title: Improving access and continuity of care for homeless people: how could general practitioners effectively contribute? Results from a mixed study.
abstract: To analyse 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.
  
  
  
  Mixed-methods design (qualitative -> quantitative (cross-sectional observational) → qualitative). Qualitative data were collected through semistructured interviews and through questionnaires with closed questions. Quantitative data were analysed with descriptive statistical analyses on SPPS; a content analysis was applied on qualitative data.
  
  
  
  Primary care; views of urban GPs working in a deprived area in Marseille were explored by questionnaires and/or semistructured interview.
  
  
  
  19 GPs involved in HP's healthcare were recruited for phase 1 (qualitative); for phase 2 (quantitative), 150 GPs who provide routine healthcare ('standard' GPs) were randomised, 144 met the inclusion criteria and 105 responded to the questionnaire; for phase 3 (qualitative), data were explored on 14 'standard' GPs.
  
  
  
  In the quantitative phase, 79% of the 105 GPs already treated HP. Most of the difficulties they encountered while treating HP concerned social matters (mean level of perceived difficulties=3.95/5, IC 95 (3.74 to 4.17)), lack of medical information (mn=3.78/5, IC 95 (3.55 to 4.01)) patient's compliance (mn=3.67/5, IC 95 (3.45 to 3.89)), loneliness in practice (mn=3.45/5, IC 95 (3.18 to 3.72)) and time required for the doctor (mn=3.25, IC 95 (3 to 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 organisation, developing a medical and psychosocial approach with closer relation with social workers and enhancing the collaboration between tailored and non-tailored programmes were also other key answers.
  
  
  
  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 organisation aiming to improve access to healthcare for HP.
authors.affiliation: EA 3279 Research Unit-Public Health, Chronic Diseases and Quality of Life, Aix-Marseille University, Marseille, France.|Department of General Practice, Aix-Marseille University, Marseille, France.
authors.forename: Maeva
authors.identifier: 0000-0003-3324-256X
authors.initials: M
authors.lastname: Jego
authors.affiliation: PASS, Department of Public Health, Timone University Hospital, APHM, Marseille, France.|UMR 6278 A.D.E.S Research Unit-Anthropology Rights Ethics and Health, Aix-Marseille University, Marseille, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Grassineau
authors.affiliation: EA 3279 Research Unit-Public Health, Chronic Diseases and Quality of Life, Aix-Marseille University, Marseille, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Balique
authors.affiliation: EA 3279 Research Unit-Public Health, Chronic Diseases and Quality of Life, Aix-Marseille University, Marseille, France.
authors.forename: Anderson
authors.initials: A
authors.lastname: Loundou
authors.affiliation: EA 3279 Research Unit-Public Health, Chronic Diseases and Quality of Life, Aix-Marseille University, Marseille, France.|PASS, Department of Public Health, Timone University Hospital, APHM, Marseille, France.
authors.forename: Roland
authors.initials: R
authors.lastname: Sambuc
authors.affiliation: Medical Evaluation Unit, Department of Public Health, Conception University Hospital, APHM, Marseille, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Daguzan
authors.affiliation: Department of General Practice, Aix-Marseille University, Marseille, France.
authors.forename: Gaetan
authors.initials: G
authors.lastname: Gentile
authors.affiliation: EA 3279 Research Unit-Public Health, Chronic Diseases and Quality of Life, Aix-Marseille University, Marseille, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Gentile
mesh_terms: D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care / Q000592:standards / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D005602:France / Q000453:epidemiology; D058005:General Practitioners; D006703:Ill-Housed Persons / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D011320:Primary Health Care; D036301:Qualitative Research; D011795:Surveys and Questionnaires
keywords: PRIMARY CARE; access to health care; general practitioners; homeless people; mixed methods