The GP role in improving outcomes for homeless inpatients

2018 ◽  
Vol 22 (1) ◽  
pp. 15-26 ◽  
Author(s):  
Zana Khan ◽  
Philip Haine ◽  
Samantha Dorney-Smith
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Homeless People ◽  
Routine Data ◽  
Community Services ◽  
Structured Interviews ◽  
Content Type ◽  
Complex Needs ◽  
Care Services

Purpose Homeless people experience extreme health inequalities and high rates of morbidity and mortality (Aldridge et al., 2017). Use of primary care services are low, while emergency healthcare use is high (Mathie, 2012; Homeless Link, 2014). Duration of admission has been estimated to be three times longer for homeless patients who often experience poor hospital discharge arrangements (Mathie, 2012; Homeless Link, 2014). This reflects ongoing and unaddressed care and housing needs (Blackburn et al., 2017). The paper aims to discuss these issues. Design/methodology/approach This paper reveals how GPs employed in secondary care, as part of Pathway teams, support improved health and housing outcomes and safe transfer of care into community services. It draws on published literature on role of GPs in working with excluded groups, personal experience of working as a GP in secondary care, structured interviews with Pathway GPs and routine data collected by the team to highlight key outcomes. Findings The expertise of GPs is highlighted and includes holistic assessment, management of multimorbidity or “tri-morbidity” – the combination of addictions problems, mental illness and physical health (Homeless Link, 2014; Stringfellow et al., 2015) and research and teaching. Originality/value The role of the GP in the care of patients with complex needs is more visible in primary care. This paper demonstrates some of the ways in which in-reach GPs play an important role in the care of multiply excluded groups attending and admitted to secondary care settings.

scholarly journals Having a voice

2018 ◽  
Vol 26 (4) ◽  
pp. 342-352 ◽  
Author(s):  
Rachel Massie ◽  
Richard Machin ◽  
Fiona McCormack ◽  
Judith Kurth
Keyword(s):  
Lived Experience ◽  
Homeless People ◽  
Urban Setting ◽  
City Centre ◽  
Research Approach ◽  
Structured Interviews ◽  
Content Type ◽  
Complex Needs ◽  
Peer Researchers ◽  
The Impact

PurposeThe purpose of this paper is to understand the lived experience of people who have experienced homelessness and street activity, and professional stakeholders’ views about the challenges faced by this client group. The study sought to identify measures to improve the current situation for both individuals experiencing homelessness and professionals working with them.Design/methodology/approachPeer researchers with lived experience of multiple and complex needs conducted semi-structured interviews/surveys with 18 participants (eight individuals experiencing homelessness and street activity and ten professional stakeholders). The authors of the paper conducted a thematic analysis of the data.FindingsThis paper offers insights into both the current challenges and assets for people who are or have been homeless in an urban setting. Key findings include the need for a coordinated partnership approach to address pathways to support, and the importance of developing opportunities for meaningful activity and building on local resources including giving homeless people a voice. These findings are discussed within the context of current policy (Housing First) and legislation (Homelessness Reduction Act 2017) and the impact on integrated care for people who have experienced homelessness.Research limitations/implicationsThe views explored in this study are specific to one city centre in the West Midlands; thus, generalisability may be limited.Originality/valueThis study presents a participatory research approach with peer researchers exploring the perspective of individuals experiencing homelessness and wider stakeholders. The findings of this research are considered with reference to the provisions of the HRA 2017.

Keyworkers’ experiences and perceptions of using psychological approaches with people experiencing homelessness

2018 ◽  
Vol 21 (2) ◽  
pp. 51-63 ◽  
Author(s):  
Josephine Benson ◽  
Michael Brennan
Keyword(s):  
Professional Training ◽  
Homeless People ◽  
Psychological Trauma ◽  
Convincing Evidence ◽  
Structured Interviews ◽  
Content Type ◽  
Complex Needs ◽  
Face To Face ◽  
Irish Context ◽  
Qualitative Descriptive

Purpose The purpose of this paper is to explore keyworkers’ experience and perceptions working with people experiencing homelessness and the use of psychologically informed approaches in an Irish context. Design/methodology/approach In this paper a qualitative descriptive methodology was employed and face-to-face in-depth semi-structured interviews were conducted. Data collected were analysed using a thematic framework and transcribed by the researcher. Findings It was the view of the keyworkers psychological approaches allowed them greater understanding of psychological trauma and its effects promotes safe physical and emotional environments builds rapport between staff and clients and enables keyworkers to work more effectively with people with complex needs. There was also convincing evidence staff are quite receptive to training. Originality/value Given there is no research exploring the use of psychologically informed approaches in homelessness service settings, this study researched an area that has not yet been explored in Ireland. This qualitative descriptive research provides a platform from which further research can be conducted. It is hoped that highlighting the psychological issues of homeless people, the data obtained will help improve Irish homeless services, and the findings extracted beneficial in terms of future service developments, professional training and education.

