Telemedicine in community shelters: possibilities to improve chronic care among people experiencing homelessness in Hungary

Abstract

Background Digital health has expanded during the COVID-19 pandemic, while the exclusion of vulnerable populations with limited access to these technologies widens the gap to receive proper care. There is very little data available on the feasibility of telemedicine solutions regarding the chronic care of homeless persons. Methods In our study, 75 participants experiencing homelessness were recruited from four social institutions in Budapest, Hungary. The telecare pilot service consisted of six online consultations with a physician and was available in shelters biweekly. Self-developed questionnaires were used after every online session on the originating and remote sites as well, while a follow-up study was also completed among patients after four to six months of pilot closure. Parameters as frequencies, averages, and percentage distributions were analyzed and two linear regression models were built on explaining the doctors’ and patients’ overall rating of visits. Results During the pilot, 92.2% (n = 415) of originally planned visits were delivered and 55 clients (73.3%) attended the full program. Both the patients’ and physicians’ overall satisfaction was very high (4.52 and 4.79, respectively, on a 5-point Likert scale) and the patients’ overall rating remained similarly high during the follow-up. Comparing the first and sixth visits, physicians reported significant improvements in almost all aspects. The linear regression models proved that confidence in the patients’ assessment and diagnosis had the most prominent effect on the physicians’ overall rating, while ease of use and lack of communication gaps influenced positively the patients’ rating. Conclusion The results suggest that telehealth services represent a promising tool to ensure better care continuity while using shelter infrastructure and on-site assistance might reduce the digital exclusion of people experiencing homelessness.

State of vulnerable populations in the techquity framework in Hungary

“…In collaboration with the DocRoom Health Research Program at the Hungarian Charity Service of the Order of Malta (Budapest, Hungary), we have been working together on numerous studies on the issue of how vulnerable groups such as people experiencing homelessness could benefit from digital health technologies. The three main aspects of the joint previous research projects were: attitudes and openness of people experiencing homelessness toward telemedicine ( 19 ), access to digital devices and health-related Internet use among people experiencing homelessness ( 20 ), and the evaluation of a telemedicine pilot project in homeless shelters ( 21 ). The number of participants in each study was N = 98, 662, and 75, respectively.…”

Health Technology Access and Peer Support Among Digitally Engaged People Experiencing Homelessness: Qualitative Study

“…Overall, our previous research showed that digital health services have great promise in community shelters for managing and preventing health issues [ 29 , 30 ], and this study found that digitally engaged individuals might be important for the success of such services.…”

“…When asked about usage patterns, several interviewees spontaneously shared their views on how age differences matter in usage prevalence, outlining that older generations might be less involved and less interested in novel technologies. Several studies, including our previous quantitative research, support that age is a key sociodemographic variable that has an impact on use [ 29 , 30 , 46 , 47 ]. Our quantitative data showed that in access to technology, age did not seem to be a key factor; however, it might be considered as a significant factor when self-evaluating competence in digital literacy skills.…”

“…Previous research has mapped out the attitudes of people experiencing homelessness in Budapest, Hungary, toward telecare services, with the main finding that trust in the general health care system is the central issue when it comes to the decision of homeless populations about whether they have trust in telecare services as well [ 28 ]. This study served as a starting point for a pilot project assessing the viability of a telecare system for homeless populations [ 29 ].…”

Staff-Facilitated Telemedicine Care Delivery for Treatment of Hepatitis C Infection among People Who Inject Drugs

“…Even after the pandemic, with the extension of telehealth policies [12], telemedicine remains an integral part of healthcare delivery to overcome geographic barriers to medical care [10,12,13]. Telemedicine, when provided in community spaces, can expand healthcare access for people experiencing social marginalization including homelessness [14][15][16]. Telemedicine, in addition to other electronic health technologies, have been successfully implemented in the HCV care cascade, specifically to gain access to marginalized populations like PWID [17][18][19][20].…”