Bolton Clarke Research Institute, Forest Hill, Victoria, Australia.
Bolton Clarke Homeless Persons Program, West Melbourne, Victoria, Australia.
PLoS One. 2024 Apr 30;19(4):e0302572. doi: 10.1371/journal.pone.0302572. eCollection 2024.
Basic foot care is a real need of people experiencing homelessness. To improve access to foot health for this group, three services structured to provide healthcare support for people experiencing homelessness collaborated in metropolitan Melbourne, Australia: an established nurse-led Homeless Persons Program (HPP), a specialty community health podiatry clinic servicing people experiencing homelessness, and a charity supporting disadvantaged communities providing free socks, foot first aid kits and second-hand footwear for distribution by nurses and podiatrists of participating services. This paper outlines the implementation and evaluation of this collaboration. A four stage implementation approach was used, addressing: 1. Who needs to do what differently? 2. What are the barriers and enablers that need to be addressed? 3. Which intervention components could overcome the modifiable barriers and enhance the enablers? 4. How can the changes be measured? The evaluation prospectively collected information about how HPP nurses referred adults to podiatry, and whether the referred individuals accessed the podiatry clinic, the outcomes of the podiatry visit, and how many received footwear, socks and foot first aid kits provided by the non-profit organisation. Over 1st June 2019 and 31st December 2020, 52 individuals were identified as adults who could potentially benefit from podiatry by the HPP nurses, of which 33 accessed podiatry. Those who did not visit the podiatry clinic were more likely to be born outside of Australia, live in more precarious housing (crisis accommodation and rough sleeping), have slightly more predisposing factors for homelessness, but have fewer medical, psychological and cognitive conditions. A structured approach including processes, education, regular, outreach to youth refuges and formal outcome monitoring enabled foot health care access in people experiencing homelessness. Further research is needed to ascertain how to support participants at risk of foot problems to access podiatry before their foot health issue reaches crisis point.
基础足部护理是无家可归者的实际需求。为了改善这一群体的足部健康，澳大利亚墨尔本的三个服务机构合作，为无家可归者提供医疗保健支持：一个成熟的护士主导的无家可归者项目 (HPP)、一个专门为无家可归者服务的社区健康足病诊所，以及一个慈善机构，为弱势社区提供免费袜子、足部急救包和二手鞋，由参与服务的护士和足病医生分发。本文概述了这一合作的实施和评估。采用了四阶段实施方法，解决了以下问题：1. 谁需要做什么不同？2. 需要解决哪些障碍和促进因素？3. 哪些干预措施可以克服可改变的障碍并增强促进因素？4. 如何衡量这些变化？该评估前瞻性地收集了关于 HPP 护士如何向足病医生转诊成年人的信息，以及被转诊的人是否接受了足病诊所的治疗、足病诊所就诊的结果，以及有多少人接受了非营利组织提供的鞋子、袜子和足部急救包。在 2019 年 6 月 1 日至 2020 年 12 月 31 日期间，52 名 HPP 护士认为可能受益于足病的成年人被确定，其中 33 人接受了足病治疗。那些没有去足病诊所的人更有可能在澳大利亚以外出生，居住在更不稳定的住房（危机住所和露宿），有更多导致无家可归的潜在因素，但患有较少的医疗、心理和认知疾病。一个包括流程、教育、定期向青年收容所提供服务以及正式的结果监测的结构化方法，使无家可归者能够获得足部保健。需要进一步研究如何在参与者的足部健康问题达到危机点之前，支持有足部问题风险的参与者获得足病治疗。