GPs’ and patients’ views on recovery from psychosis

2014 ◽  
Vol 19 (2) ◽  
pp. 99-109 ◽  
Author(s):  
Seamus Ryan ◽  
Anne Rogers ◽  
Helen Lester
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Multiple Perspectives ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Peer Supervision ◽  
Content Type ◽  
Whole Person ◽  
Clinical Interest

Purpose – Recovery is a key organising principle underlying mental health services, but remains under-researched in primary care. The purpose of this paper is to explore what recovery from psychosis means from multiple perspectives, the role of primary care in fostering recovery, and interventions that might enhance its promotion in primary care. Design/methodology/approach – A total of 20 patients who had experienced psychosis and 24 General Practitioners (GPs) with varying expressed interest in mental health participated in semi-structured interviews, and were invited to two subsequent mixed focus groups. Data were analysed using Framework Analysis. Findings – Recovery was conceptualised by GPs without a specialist clinical interest in mental health as improvements in symptomatic outcomes, by GPs with a special interest as improvements in social or functional outcomes, and by patients as a process involving a “whole person” approach. Both GPs and patients highlighted benefits of primary care including continuity, accessibility, and the role primary care professionals can play in supporting patients’ families, and helping patients expand social support networks. Despite feeling “fobbed off” at times, patients desired a shift in responsibility for psychosis from secondary to primary care. Practical implications – Reflective peer supervision meetings for GPs and patient-led training might improve primary care's ability to provide a more recovery-focused environment. Originality/value – This study provided original and valuable findings regarding how GPs viewed their own role in promoting recovery from psychosis. This study also provided original findings regarding how patients viewed the role of primary care in promoting recovery from psychosis.

Literature review of managerial levers in primary care

2020 ◽  
Vol 34 (5) ◽  
pp. 505-528
Author(s):  
Elisabetta Garagiola ◽  
Alessandro Creazza ◽  
Emanuele Porazzi
Keyword(s):  
Primary Care ◽  
Literature Review ◽  
Performance Management ◽  
Healthcare Services ◽  
Community Services ◽  
Future Research ◽  
Economic Evaluations ◽  
Long Term Conditions ◽  
Content Type ◽  
Care Services

PurposeThis study aims to analyze the managerial levers previously considered in literature in the setting of the provision of primary care and community services (in particular for patients with long-term conditions being treated also at home) as well as those scarcely explored that could potentially be adopted in the future.Design/methodology/approachThis study was a structured literature review. The authors retrieved papers, published from 2005–2020, from electronic databases (i.e. ABI/INFORM Complete, Jstor, PubMed and Scopus). Each selected paper was assigned to a framework category, and a thematic analysis was performed.FindingsTopics scarcely explored in literature were related to logistics/supply chain, economic evaluations, performance management and customer satisfaction. Some papers embraced more than one management topic, confirming the multidisciplinary nature of territorial healthcare services. The majority of research, however, focused on only one aspect of primary care services, and a lack of an integrated view regarding the provision of those services emerged.Originality/valueThis study represents a first attempt to rationalize the fragmented body of knowledge on the topic of the provision of primary and community care services. This study enabled some light to be shed on the managerial levers already explored previously in literature and also identifies a number of trajectories for future research.

scholarly journals Referrals to Urgent Dental Centres During the COVID-19 Pandemic: A Multi-Site Analysis Research Project

2021 ◽  
Vol 10 (1) ◽  
pp. 40-45
Author(s):  
Adam Shathur ◽  
Samuel Reeves ◽  
Faizal Sameja ◽  
Vishal Patel ◽  
Allan Jones
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Easy Access ◽  
Dental Services ◽  
Care Services ◽  
Dental Practitioners ◽  
Consultation And Referral ◽  
Care Systems ◽  
Access To Primary Care ◽  
The Uk

