Access to primary care for people experiencing homelessness during the COVID-19 pandemic

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

4C.2

Presenter:

Kelly Howells

Twitter:

@kellyhowells17

Co-authors:

Mat Amp, Martin Burrows, Jo Brown, Wan-Ley Yeung, Shaun Jackson, Joanne Dickinson, Rachel Brennan, Stephen Campbell, Darren Ashcroft, Tom Blakeman, Caroline Sanders

Author institutions:

The University of Manchester, Groundswell, Salford Primary Care Together, Urban Medical Practice, Bolton NHS Foundation Trust

Problem

Despite high level of health care need amongst people experiencing homelessness, poor access is a major concern. This is sometimes due to organisational and bureaucratic barriers, but also because they often feel stigmatised and treated badly when they do seek health care (Brennan, 2018). The COVID-19 pandemic and the required social distancing measures have caused unprecedented disruption and change for the organisation of primary care, particularly for people experiencing homelessness who may not have access to a phone. Against this back drop, there are many questions to address regarding whether the changes required to deliver services to people experiencing homelessness in the context of COVID-19 have helped to address or compound problems in accessing care and inequalities in health outcomes. This qualitative study explores how the rapid change to remote care during the COVID-19 pandemic impacted the access and safety of care for people experiencing homelessness.

Approach

Individual semi-structured interviews were conducted with 21 people experiencing homelessness and 22 clinicians and support workers across 3 case study sites in Greater Manchester. An action led and participatory research methodology was employed to address the study objectives. Interviews with people experiencing homelessness were conducted by a researcher with lived experience of homelessness. Researchers with lived experience are able to engage with vulnerable communities in an empathetic, non-judgemental way as their shared experience promotes a sense of trust and integrity, which in turn encourages participation in research and may help people speak more openly about their experience. Interviews with health professionals and stakeholders concerning their experiences of delivering and facilitating care for homeless people during the pandemic will also be explored.

Findings

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. The findings highlighted that the responsiveness and success of implementing a remote model for people experiencing homelessness relies heavily on flexible and collaborative working across health and community organisations.

Consequences

The findings have highlighted the importance of supporting communication and choice for mode of consultation for marginalised patient groups such as people experiencing homelessness. We argue that consultations should not be remote ‘by default’ and instead take into consideration both the clinical and social factors underpinning health.

Submitted by:

Kelly Howells

Funding acknowledgement:

This work was funded by the National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre (award number: PSTRC-2016-003).