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Improving access and continuity of care for homeless people: how could general practitioners effectively contribute? Results from a mixed study
  1. Maeva Jego1,2,
  2. Dominique Grassineau3,4,
  3. Hubert Balique1,
  4. Anderson Loundou1,
  5. Roland Sambuc1,3,
  6. Alexandre Daguzan5,
  7. Gaetan Gentile2,
  8. Stéphanie Gentile1
  1. 1EA 3279 Research Unit—Public Health, Chronic Diseases and Quality of Life, Aix-Marseille University, Marseille, France
  2. 2Department of General Practice, Aix-Marseille University, Marseille, France
  3. 3PASS, Department of Public Health, Timone University Hospital, APHM, Marseille, France
  4. 4UMR 6278 A.D.E.S Research Unit—Anthropology Rights Ethics and Health, Aix-Marseille University, Marseille, France
  5. 5Medical Evaluation Unit, Department of Public Health, Conception University Hospital, APHM, Marseille, France
  1. Correspondence to Dr Maeva Jego; Maeva.jego{at}univ-amu.fr

Abstract

Objectives To analyse the views of general practitioners (GPs) about how they can provide care to homeless people (HP) and to explore which measures could influence their views.

Design Mixed-methods design (qualitative –> quantitative (cross-sectional observational) → qualitative). Qualitative data were collected through semistructured interviews and through questionnaires with closed questions. Quantitative data were analysed with descriptive statistical analyses on SPPS; a content analysis was applied on qualitative data.

Setting Primary care; views of urban GPs working in a deprived area in Marseille were explored by questionnaires and/or semistructured interview.

Participants 19 GPs involved in HP's healthcare were recruited for phase 1 (qualitative); for phase 2 (quantitative), 150 GPs who provide routine healthcare (‘standard’ GPs) were randomised, 144 met the inclusion criteria and 105 responded to the questionnaire; for phase 3 (qualitative), data were explored on 14 ‘standard’ GPs.

Results In the quantitative phase, 79% of the 105 GPs already treated HP. Most of the difficulties they encountered while treating HP concerned social matters (mean level of perceived difficulties=3.95/5, IC 95 (3.74 to 4.17)), lack of medical information (mn=3.78/5, IC 95 (3.55 to 4.01)) patient's compliance (mn=3.67/5, IC 95 (3.45 to 3.89)), loneliness in practice (mn=3.45/5, IC 95 (3.18 to 3.72)) and time required for the doctor (mn=3.25, IC 95 (3 to 3.5)). From qualitative analysis we understood that maintaining a stable follow-up was a major condition for GPs to contribute effectively to the care of HP. Acting on health system organisation, developing a medical and psychosocial approach with closer relation with social workers and enhancing the collaboration between tailored and non-tailored programmes were also other key answers.

Conclusions If we adapt the conditions of GPs practice, they could contribute to the improvement of HP's health. These results will enable the construction of a new model of primary care organisation aiming to improve access to healthcare for HP.

  • PRIMARY CARE
  • general practitioners
  • homeless people
  • access to health care
  • mixed methods

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors MJ designed the study, performed data collection on the three phases (all interviews, and questionnaires), performed the analyses, drafted the article and approved the final version; DG co-directed the third part of this study, contributed to the conception of the work and interpretation of data, revised the article and approved the final version; HB directed this whole work, gave advices for designing the study and analyses, revised the article and approved the final version; RS gave advices for designing the study, revised the article and approved the final version; AL gave advices for designing the study, supported the data analyses, revised the article and approved the final version; AD participated to the building of the research question, was a support to enhance the methodology of this study (at each methodological step), gave advices concerning the data analysis process, revised the article for editing the methods and discussion about mixed methods, and approved the final version. GG contributed to the conception of the work and interpretation of data, revised the article and approved the final version; SG was the tutor of this whole work, gave advices to get research scholarship, gave advices for designing the study and analyses, revised the article and approved the final version.

  • Funding Phases 1 and 2 of this work were supported by AP-HM (Assistance Publique Hôpitaux de Marseille) and ARS PACA (regional health agency of region PACA): research scholarship allocated to the principal author (MJ) to perform a public health research master during year 2013–2017 (M-2013/2014-8).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethics Committee Faculty of Medicine of Aix-Marseille University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Additional data can be accessed via the Dryad data repository at http://datadryad.org/ with the doi:10.5061/dryad.j9q7h.