Integrating healthcare services for people experiencing homelessness in Australia: key issues and research principles (original) (raw)
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International Journal of Environmental Research and Public Health
People who are homeless experience significantly poorer health than the general population and often face multifaceted challenges engaging with public healthcare services. Mission Health Nurse-led Clinic (MHNC) was established in 2019 to meet the healthcare needs of this marginalised population in Launceston, Tasmania. This study examines barriers to healthcare access amongst individuals who experience homelessness, client and staff perceptions of the MHNC services and explored opportunities for service expansion. Descriptive statistics were drawn from administrative data, and all interviews were thematically analysed. A total of 426 presentations were reported for 174 individuals experiencing homelessness over 26 months. The median client age was 42 years and 60.9% were male; A total of 38.5% were homeless or lived in a supported accommodation. The predominant reasons for clinic visits included prescription requests (25.3%) and immunisations (20.1%). A total of 10 clients and 5 Cit...
Complex health service needs for people who are homeless
Australian Health Review, 2011
Background. Homeless people face many challenges in accessing and utilising health services to obtain psychosocial supports offered in hospital and community settings. The complex nature of health issues is compounded by lack of accessibility to services and lack of appropriate and safe housing. Objective. To examine the perceptions and experiences of homeless people in relation to their health service needs as well as those of service providers involved with their care. Design. A purposive sampling approach was undertaken with a thematic framework analysis of semi-structured interviews. Participants. Interviews were undertaken with 20 homeless people who accessed the emergency department in an acute hospital in Melbourne, Australia and 27 service providers involved in hospital and community care. Results. Six key themes were identified from interviews: complexity of care needs, respect for homeless people and co-workers, engagement as a key strategy in continued care, lack of after...
International Journal of Environmental Research and Public Health, 2022
The bidirectional relationship between homelessness and poor health and the barriers that individuals who experience homelessness face when trying to access healthcare are well documented. There is, however, little Australian research exploring the situation of individuals who experience homelessness in regional contexts and, moreover, from the perspective of service providers. A qualitative descriptive methodology underpinned this study, with in-depth semi-structured interviews being conducted with 11 service providers to identify barriers to care faced by people who experience homelessness and barriers that service providers themselves experience in supporting this population. The key barriers identified were client-level barriers: living day-by-day, financial, health literacy, mental health conditions, behaviour, safety and stigma; provider-level barriers: few bulk-billing doctors, fragmented services, limited resources, negative past experiences with healthcare; and system level barriers: transportation, over-stretched healthcare services. The combined impact of these barriers has significantly contributed to the desperate situation of people experiencing homelessness in Launceston. This situation is likely replicated in other regional populations in Australia. Given that individuals experiencing homelessness have higher rates of every measure in health inequality, steps need to be taken to reduce barriers, and a standardised approach to health care urgently needs to be implemented by governments at the state and national level to improve the health of regionally based individuals experiencing homelessness.
Access to healthcare for people experiencing homelessness in the UK and Ireland: a scoping review
BMC Health Services Research, 2022
Background: People experiencing homelessness (PEH) have poorer physical and mental health than the general population. They are also more likely to have less access to healthcare. These processes of access can be better understood using Levesque's access framework which addresses both supply (service provision) and demand (user abilities). Methods: Following the Joanna Briggs Institute (JBI) guidelines, electronic peer-reviewed databases were searched in February 2022 for studies published since 2000 related to access to healthcare for PEH ages 16 and older in the United Kingdom (UK) and Ireland. Retrieved articles were screened and those eligible were selected for data extraction. Qualitative and quantitative studies were included. Results: Fifty-six papers out of 538 identified were selected and aliased. Six main themes were identified: staff education, flexibility of systems, service coordination, patient preparedness, complex health needs and holistic care. These relate to the Levesque access framework. Conclusions: Improving access to healthcare for PEH requires changes to how services are provided and how service-user abilities are supported.
Access to Healthcare for People Experiencing Homelessness: A Scoping Review
Research Square (Research Square), 2022
Background: People experiencing homelessness (PEH) have poorer physical and mental health than the general population. They are also more likely to have less access to healthcare. These processes of access can be better understood using Levesque's access framework which addresses both supply (service provision) and demand (user abilities). Methods: Following the Joanna Briggs Institute (JBI) guidelines, electronic peer-reviewed databases were searched in February 2022 for studies published since 2000 related to access to healthcare for PEH ages 16 and older in the UK and Ireland. Retrieved articles were screened and those eligible were selected for data extraction. Qualitative and quantitative studies were included. Results: Fifty-six papers out of 538 identi ed were selected and aliased. Six main themes were identi ed: staff education, exibility of systems, service coordination, patient preparedness, complex health needs and holistic care. These relate to the Levesque access framework. Conclusions: Improving access to healthcare for PEH requires changes to how services are provided and how service-user abilities are supported. Background People experiencing homelessness (PEH) have poorer health than the general population. Mortality rates are much higher and morbidity trends show that infections, mental health, cardiovascular and respiratory conditions are more prevalent among homeless populations (Aldridge et al., 2018). Premature ageing and frailty are more common (Rogans-Watson et al., 2020) and PEH are also disproportionately affected by mental health issues. One study concluded that self-harm rates among PEH was 30 times higher than that of their housed counterparts (Barrett et al., 2018). PEH have higher rates of hospital readmission, with one study reporting the rate of PEH having an emergency readmission as 2.49 times higher than their housed counterparts (Lewer et al., 2021). Despite this, PEH are known to have poorer access to healthcare, as described by Julian Tudor Hart's 'Inverse Care Law'. This explains that the availability of medical care tends to vary inversely with the need for it in the population served (Haggerty et al., 2020, Tudor Hart, 1971). PEH are frequent attenders at emergency departments but relatively low users of primary and preventative health services, which may indicate that health is often not a priority until a crisis point is reached (Ni Cheallaigh et al., 2017, Keogh et al., 2015). Access to healthcare for PEH has been highlighted as a priority for research, both in the United Kingdom (UK) and Ireland (Jagpal et al., 2020, Bergin, 2010). Prior to this scoping review, a preliminary search was conducted to ensure that there are no reviews published or in in progress on the topic of access to healthcare for PEH in the UK and Ireland. The databases searched were Medline, Joanna Briggs Institute (JBI) Evidence Synthesis and the Cochrane Database (Medline, Cochrane, JBI). Therefore, this scoping
The inquiry into the funding of homelessness services in Australia
2015
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