Keywords: Homeless, Health prevention, Cancer screening, integrated care
Background:
Homeless population in Europe has a 30-year average lifespan less than general population, while cancer mortality is double. There is a need for interventions to improve their access to health care. Successfully implemented patient navigation and patient empowerment models have been associated with increased access to health care.
Research questions:
Does a model of care co-designed with individuals experiencing homelessness and professionals based on the Patient Navigation and Patient Empowerment improve cancer prevention and facilitate early detection?
Method:
Pilot study. The sample will be made up of 400 homeless aged over 18 years and recruited in social and health resources of the Madrid Social Care Network and Madrid Health Service. Quantitative and qualitative analysis.
CFIR y RE-AIM frameworks for the evaluation of the implementation. A health navigator on four timelines will develop the interventions and results evaluation: T0-Start, T1-4 weeks from start, T2-trimester, T3-semester, where the before and after actions of the interventions will be measured.
Variables studied will be clinical, treatments, administrative, social determinants of access to health, social exclusion, autonomy-promotion, relational adherence processes. The measurable actions necessary for access to health: Information, education for health, access to the social and health system and intervention on barriers and facilitators of access.
Authorized by an Ethics Committee.
Results:
Detection and quantification of barriers to access to systems through the model (Tashani): Availability, accessibility, acceptability, contact with services, effective coverage.
Type/s of action of the health navigator developed for the elimination of barriers, and creation of facilitators.
Conclusions:
CANCERLESS will deliver proven integrated services through:
A new model of socio-health care for the early detection of cancer in homeless people.
proactive work protocols that define the framework of action
New navigation figure between the systems.
An information system to identify social determinants in access to health, type of action required, time and methodology of social intervention
Points for discussion:
Do we provide person-centered integrated health and social care considering the needs and preferences of the most vulnerable groups?
Is homelessness addressed from a comprehensive and integrated approach in primary care and general practice?
What variables from the Patient Navigation model generated synergies between the health and social care providers?