Johnson Emily, Marrison Sarah Tucker, Banks Mattie, Swords Adams Cristin
College of Nursing, Medical University of South Carolina, Charleston, SC, United States.
Department of Family Medicine, Medical University of South Carolina, Charleston, SC, United States.
Front Public Health. 2025 May 9;13:1487842. doi: 10.3389/fpubh.2025.1487842. eCollection 2025.
Unhoused individuals experience numerous barriers to healthcare access and higher morbidity and mortality rates than housed individuals. In collaboration with community-based organizations (CBOs) and healthcare profession learners we developed a program involving in-person and telehealth visits at a CBO clinic and via street medicine outreach to address healthcare needs of the unhoused in a small Southeastern city. In its fifth year of operation, from January through April 2024, we evaluated the program using key stakeholder interviews (patients, CBO staff learners) guided by the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. A template analysis approach was utilized to evaluate barriers and facilitators to implementation outcomes. Results demonstrated consistent themes across stakeholders. Factors central to reach included advertisement by word-of-mouth, location convenience, and perceived service benefits. For learners, barriers to reach included clinic hours conflicting with academic schedules and apprehension of providing medical care in this setting. Regarding effectiveness, facilitating themes included opportunities for autonomy and enhanced understanding of treatment of underserved populations (learners) and improvement in health (patients, CBO staff). There were no consistently identified unintended negative consequences of the program. For adoption, all stakeholders described strong perceptions of trust in providers and the importance of team communication and coordination of care, in addition to the need to add disciplines included in the multidisciplinary care team. Facilitating implementation themes included comprehensive access for existing patients, while barriers identified were adequacy of access to social resources (housing, food, transportation) and continued increase in numbers of unhoused individuals outpacing available services. Themes facilitating maintenance included continued outreach efforts and integration into existing healthcare and community-based systems. The addition of additional services and specialties was consistently identified as essential to health status of the patients and an opportunity for growth of the program. This implementation evaluation involving key stakeholders of a community engaged telehealth-based intervention for the unhoused provides thematic considerations to guide program implementation and sustainability to improve health equity for vulnerable populations.
无家可归者在获得医疗保健方面面临诸多障碍，其发病率和死亡率也高于有家可归者。我们与社区组织（CBO）和医疗专业学习者合作，在一个东南部小城市开展了一个项目，包括在CBO诊所进行面对面和远程医疗问诊，并通过街头医疗外展服务来满足无家可归者的医疗需求。在该项目运营的第五年，即2024年1月至4月，我们使用关键利益相关者访谈（患者、CBO工作人员、学习者），并以“覆盖、效果、采纳、实施、维持”（RE-AIM）框架为指导，对该项目进行了评估。采用模板分析方法来评估实施结果的障碍和促进因素。结果显示各利益相关者之间存在一致的主题。覆盖方面的核心因素包括口碑宣传、地点便利以及感知到的服务益处。对于学习者来说，覆盖的障碍包括诊所工作时间与学术日程冲突，以及在这种环境下提供医疗服务的担忧。在效果方面，促进主题包括自主性机会以及对弱势群体治疗的深入理解（学习者）和健康改善（患者、CBO工作人员）。该项目没有一直被认定的意外负面后果。在采纳方面，所有利益相关者都表示对提供者有强烈的信任，以及团队沟通和护理协调的重要性，此外还需要增加多学科护理团队中的学科。促进实施的主题包括现有患者的全面就诊机会，而识别出的障碍是获得社会资源（住房、食物、交通）的充足性以及无家可归者数量持续增加超过现有服务能力。促进维持的主题包括持续的外展努力以及融入现有的医疗保健和社区系统。增加额外的服务和专科一直被认为对患者的健康状况至关重要，也是该项目发展的一个机会。这项涉及社区参与的针对无家可归者的远程医疗干预关键利益相关者的实施评估提供了主题考量，以指导项目实施和可持续性，从而改善弱势群体的健康公平性。
