Abstract
BackgroundThe COVID-19 pandemic has caused unprecedented disruption and change to the organisation of primary care, including for people experiencing homelessness who may not have access to a phone. Little is known about whether the recent changes required to deliver services to people experiencing homelessness will help to address or compound inequality in accessing care.AimTo explore the experience and impact of organisational and technology changes in response to COVID-19 on access to health care for people experiencing homelessness.Design and settingAn action-led and participatory research methodology was employed in three case study sites made up of primary care services delivering care for people experiencing homelessness.MethodIndividual semi-structured interviews were conducted with 21 people experiencing homelessness and 22 clinicians and support workers. Interviews were analysed using a framework approach.ResultsThe move to remote telephone consultations highlighted the difficulties experienced by participants in accessing health care. These barriers included problems at the practice level associated with remote triage as participants did not always have access to a phone or the means to pay for a phone call. This fostered increased reliance on support workers and clinicians working in the community to provide or facilitate a primary care appointment.ConclusionThe findings have emphasised the importance of addressing practical and technology barriers as well as supporting communication and choice for mode of consultation. The authors argue that consultations should not be remote ‘by default’ and instead take into consideration both the clinical and social factors underpinning health.
Highlights
IntroductionShelter calculates approximately 253,000 people are experiencing homelessness in England, with many thousands more at risk [2, 3]
The move to remote telephone consultations highlighted the difficulties experienced by participants in accessing healthcare. These barriers including problems at the practice level associated with remote triage as participants did not always have access to a phone or the means to pay for a phone call. This fostered increased reliance on support workers and clinicians working in the community to provide or facilitate a primary care appointment
We argue that while the remote model may facilitate more ‘timely’ access for some individuals, remote care should not be the default approach
Summary
Shelter calculates approximately 253,000 people are experiencing homelessness in England, with many thousands more at risk [2, 3]. Recent evidence shows widening health inequalities for people experiencing homelessness [5] with common experiences of both acute and ongoing complex mental, social and physical care needs and reduced life expectancy [6]. The COVID-19 pandemic has caused unprecedented disruption and change for the organisation of primary care, including for people experiencing homelessness who may not have access to a phone. Little is known about whether the recent changes required to deliver services to people experiencing homelessness will help to address or compound inequality in accessing care. Aim To explore the experience and impact of organisational and technology changes in response to COVID-19 on access to healthcare for people experiencing homelessness.
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