Introduction: The COVID-19 pandemic enforced the cessation of routine dentistry and the creation of local urgent dental care systems in the UK. General dental practices are obligated by NHS guidance to remain open and provide remote consultation and referral where appropriate to patients having pain or problems. Aims: To compare two urgent dental centres with different triage and referral systems with regard to quality and appropriateness of referrals, and patient management outcomes. Methods: 110 consecutive referrals received by a primary care urgent dental centre and a secondary care urgent dental centre were assessed. It was considered whether the patients referred had access to remote primary care dental services, fulfilled the criteria required to be deemed a dental emergency as mandated by NHS guidance, and what the outcomes of referrals were. Results: At the primary care centre, 100% of patients were referred by general dental practitioners and had access to remote primary care dental services. 95.5% of referrals were deemed appropriate and were seen for treatment. At the secondary care site, 94.5% of referrals were direct from the patient by contacting NHS 111. 40% had received triaging to include ‘advice, analgesia and antimicrobial’ from a general dental practitioner, and 25.5% were deemed appropriate and resulted in treatment. Conclusion: Urgent dental centres face many issues, and it would seem that easy access to primary care services, collaboration between primary care clinicians and urgent dental centres, and training of triaging staff are important in operating a successful system.

scholarly journals Sinabung volcano: how culture shapes community resilience

2019 ◽  
Vol 28 (3) ◽  
pp. 290-303
Author(s):  
Marta Mori ◽  
Ronan McDermott ◽  
Saut Sagala ◽  
Yasmina Wulandari
Keyword(s):  
Structured Interviews ◽  
Content Type ◽  
Aid Dependency ◽  
Relief Operations ◽  
Long Term Impact ◽  
Cultural Experts ◽  
Practical Implications

Purpose The purpose of this paper is to explore how culture, including traditions and social structures, can influence resilience and how culturally sensitive relief operations can put affected people and their context at the core of any interventions. Design/methodology/approach A case study of the Mt Sinabung volcano area in Indonesia was undertaken. As part of the case study, an analysis of interventions was conducted, which was complemented by semi-structured interviews with Karo cultural experts and humanitarian organisations. Findings Culture influences the manner in which the Karo people react to volcano eruptions with varying implications for recovery. In addition, relief organisations which understand people’s actions through a cultural lens have better managed to tailor programs with long-term impact, thereby avoiding aid dependency. Practical implications Practical examples of disaster management activities that adequately account for the beneficiaries’ way of living prior to the eruptions are provided. Aid actors are provided with guidance concerning how to better tailor their activities in line with a cultural lens. Originality/value The study provides empirical grounding for claims concerning the role of culture in planning interventions in Indonesia and other similar contexts.

“There is still a perception that homelessness is a housing problem”: devolution, homelessness and health in the UK

2016 ◽  
Vol 19 (2) ◽  
pp. 33-44 ◽  
Author(s):  
Martin Whiteford ◽  
Glenn Simpson
Keyword(s):  
Qualitative Interviews ◽  
Homeless People ◽  
Small Sample ◽  
Issue Salience ◽  
Structured Interviews ◽  
Healthcare Provision ◽  
Policy And Practice ◽  
Content Type ◽  
The Uk ◽  
Comparative Policy

Purpose The purpose of this paper is to provide an exploratory account of the links between devolution, homelessness and health in the UK. Specifically, it focusses on the policy context and governance structures that shape the systems of healthcare for homeless people in London, Scotland, Wales and Northern Ireland. Design/methodology/approach Empirically the paper draws on semi-structured interviews with a small sample of policy and practice actors from the devolved territories. Qualitative interviews were supplemented by a comparative policy analysis of the homelessness and health agenda within the devolved regions. Theoretically, it takes inspiration from Chaney’s concept of the “issue salience of homelessness” and explores the comparative character of healthcare as pertains to homeless people across the devolved territories. Findings The paper provides clear evidence of areas of divergence and convergence in policy and practice between the devolved regions. These features are shown to be strongly mediated by the interplay of two factors: first, the scope and scale of national and local homelessness prevention strategies; and second, intra-national variation in public health responses to homelessness. Originality/value The paper offers considerable insight from a comparative policy perspective into the nature of healthcare provision for homeless people in the devolved regions.

