The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown, NSW, Australia.
The Haymarket Foundation, Sydney, NSW, Australia.
Health Promot J Austr. 2023 Oct;34(4):889-894. doi: 10.1002/hpja.717. Epub 2023 Mar 22.
People experiencing homelessness and/or complex needs often require targeted health services to address unique vulnerabilities. COVID-19 restrictions acted as a barrier for this group accessing health and alcohol and other drug (AOD) treatment services. The Haymarket Foundation, an accommodation and health facility in Australia, transitioned from in-person AOD-counselling services to online consultations. Clients accessing these services were tracked, from March 2019 to November 2020, to assess the impact of the switch to telehealth on client retention.
Qualitative analysis of Haymarket clients' service experience surveys and quantitative descriptives of "no-show" (nonattended sessions) rates and survival analysis of client treatment separations were completed to assess the impact of transitioning to telehealth on client retention.
Although the initial transition to telehealth in March 2020 minimally impacted client no-show rates, reinstated government restrictions in June/July 2020 coincided with increasing no-shows and a substantial increase in treatment exits without notice, especially amongst males. Qualitative analysis showed clients had mixed feelings towards telehealth: some attributed their dissatisfaction to the inability to build rapport with their counsellor online, or with COVID-19 in general. Others appreciated the availability and genuine care of their counsellors through either setting.
Telehealth may be a feasible replacement for face-to-face AOD counselling for people experiencing homelessness, however further investigation needs to be conducted to understand factors associated with improved client retention. SO WHAT?: This pilot demonstrates telehealth may be a feasible ongoing feature of health promotion for vulnerable high-needs populations, including people experiencing homelessness who use substances.
无家可归者和/或有复杂需求的人通常需要有针对性的健康服务来解决其独特的脆弱性问题。由于 COVID-19 疫情的限制，这一群体在获取健康和酒精及其他药物（AOD）治疗服务方面面临障碍。澳大利亚的 Haymarket 基金会是一家提供住宿和健康服务的机构，它将 AOD 咨询服务从线下转移到了线上。从 2019 年 3 月至 2020 年 11 月，对使用这些服务的客户进行了跟踪，以评估转向远程医疗对客户保留率的影响。
对 Haymarket 客户服务体验调查进行定性分析，并对“未露面”（未出席的咨询）率进行定量描述和客户治疗分离的生存分析，以评估转向远程医疗对客户保留率的影响。
尽管 2020 年 3 月最初向远程医疗的过渡对客户未露面率的影响很小，但 2020 年 6 月/7 月重新实施的政府限制措施与未露面率的增加以及治疗退出而没有事先通知的情况增加，尤其是在男性中，情况更为严重。定性分析显示，客户对远程医疗的看法喜忧参半：一些人将其不满归因于无法在线与顾问建立融洽关系，或对 COVID-19 普遍感到不满。其他人则赞赏顾问通过远程医疗提供的服务和真正的关怀。
远程医疗可能是为无家可归者提供 AOD 咨询的一种可行替代方案，但需要进一步调查以了解与改善客户保留率相关的因素。那么，有何启示呢？该试点研究表明，远程医疗可能是促进脆弱性高需求人群（包括使用药物的无家可归者）健康的一种可行的持续特征。
