Relocating patients from a specialist homeless healthcare centre to general practices: a multi-perspective study

Abstract

Background: The relocation of formerly homeless patients eligible to transfer from a specialist homeless healthcare centre (SHHC) to mainstream general practices is key to patient integration in the local community. Failure to transition patients conferring eligibility for relocation may also negatively impact on SHHC service delivery.

Aim: To explore barriers and facilitators of relocation from the perspectives of formerly homeless patients and healthcare staff involved in their care.

Design and setting: Qualitative semi-structured face-to-face and telephone interviews conducted in the north east of Scotland.

Method: Participants were patients and healthcare staff including GPs, nurses, substance misuse workers, administrative, and local community pharmacy staff recruited from one SHHC, two mainstream general practices, and four community pharmacies. Interview schedules based on the 14 domains of the Theoretical Domains Framework (TDF) were drafted. Transcripts of the interviews were analysed by two independent researchers using a framework approach.

Results: Seventeen patients and 19 staff participated. Key barriers and facilitators aligned to TDF domains included: beliefs about consequences regarding relocation; patient intention to relocate; environmental context and resources in relation to the care of the patients and assessing patient eligibility; patient skills in relation to integration; social and professional role and identity of staff and patients; and emotional attachment to the SHHC.

Conclusion: Implementation of services, which promote relocation and integration, may optimise patient relocation from SHHCs to mainstream general practices. These include peer support networks for patients, better information provision on the relocation process, and supporting patients in the journey of identifying and adjusting to mainstream practices.

Keywords: Theoretical Domains Framework; delivery of health care; general practice; homeless persons; primary health care.