Siersbaek Rikke, Ford John, Ní Cheallaigh Clíona, Burke Sara, Thomas Steve
Centre for Health Policy and Management, Trinity College Dublin, Dublin 2, Dublin, Ireland.
Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0SR, UK.
HRB Open Res. 2021 Jan 21;3:73. doi: 10.12688/hrbopenres.13154.2. eCollection 2020.
Over the last several years, homelessness has increased in Ireland and across Europe. Rates have recently declined since the coronavirus disease 2019 (COVID-19) pandemic, but it is unclear whether emergency housing measures will remain in place permanently. Populations experiencing long-term homelessness face a higher burden of multi-morbidity at an earlier age than housed populations and have poorer health outcomes. However, this population also has more difficulty accessing appropriate health services. A realist review by the authors found that important health system contexts which impact access are resourcing, training, funding cycles, health system fragmentation, health system goals, how care is organised, culture, leadership and flexibility of care delivery. Using a realist evaluation approach, this research will explore and refine key system-level factors, highlighted in our realist review, in a local health care system. The aim of this study is to understand how funding procedures and health system performance management impact service settings, staff, providers and their ability to make services accessible to populations experiencing homelessness. : A realist evaluation will be undertaken to explain how funding and health system performance management impact healthcare accessibility for populations experiencing homelessness. Data will be collected using qualitative and realist interview techniques and focus group methodology. Secondary data such as policy documents and budgets will utilised. The analysis will follow Pawson and Tilley's iterative phases starting with building an Initial programme theory, then data collection, data analysis, synthesis and finally building a refined programme theory. : Building on a realist review conducted by the same research team, this study will further test and refine findings that explain how health system factors impact healthcare accessibility for populations experiencing homelessness. The study has the potential to inform policy makers, health planners and managers of contextual factors that can be modified to increase healthcare accessibility.
在过去几年中，爱尔兰及整个欧洲的无家可归者数量有所增加。自2019冠状病毒病（COVID-19）大流行以来，这一比例最近有所下降，但尚不清楚紧急住房措施是否会永久实施。长期无家可归的人群比有住房的人群在更早的年龄面临更高的多种疾病负担，且健康状况更差。然而，这一人群在获得适当医疗服务方面也面临更多困难。作者进行的一项现实主义综述发现，影响医疗服务可及性的重要卫生系统背景因素包括资源配置、培训、资金周期、卫生系统碎片化、卫生系统目标、护理组织方式、文化、领导力以及护理服务的灵活性。本研究将采用现实主义评价方法，在当地医疗系统中探索并完善我们现实主义综述中强调的关键系统层面因素。本研究的目的是了解资金程序和卫生系统绩效管理如何影响服务环境、工作人员、提供者以及他们为无家可归人群提供可及服务的能力。将进行一项现实主义评价，以解释资金和卫生系统绩效管理如何影响无家可归人群的医疗服务可及性。将使用定性和现实主义访谈技术以及焦点小组方法收集数据。还将利用政策文件和预算等二手数据。分析将遵循帕森和蒂利的迭代阶段，首先构建初始项目理论，然后进行数据收集、数据分析、综合，最后构建完善的项目理论。基于同一研究团队进行的现实主义综述，本研究将进一步检验和完善有关卫生系统因素如何影响无家可归人群医疗服务可及性的研究结果。该研究有可能为政策制定者、卫生规划者和管理者提供信息，说明哪些背景因素可以改变，以提高医疗服务的可及性。
