[Barriers and facilitators in accessing and using primary health care centers for people experiencing homelessness]

OBJECTIVE

To identify barriers and facilitators for the access and use of primary care centers for people experiencing homelessness.

DESIGN

Qualitative study, phenomenological theoretical-methodological approach. Between May 19 and July 27, 2023.

LOCATION

Besòs Primary Health Care Center and Gregal social dining (Besòs and Maresme neighborhood, Barcelona).

PARTICIPANTS

People experiencing homelessness attending the Gregal social dining and professionals from the Besòs Primary Health Care Center.

METHOD

Theoretical purposive sampling. Individual and group interviews and open non-participant observation. Thematic content analysis, triangulation by independent analysis of three members of the research team and triangulation of methods. Discourse saturation was achieved through variability of discourse and techniques.

RESULTS

Eleven individual interviews, three group interviews and two observations. Different barriers and facilitators were identified. These were classified into five categories: (1)concept and identification of people experiencing homelessness; (2)personal factors of people experiencing homelessness; (3)behaviors and attitudes of professionals; (4)structural factors related to health system regulation, anf (5)internal organizational factors of primary health care centers.

CONCLUSIONS

People experiencing homelessness face multiple barriers to access primary health care, although there are also facilitators such as trusting relationships and multidisciplinary and intersectoral work that can be enhanced from primary health care centers to contribute to health equity.

Examining management plans for patients who frequently presented to the emergency department

BACKGROUND

Patients who frequently present to Emergency Department (ED) experience complex health and social needs. While research has examined interventions that aim to decrease frequent ED attendances, there is a need to understand the types of interventions provided to patients by hospital clinicians during presentations.

METHODS

Using qualitative content analysis, 82 management plans were evaluated to understand the scope and type of interventions provided by clinicians for patients frequently presenting to the ED at the Royal Melbourne Hospital, Australia.

RESULTS

Patients often presented to the ED due to mental and psychological distress, substance use and physical health concerns alongside psychosocial vulnerabilities. The goals of care documented in plans focussed on management of health issues, aggression within the ED, and coordinating care with community services. Recommended interventions addressed presenting needs with multi-disciplinary approach to respond to distress and aggression. Finally, the plans provided insight into service coordination dynamics between the ED and community-based health and social care services.

CONCLUSIONS

The plans recommended interventions that sought to provide holistic care for patients in collaboration with relevant community-based services. The findings suggest that clinicians in the ED can provide appropriate and meaningful care for patients who experience frequent presentations.