无家可归者的医疗保健不平等和获取障碍：巴塞罗那（西班牙）的一项定性研究。
Healthcare inequities and barriers to access for homeless individuals: a qualitative study in Barcelona (Spain).
机构信息
Department of Political Science and Administration, Faculty of Political Science, Universidad de Santiago de Compostela, Campus Vida, S/N, 15782, Santiago de Compostela, Spain.
Graduate in Political Science and Master in Equality, Gender and Education, Universidad de Santiago de Compostela, Santiago de Compostela, Spain.
出版信息
Int J Equity Health. 2021 Mar 20;20(1):84. doi: 10.1186/s12939-021-01409-2.
BACKGROUND
In Spain, homeless individuals have lower perceived quality of health than the rest of the population and their life expectancy is 30 years lower than the national average. While the Spanish health system provides universal access and coverage, homeless individuals do not access or use public care enough to maintain their health. The objective of this study is to determine if homeless individuals can access public health services in conditions of equality with the rest of the population, as established in healthcare legislation, and to better understand the causes of observed inequalities or inequities of access.
METHODS
A detailed qualitative study was carried out in the city of Barcelona (Spain) from October 2019 to February 2020. A total of nine open and in-depth interviews were done with homeless individuals along with seven semi-structured interviews with key informants and two focus groups. One group was composed of eight individuals who were living on the street at the time and the other consisted of eight individuals working in healthcare and social assistance.
RESULTS
The participants indicated that homeless individuals tend to only access healthcare services when they are seriously ill or have suffered some kind of injury. Once there, they tend to encounter significant barriers that might be 1) administrative; 2) personal, based on belief that that will be poorly attended, discriminated against, or unable to afford treatment; or 3) medical-professional, when health professionals, who understand the lifestyle of this population and their low follow-through with treatments, tend towards minimalist interventions that lack the dedication they would apply to other groups of patients.
CONCLUSIONS
The conclusions derived from this study convey the infrequent use of health services by homeless individuals for reasons attributable to the population itself, to healthcare workers and to the entire healthcare system. Accordingly, to reduce inequities of access to these services, recommendations to healthcare service providers include adapting facilities to provide more adequate care for this population; increasing sensitivity/awareness among healthcare workers; developing in situ care systems in places where the homeless population is most concentrated; and establishing healthcare collaboration agreements with entities that work with this population.
背景
在西班牙，无家可归者的健康感知质量低于其他人群，预期寿命比全国平均水平低 30 年。尽管西班牙的卫生系统提供了普遍的可及性和覆盖范围，但无家可归者并没有充分利用公共卫生服务来维护自己的健康。本研究旨在确定无家可归者是否能够在与卫生保健立法规定的其他人群平等的条件下获得公共卫生服务，并更好地了解观察到的获取服务方面的不平等或不公平现象的原因。
方法
本研究于 2019 年 10 月至 2020 年 2 月在西班牙巴塞罗那市进行了一项详细的定性研究。共对 9 名无家可归者进行了开放式和深入访谈，并对 7 名关键知情人和 2 个焦点小组进行了半结构化访谈。其中一个小组由 8 名当时在街上生活的人组成，另一个小组由 8 名在医疗保健和社会援助领域工作的人组成。
结果
参与者表示，无家可归者往往只有在病重或遭受某种伤害时才会去寻求医疗服务。一旦到了那里，他们往往会遇到重大障碍，这些障碍可能是 1）行政性的；2）个人性的，基于他们认为自己会受到较差的对待、歧视或无法负担治疗费用的信念；或 3）医疗专业性的，因为了解这部分人群生活方式和他们对治疗的低依从性的卫生专业人员往往会采取极简主义的干预措施，而缺乏他们对其他患者群体的投入。
结论
本研究得出的结论表明，无家可归者很少因自身原因、医护人员原因或整个医疗保健系统原因而使用卫生服务。因此，为了减少获取这些服务的不平等现象，向卫生服务提供者提出了以下建议：使设施适应为这部分人群提供更充分的照顾；提高医护人员的敏感性/意识；在无家可归者最集中的地方发展就地护理系统；并与为该人群服务的实体建立医疗保健合作协议。
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