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

Objectives: To analyse the views of general practitioners (GPs) about ă how they can provide care to homeless people (HP) and to explore which ă measures could influence their views. ă Design: Mixed-methods design (qualitative -> quantitative ă (cross-sectional observational) -> qualitative). Qualitative data were ă collected through semistructured interviews and through questionnaires ă with closed questions. Quantitative data were analysed with descriptive ă statistical analyses on SPPS; a content analysis was applied on ă qualitative data. ă Setting: Primary care; views of urban GPs working in a deprived area in ă Marseille were explored by questionnaires and/or semistructured ă interview. ă Participants: 19 GPs involved in HP's healthcare were recruited for ă phase 1 (qualitative); for phase 2 (quantitative), 150 GPs who provide ă routine healthcare ('standard' GPs) were randomised, 144 met the ă inclusion criteria and 105 responded to the questionnaire; for phase 3 ă (qualitative), data were explored on 14 `standard' GPs. ă Results: In the quantitative phase, 79% of the 105 GPs already treated ă HP. Most of the difficulties they encountered while treating HP ă concerned social matters (mean level of perceived difficulties=3.95/5, ă IC 95 (3.74 to 4.17)), lack of medical information (mn=3.78/5, IC 95 ă (3.55 to 4.01)) patient's compliance (mn=3.67/5, IC 95 (3.45 to 3.89)), ă loneliness in practice (mn=3.45/5, IC 95 (3.18 to 3.72)) and time ă required for the doctor (mn=3.25, IC 95 (3 to 3.5)). From qualitative ă analysis we understood that maintaining a stable follow-up was a major ă condition for GPs to contribute effectively to the care of HP. Acting on ă health system organisation, developing a medical and psychosocial ă approach with closer relation with social workers and enhancing the ă collaboration between tailored and non-tailored programmes were also ă other key answers. ă Conclusions: If we adapt the conditions of GPs practice, they could ă contribute to the improvement of HP's health. These results will enable ă the construction of a new model of primary care organisation aiming to ă improve access to healthcare for HP.