Student-led oral health education for the homeless community of East London

Models of dental care for people experiencing homelessness in the UK: a scoping review of the literature

Background People who experience homelessness have poor oral health and face barriers to accessing care. Recommendations have been outlined for health services to address their needs, termed 'inclusion health'. The Smile4Life report recommended three 'tiers' of dental service: emergency, ad hoc and routine care. Other medical services have developed into different models of care, for example mainstream practices with enhanced services for people who experience homelessness. There is little understanding of how inclusion health recommendations have been implemented across dental settings.Aims To describe and compare dental services that exist for people who experience homelessness in the UK.Methods Two Medline searches were performed in October 2020 to assess the models of dental care for people who experience homelessness in the UK.Results Nine dental services in the UK were identified who treated people who experience homelessness. Most did not explore definitions of homelessness. There were a mixture of models, including using blended approaches, such as different sites and appointment types, to flex to the needs of their population.Conclusion Many services that are dedicated to treat this population are based in the community dental services which allows for flexible models of care due to sporadic patient attendance, high treatment requirements and complex needs. More research is required to determine how other settings can accommodate these patients, as well as understanding how more rural populations access dental care.

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

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.

A survey of dental services in England providing targeted care for people experiencing social exclusion: mapping and dimensions of access

Introduction Poor oral health and barriers to accessing dental services are common among people experiencing social exclusion. This population experience a disproportionate and inequitable burden of oral disease. A small number of dental services have published models of care that target this population, but no national surveys have been conducted.Aims This study aims to identify what types of services are providing dental and oral healthcare for people experiencing social exclusion in England and the models of delivery adopted by these services.Methods A snowballing sampling strategy was used to identify services that provide targeted for adults experiencing social exclusion. The study used a survey to collect data about the location, service models and barriers and enablers of these services.Results In total, 74 responses from different services met the inclusion criteria for the study. Seventy one were included in the mapping exercise and 53 provided free-text comments that contributed to an understanding of barriers and enablers of services.Discussion Most services operated to meet the needs of the mainstream population and described inflexibilities in their service design models as barriers to providing care for socially excluded groups.Conclusion Limitations of current models of service delivery create frustrations for providers and people experiencing social exclusion. Creative commissioning and organisational flexibility are key to facilitating adaptable services.

Strategies to improve access to and uptake of dental care by people experiencing homelessness in Australia: a grey literature review

Objectives The poor oral health of Australians experiencing homelessness negatively affects their quality of life. Better oral health is associated with having annual dental check-ups. Because there is limited peer-reviewed literature describing strategies that improve access to and uptake of dental care by homeless people, in this study we searched the grey literature to discover what strategies are used. Methods The Informit database and Google and Bing search engines were searched using the keywords 'homeless and oral and dental services'. Bing and Google were searched unrestricted by site and Google was searched for sites ending in 'org.au'. Searches were restricted to Australia from June 2008 to June 2018. The first 300 websites were read, and those describing or linking to pages describing a strategy that improved access to or uptake of dental care were included in the study. The content of the webpages was evaluated and summarised, with common strategies reported as a narrative description. Results Nineteen programs were described. Common strategies were providing free care, in-reach care, outreach care and the need to work closely with support organisations. Conclusions To improve access to and uptake of dental care by people experiencing homelessness, dental services need to be free and organised in collaboration with support organisations. What is known about the topic? The peer-reviewed literature describing strategies used to improve access to and uptake of dental care by people experiencing homelessness in Australia is limited. The authors could only locate two such studies, one based in Melbourne and one in Brisbane. Both programs had a similar aim, but used different strategies to achieve it, suggesting a lack of consensus about the best way to encourage dental visiting by people experiencing homelessness. What does this paper add? This paper used the grey literature to describe common strategies used in Australia to improve access to and uptake of dental care by people experiencing homelessness. What are the implications for practitioners? Dental service providers aiming to increase access to and uptake of dental care by people experiencing homelessness need to work collaboratively with support organisations and provide care free of charge.

Homeless adults' access to dental services and strategies to improve their oral health: a systematic literature review

Homeless people have poor oral health and high treatment needs, yet tend to make problem-based dental visits. This review aimed to determine how and where homeless adults receive oral health care, the barriers that prevent homeless adults accessing dental care and find strategies to promote oral health to homeless adults. The databases MEDLINE via OvidSP, PubMed, CINAHL and Scopus were searched using the keywords: homeless, roofless, houseless, rough sleeper, couch surfer, shelter, hostel, dental and oral health. The inclusion criteria were: participants over the age of 17 years, studies written in English, based in developed countries and published after 2003. Selected articles were assessed using the Mixed Methods Appraisal Tool and data extracted were thematically analysed. Twenty-two studies met the inclusion criteria. Five main themes were found: how homeless people accessed dental care; factors affecting the uptake of care; strategies used to improve access to care; the effect of non-dental staff on dental care; and challenges with providing care to homeless people. Dental care for homeless adults was affected by numerous factors. Improving their access to dental services requires collaboration between support service providers, dental care to be near homeless populations and flexibility by dental services.