St Vincent's Hospital Melbourne, Melbourne, Australia.
The University of Melbourne, Melbourne, Australia.
BMC Health Serv Res. 2024 Apr 20;24(1):492. doi: 10.1186/s12913-024-10971-8.
Homelessness is associated with significant health disparities. Conventional health services often fail to address the unique needs and lived experience of homeless individuals and fail to include participatory design when planning health services. This scoping review aimed to examine areas of patient experience that are most frequently reported by people experiencing homelessness when seeking and receiving healthcare, and to identify existing surveys used to measure patient experience for this cohort.
A scoping review was undertaken reported according to the PRISMA-ScR 2020 Statement. Databases were searched on 1 December 2022: MEDLINE, EMBASE, APA PsychINFO and CINAHL. Included studies focused on people experiencing homelessness, healthcare services and patient experience, primary research, published in English from 2010. Qualitative papers and findings were extracted and synthesized against a modified framework based on the National Institute for Health and Care Excellence guidelines for care for people experiencing homelessness, the Institute of Medicine Framework and Lachman's multidimensional quality model. People with lived experience of homelessness were employed as part of the research team.
Thirty-two studies were included. Of these, 22 were qualitative, seven quantitative and three mixed methods, from the United States of America (n = 17), United Kingdom (n = 5), Australia (n = 5) and Canada (n = 4). Health services ranged from primary healthcare to outpatient management, acute care, emergency care and hospital based healthcare. In qualitative papers, the domains of 'accessible and timely', 'person-centred', and values of 'dignity and respect' and 'kindness with compassion' were most prevalent. Among the three patient experience surveys identified, 'accessible and timely' and 'person-centred' were the most frequent domains. The least frequently highlighted domains and values were 'equitable' and 'holistic'. No questions addressed the 'safety' domain.
The Primary Care Quality-Homeless questionnaire best reflected the priorities for healthcare provision that were highlighted in the qualitative studies of people experiencing homelessness. The most frequently cited domains and values that people experiencing homelessness expressed as important when seeking healthcare were reflected in each of the three survey tools to varying degrees. Findings suggest that the principles of 'Kindness and compassion' require further emphasis when seeking feedback on healthcare experiences and the domains of 'safety', 'equitable', and 'efficiency' are not adequately represented in existing patient experience surveys.
无家可归与显著的健康差异有关。传统的卫生服务往往未能满足无家可归者的独特需求和生活体验，在规划卫生服务时也未能纳入参与式设计。本范围综述旨在研究无家可归者在寻求和接受医疗保健时最常报告的患者体验领域，并确定用于衡量这一人群患者体验的现有调查。
根据 PRISMA-ScR 2020 声明进行了范围综述。于 2022 年 12 月 1 日在 MEDLINE、EMBASE、APA PsychINFO 和 CINAHL 数据库中进行了检索。纳入的研究侧重于无家可归者、医疗保健服务和患者体验、原始研究，并于 2010 年以后以英文发表。从国家卫生与保健卓越研究所（National Institute for Health and Care Excellence）针对无家可归者护理指南、医学研究所（Institute of Medicine）框架和拉赫曼多维质量模型中提取并综合了定性论文和发现。无家可归者的生活体验者作为研究团队的一部分参与其中。
共纳入 32 项研究。其中，22 项为定性研究，7 项为定量研究，3 项为混合方法研究，来自美国（n=17）、英国（n=5）、澳大利亚（n=5）和加拿大（n=4）。卫生服务范围从初级保健到门诊管理、急性护理、急诊护理和医院内医疗保健。在定性论文中，“可及性和及时性”、“以患者为中心”以及“尊严和尊重”和“仁慈与同情”的价值观等领域最为普遍。在确定的三个患者体验调查中，“可及性和及时性”和“以患者为中心”是最常出现的领域。提及最少的领域和价值观是“公平”和“全面”。没有问题涉及“安全”领域。
初级保健质量-无家可归者问卷最能反映无家可归者定性研究中强调的医疗服务提供重点。无家可归者在寻求医疗保健时最常提到的重要领域和价值观在三种调查工具中都有不同程度的反映。研究结果表明，在寻求医疗保健体验反馈时，“仁慈与同情”原则需要进一步强调，而现有患者体验调查中没有充分体现“安全”、“公平”和“效率”等领域。
