare and psychosocial multidisciplinary model to address rough sleeping

Nurses’ perceptions of the skills, knowledge and attributes required to optimise scope of practice and improve access to care for people experiencing homelessness in Australia: A cross-sectional study

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