Beyond social capital: a capability approach to understanding Refugee Community Organisations and other providers for “hard to reach” groups

2014 ◽  
Vol 10 (2) ◽  
pp. 61-72 ◽  
Author(s):  
Jennifer Clarke
Keyword(s):  
Capability Approach ◽  
Service Providers ◽  
Structured Interviews ◽  
Content Type ◽  
Refugee Community ◽  
Community Organisations ◽  
Purposive Sample ◽  
The Capability Approach

Purpose – The purpose of this paper is to explore the value of the “capability approach” as an alternative framework for understanding and conceptualising the role of Refugee Community Organisations (RCOs) and other providers for groups conventionally considered “hard to reach”. Design/methodology/approach – A study of the education services of RCOs, drawing primarily on semi-structured interviews with 71 users, is put forward as a case study for how the capability approach can be operationalised. Findings – The capability approach is found to offer various valuable insights, relating to its appreciation of the multi-dimensional nature of human wellbeing, the significance of individual diversity, and the importance of human agency. Research limitations/implications – The case study is based on a relatively small purposive sample, and may have limited external validity. As the research design proved strong for exploring how RCOs develop their users’ capabilities but weak for exploring if and how they may also constrict them, further research in this area is required. Practical implications – A number of valuable attributes of the capability approach are highlighted for broadening the understanding, the role of RCOs and other service providers. Social implications – The paper outlines the potential of the capability approach to contribute to policymaking related to RCOs and other providers, and to debates relating to social exclusion, cohesion and integration. Originality/value – The paper draws attention to the value of the capability approach within the field of migration research.

scholarly journals Adaptations in traditional courtyard houses in Baghdad, Iraq

2017 ◽  
Vol 35 (4) ◽  
pp. 348-363 ◽  
Author(s):  
Rand H.M. Agha ◽  
John M. Kamara
Keyword(s):  
Design Methodology ◽  
Full Range ◽  
Physical Structure ◽  
Structured Interviews ◽  
Content Type ◽  
Case Study Analysis ◽  
Physical Spaces ◽  
Adaptation Model

Purpose The purpose of this paper is to investigate the adaptations that have been made to traditional courtyard houses (TCHs) in Baghdad, Iraq. The aim is to develop an understanding of various factors in the adaptation of these buildings to suit contemporary lifestyles, which will contribute to the wider field of building adaptability. Design/methodology/approach Empirical evidence was collected through case studies of 12 TCHs in the Al-Kadhimiya area of Baghdad, which involved a physical survey of buildings and semi-structured interviews with 24 occupants. Findings Case study analysis show that building adaptability involves both a change to physical spaces and also to lifestyles; with the latter being more likely when there are limitations in how much change can be made to the physical structure. Research limitations/implications The focus of this research is mainly on users’ adaptation of spaces and therefore does not consider the full range of stakeholders involved in the adaptation process. The findings also only apply to the cases considered and may not be applicable to other house types or locations. Originality/value Studies on building adaptability mostly focus on the ease of change to the building fabric, although the role of users is acknowledged. This study provides insights into the complexity and variety of changes that users can make, which are influenced by lifestyles and driven by the need for comfort. These insights are represented in an adaptation model, which can serve as a basis for further research.

Re-conceptualising call-centres as sites of control: the insider perspective

2014 ◽  
Vol 48 (1/2) ◽  
pp. 25-46 ◽  
Author(s):  
Edward Kasabov ◽  
Anna C.C.C. da Cunha
Keyword(s):  
Design Methodology ◽  
Customer Orientation ◽  
Practical Importance ◽  
Call Centre ◽  
Structured Interviews ◽  
Content Type ◽  
Call Centres ◽  
Customer Dissatisfaction ◽  
Customer Centricity

Purpose – The role of call-centres during service recovery has attracted much attention in research. However, marketers know less about controlling customers during recovery interactions and consequences of such control. In order to address this gap and empirically ascertain whether service interactions are marked by customer centricity or by employees exerting control over customers, the aim of the authors was to organise an empirical research in two Brazilian call-centres. Design/methodology/approach – The research consisted of direct, open observation and 33 semi-structured interviews with insiders (call-centre managers, supervisors and operatives). Findings – Four key findings emerged during interviews with insiders. First, control over customers may be more widely practiced than assumed in certain sections of marketing academe. Second, such control is viewed positively by call-centre insiders and is sanctioned by management. Third, control does not disempower and demoralise call-centre staff but protects operatives. Finally, control does not seem to unavoidably generate lasting customer dissatisfaction. These findings are incorporated in a framework of call-centre management which incorporates control through scripting. Research limitations/implications – The discussion calls for the revisit of certain marketing concepts and philosophies, including customer orientation, by demonstrating that control over customers is practised and should not be viewed negatively or avoided altogether in practice and as a topic of analysis. A re-conceptualisation of call-centres as sites of control over customers is proposed. Originality/value – Control and power are rarely analysed in services marketing. This is one of a few studies that makes sense of providers' (insiders') viewpoints and argues that control may play a constructive role and should be seen as a legitimate topic of services and call-centre analysis. As such it addresses a question of intellectual and practical importance which is rarely discussed and may be viewed as incongruous with an age when customers are assumed to have rights.

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