Interventions to Improve Access to Primary Care for People Who Are Homeless: A Systematic Review.

Q1 Medicine
Ontario Health Technology Assessment Series Pub Date : 2016-04-01 eCollection Date: 2016-01-01
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引用次数: 0

Abstract

Background: People who are homeless encounter barriers to primary care despite having greater needs for health care, on average, than people who are not homeless. We evaluated the effectiveness of interventions to improve access to primary care for people who are homeless.

Methods: We performed a systematic review to identify studies in English published between January 1, 1995, and July 8, 2015, comparing interventions to improve access to a primary care provider with usual care among people who are homeless. The outcome of interest was access to a primary care provider. The risk of bias in the studies was evaluated, and the quality of the evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria.

Results: From a total of 4,047 citations, we identified five eligible studies (one randomized controlled trial and four observational studies). With the exception of the randomized trial, the risk of bias was considered high in the remaining studies. In the randomized trial, people who were homeless, without serious mental illness, and who received either an outreach intervention plus clinic orientation or clinic orientation alone, had improved access to a primary care provider compared with those receiving usual care. An observational study that compared integration of primary care and other services for people who are homeless with usual care did not observe any difference in access to a primary care provider between the two groups. A small observational study showed improvement among participants with a primary care provider after receiving an intervention consisting of housing and supportive services compared with the period before the intervention. The quality of the evidence was considered moderate for both the outreach plus clinic orientation and clinic orientation alone, and low to very low for the other interventions. Despite limitations, the literature identified reports of interventions developed to overcome barriers in access to primary care in people who are homeless. The interventions studied are complex and include multiple components that are consistent with proposed dimensions of access to care (availability, affordability, and acceptability).

Conclusions: Our systematic review of the literature identified various types of interventions that seek to improve access to primary care by attempting to address barriers to care encountered by people who are homeless. Moderate-quality evidence indicates that orientation to clinic services (either alone or combined with outreach) improves access to a primary care provider in adults who are homeless, without serious mental illness, and living in urban centres.

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改善无家可归者获得初级保健的干预措施:系统回顾。
背景:无家可归者在获得初级保健方面遇到障碍,尽管他们对保健的平均需求比非无家可归者更大。我们评估了改善无家可归者获得初级保健的干预措施的有效性。方法:我们对1995年1月1日至2015年7月8日期间发表的英文研究进行了系统回顾,比较了改善无家可归者获得初级保健提供者和常规护理的干预措施。感兴趣的结果是获得初级保健提供者。对研究的偏倚风险进行评估,并根据建议分级评估、发展和评价(GRADE)工作组标准对证据质量进行评估。结果:从总共4047篇引用中,我们确定了5项符合条件的研究(1项随机对照试验和4项观察性研究)。除随机试验外,其余研究均认为偏倚风险较高。在随机试验中,无家可归的人,没有严重的精神疾病,接受外展干预加诊所指导或单独接受诊所指导的人,与接受常规护理的人相比,获得初级保健提供者的机会更多。一项观察性研究比较了为无家可归者提供的初级保健和其他服务与常规护理的整合,没有观察到两组人在获得初级保健提供者方面有任何差异。一项小型观察性研究显示,接受由住房和支持性服务组成的干预后,有初级保健提供者的参与者与干预前相比有所改善。对于外展加临床导向和单独的临床导向,证据的质量被认为是中等的,对于其他干预措施,证据的质量从低到非常低。尽管存在局限性,但文献确定了为克服无家可归者获得初级保健的障碍而制定的干预措施的报告。所研究的干预措施是复杂的,包括与获得医疗服务的建议维度(可获得性、可负担性和可接受性)相一致的多个组成部分。结论:我们对文献的系统回顾确定了各种类型的干预措施,这些干预措施试图通过解决无家可归者遇到的护理障碍来改善获得初级保健的机会。中等质量的证据表明,以诊所服务为导向(单独或与外联服务相结合)改善了无家可归、无严重精神疾病和居住在城市中心的成年人获得初级保健提供者的机会。
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来源期刊
Ontario Health Technology Assessment Series
Ontario Health Technology Assessment Series Medicine-Medicine (miscellaneous)
CiteScore
4.60
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