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Appendix P. Tayside Health Board - Health Inequalities in the Homeless
Topics: Hard to Reach Groups; Mental Health; Primary Care; Substance Misuse
Background
The homeless population have a complex set of unmet needs with, for example, high rates of physical illness, chronic disease or mental health problems, poor nutrition and drug misuse. In addition, they often have difficulty accessing services partly due to their lack of permanent residency in one location and partly due to attitudes of service providers. The project therefore sought to pilot a proactive preventative outreach model of care to homeless people.
Funding allocation
The pilot was allocated £358,692
Aim(s)
To provide an outreach primary care service to homeless people living in hostels in Dundee, taking a proactive preventative approach to enable clients to make informed choices about their health and wellbeing.
Methodology
The project utilised a pre-post comparison and recruited two groups of clients - the intervention group and the control group. The intervention group comprised homeless people from selected hostels in Dundee City. The control group comprised homeless people from other hostels and homeless accommodation in Dundee City.
The intervention was delivered in a number of ways. For example, nurses provided twice weekly open access clinics within a variety of suitable locations; GPs offered outreach clinics in two hostels once a month; an advocacy service was provided and some preventative work e.g. dental services were provided in hostels.
In contrast, those in the control group received an existing named health link only in line with standard practice.
The primary outcome of the project was to measure the increase in self-reported use of health services pre and post contact with the service.
There were also a number of secondary outcomes. These were the numbers and demographic distribution of: patients contacted; patients who were contacted and offered follow-up services; patients who attended follow-up services; and patients views regarding acceptability.
Key results
Results of a post intervention follow-up showed that there was an increase in service use for both intervention and control groups. In addition, the intervention group recorded significantly higher access to drug services and open access drop-in. The intervention group also recorded increased contact with primary care services and a significant increase in social work contact.
Conclusions
The project successfully increased service use through the use of the outreach service proposed a number of recommendations. A number of elements of the intervention package were identified as being responsible for changes in service usage. These included the ability of the project team to identify the gaps in services for particular groups or from certain health services and the lack of intimidation in dealing with homeless people compared to that which is often felt by statutory service providers.
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