Data from: Improving access and continuity of care for homeless people: how could general practitioners effectively contribute? results from a mixed study.

Objectives: To analyze 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 semi-structured interviews; quantitative data were collected through questionnaires with closed questions. Quantitative data were analyzed with descriptive statistical analyses on SPPS; a content analysis was applied on qualitative data.
Setting: primary care; views of urban GPs working in deprived area in Marseille were explored by questionnaires and/or semi-structured interview.
Participants: 19 GPs involved in HP’s healthcare were recruited for phase 1 (qualitative); for phase 2 (quantitative), 150 GPs who provide routine health care (“standard” GPs) were randomized, 144 met the inclusion criteria and 105 responded the questionnaire; for phase 3 (qualitative), data were explored on 14 “standard” GPs.
Results:
In quantitative phase, 79% of the 105 GPs already treated HP. Most of the difficulties they encountered treating HP concerned social matters (mean level of perceived difficulties = 3.95/5, IC95 [3.74-4.17]), lack of medical information (mn=3.78/5, IC95 [3.55-4.01]patient’s compliance (mn=3.67/5, IC95 [3.45-3.89]), loneliness in practice (mn=3.45/5, IC95 [3.18-3.72]) and time required for doctor (mn=3.25, IC95 [3-3.5]. 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 organization, developing a medical and psychosocial approach with closer relation with social workers and enhancing the collaboration between tailored and non-tailored programs were also other key answers.

Conclusion: 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 organization aiming to improve access to health care for HP.

研究目标：分析全科医生（General Practitioners, GPs）对为无家可归者（Homeless People, HP）提供医疗服务的相关看法，并探索可影响其服务观念的相关措施。
研究设计：采用混合方法研究设计，即定性研究→定量研究（横断面观察性研究）→定性研究。定性数据通过半结构化访谈采集；定量数据通过封闭式问卷采集。定量数据采用SPSS进行描述性统计分析，定性数据则采用内容分析法开展编码分析。
研究场景：基层医疗场景，本次研究针对马赛贫困城区执业的城市全科医生，通过问卷及/或半结构化访谈调研其服务相关看法。
研究对象：第一阶段（定性研究）共招募19名参与无家可归者医疗服务的全科医生；第二阶段（定量研究）随机抽取150名提供常规医疗服务的“普通”全科医生，其中144名符合纳入标准，105名完成问卷调研；第三阶段（定性研究）共纳入14名“普通”全科医生开展数据分析。
研究结果：定量阶段结果显示，105名受访全科医生中有79%曾接诊无家可归者。他们在接诊该群体时遇到的主要困难依次为社会事务相关问题（感知困难平均得分3.95/5，95%置信区间[3.74-4.17]）、缺乏患者医疗信息（平均得分3.78/5，95%置信区间[3.55-4.01]）、患者依从性不佳（平均得分3.67/5，95%置信区间[3.45-3.89]）、执业过程中的孤独感（平均得分3.45/5，95%置信区间[3.18-3.72]）以及医生所需投入的诊疗时间成本（平均得分3.25/5，95%置信区间[3.00-3.50]）。定性分析结果表明，维持稳定的随访服务是全科医生有效参与无家可归者医疗照护的核心前提。此外，优化医疗体系组织架构、构建融合医学与社会心理的服务模式、加强与社会工作者的紧密协作，以及完善针对性与非针对性服务项目间的协作机制，亦是关键应对策略。
研究结论：若能优化全科医生的执业环境与条件，即可助力提升无家可归者的健康水平。本研究结果可为构建新型基层医疗服务模式提供依据，以改善无家可归者的医疗服务可及性。