了解非传统诊所环境中无家可归者的初级卫生保健体验。
Understanding the primary health care experiences of individuals who are homeless in non-traditional clinic settings.
机构信息
The Steve Hicks School of Social Work at the University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA.
Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
出版信息
BMC Prim Care. 2022 Dec 27;23(1):338. doi: 10.1186/s12875-022-01932-3.
BACKGROUND
Despite the widespread implementation of Health Care for the Homeless programs that focus on comprehensive, integrated delivery systems of health care for people experiencing homelessness, engaging and retaining people experiencing homelessness in primary care remains a challenge. Few studies have looked at the primary care delivery model in non-traditional health care settings to understand the facilitators and barriers to engagement in care. The objective of our study was to explore the clinic encounters of individuals experiencing homelessness receiving care at two different sites served under a single Health Care for the Homeless program.
METHODS
Semi-structured interviews were conducted with people experiencing homelessness for an explorative qualitative study. We used convenience sampling to recruit participants who were engaged in primary care at one of two sites: a shelter clinic, n = 16, and a mobile clinic located in a church, n = 15. We then used an iterative, thematic approach to identify emergent themes and further mapped these onto the Capability-Opportunity-Motivation model.
RESULTS
Care accessibility, quality and integration were themes that were often identified by participants as being important facilitators to care. Psychological capability and capacity became important barriers to care in instances when patients had issues with memory or difficulty with perceiving psychological safety in healthcare settings. Motivation for engaging and continuing in care often came from a team of health care providers using shared decision-making with the patient to facilitate change.
CONCLUSION
To optimize health care for people experiencing homelessness, clinical interventions should: (1) utilize shared-decision making during the visit, (2) foster a sense of trust, compassion, and acceptance, (3) emphasize continuity of care, including consistent providers and staff, and (4) integrate social services into Health Care for the Homeless sites.
背景
尽管已经广泛实施了以提供全面、综合医疗服务为重点的无家可归者医疗保健计划，但让无家可归者参与并维持初级保健仍然是一个挑战。很少有研究关注非传统医疗保健环境中的初级保健提供模式，以了解参与护理的促进因素和障碍。我们的研究目的是探索在单个无家可归者医疗保健计划下的两个不同地点接受护理的无家可归者的诊所就诊情况。
方法
我们对无家可归者进行了半结构化访谈，以进行探索性定性研究。我们使用便利抽样招募了在两个地点之一接受初级保健的参与者：一个是收容所诊所，n=16，另一个是位于教堂的流动诊所，n=15。然后，我们使用迭代、主题方法来确定新兴主题，并将这些主题进一步映射到能力-机会-动机模型上。
结果
可及性、质量和整合是参与者经常认为对护理很重要的促进因素。在患者存在记忆问题或在医疗保健环境中难以感知心理安全的情况下，心理能力和能力成为护理的重要障碍。参与和继续护理的动机通常来自一组医疗保健提供者，他们与患者一起使用共同决策来促进改变。
结论
为了优化无家可归者的医疗保健，临床干预措施应：（1）在就诊期间利用共同决策，（2）培养信任、同情和接受感，（3）强调连续性护理，包括一致的提供者和工作人员，以及（4）将社会服务整合到无家可归者医疗保健点。
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