Integration, effectiveness and costs of different models of primary health care provision for people who are homeless: an evaluation study

Article


Crane, M., Joly, L., Daly, B.J., Gage, H., Manthorpe, J., Cetrano, G., Ford, C. and Williams, P. 2023. Integration, effectiveness and costs of different models of primary health care provision for people who are homeless: an evaluation study. Health and Social Care Delivery Research. 11 (16). https://doi.org/10.3310/WXUW5103
TypeArticle
TitleIntegration, effectiveness and costs of different models of primary health care provision for people who are homeless: an evaluation study
AuthorsCrane, M., Joly, L., Daly, B.J., Gage, H., Manthorpe, J., Cetrano, G., Ford, C. and Williams, P.
Abstract

Background
There is a high prevalence of health problems among single people who are homeless. Specialist primary health care services for this population have been developed in several locations across England; however, there have been very few evaluations of these services.

Objectives
This study evaluated the work of different models of primary health care provision in England to determine their effectiveness in engaging people who are homeless in health care and in providing continuity of care for long-term conditions. It concerned single people (not families or couples with dependent children) staying in hostels, other temporary accommodation or on the streets. The influence on outcomes of contextual factors and mechanisms (service delivery factors), including integration with other services, were examined. Data from medical records were collated on participants’ use of health care and social care services over 12 months, and costs were calculated.

Design and setting
The evaluation involved four existing Health Service Models: (1) health centres primarily for people who are homeless (Dedicated Centres), (2) Mobile Teams providing health care in hostels and day centres, (3) Specialist GPs providing some services exclusively for patients who are homeless and (4) Usual Care GPs providing no special services for people who are homeless (as a comparison). Two Case Study Sites were recruited for each of the specialist models, and four for the Usual Care GP model.

Participants
People who had been homeless during the previous 12 months were recruited as ‘case study participants’; they were interviewed at baseline and at 4 and 8 months, and information was collected about their circumstances and their health and service use in the preceding 4 months. Overall, 363 participants were recruited; medical records were obtained for 349 participants. Interviews were conducted with 65 Case Study Site staff and sessional workers, and 81 service providers and stakeholders.

Results
The primary outcome was the extent of health screening for body mass index, mental health, alcohol use, tuberculosis, smoking and hepatitis A among participants, and evidence of an intervention if a problem was identified. There were no overall differences in screening between the models apart from Mobile Teams, which scored considerably lower. Dedicated Centres and Specialist GPs were more successful in providing continuity of care for participants with depression and alcohol and drug problems. Service use and costs were significantly higher for Dedicated Centre participants and lower for Usual Care GP participants. Participants and staff welcomed flexible and tailored approaches to care, and related services being available in the same building. Across all models, dental needs were unaddressed and staff reported poor availability of mental health services.

Limitations
There were difficulties recruiting mainstream general practices for the Usual Care GP model. Medical records could not be accessed for 14 participants of this model.

Conclusions
Participant characteristics, contextual factors and mechanisms were influential in determining outcomes. Overall, outcomes for Dedicated Centres and for one of the Specialist GP sites were relatively favourable. They had dedicated staff for patients who were homeless, ‘drop-in’ services, on-site mental health and substance misuse services, and worked closely with hospitals and homelessness sector services.

Sustainable Development Goals3 Good health and well-being
Middlesex University ThemeHealth & Wellbeing
PublisherNIHR Journals Library
JournalHealth and Social Care Delivery Research
ISSN2755-0060
Electronic2755-0079
Publication dates
PrintOct 2023
Publication process dates
Accepted2023
Deposited31 Mar 2025
Output statusPublished
Publisher's version
License
File Access Level
Open
Copyright Statement

Copyright © 2023 Crane et al. This work was produced by Crane et al. under the terms of a commissioning contract issued
by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the
Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation
in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/.
For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must
be cited.

Digital Object Identifier (DOI)https://doi.org/10.3310/WXUW5103
Web of Science identifierMEDLINE:37839804
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