(BRC) Understanding and addressing patient safety concerns associated with integrated care innovations for people experiencing homelessness: a mixed methods approach (Non-Clinical)


   Faculty of Biology, Medicine and Health

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  Dr C Sanders, Dr Thomas Allen, Dr Kelly Howells  No more applications being accepted  Competition Funded PhD Project (Students Worldwide)

About the Project

Homelessness (including street homelessness, temporary accommodation and sofa surfing) is a persistent and growing problem. People experiencing homelessness experience a much greater burden of physical and mental health problems than the general population. Homelessness is associated with a thirty-year reduction in average life expectancy in the UK. Despite high levels of need, people experiencing homelessness face substantial barriers to accessing health and social care including stigma, discrimination, lack of trust and fragmented care. Barriers to accessing community services result in medical emergencies with inpatient costs that are eight times higher for patients experiencing homelessness compared to the general population. Recent NICE guidance concluded that there is good evidence on effectiveness and cost-effectiveness of housing-related interventions with wraparound support for health and social care. However, there is lack of evidence on: how this wraparound support is delivered; the patient safety impacts of changing service delivery models; the experiences of those receiving new models of provision; and impacts on costs, health and wellbeing. Our research addresses these key gaps in evidence.

There are 3 main parts of the study:

1.   A systematic narrative review of existing evidence

2.   We will interview people experiencing homelessness and a wide range of service providers (NHS, social care and voluntary sector) to investigate perspectives and experiences relevant to patient safety in the context of service changes to deliver integrated care. We will explore how service providers deliver integrated care and the experiences of people using services. We will also look at key documents (such as policies and guidance on delivering integrated care) and investigate any barriers to implementing

3.   We will analyse information held in health and care records to understand the health needs and inequalities for people experiencing homelessness.

Overall, the research will provide important information on how best to join up and improve services in ways that: improve health and wellbeing for people experiencing homelessness; improve the safety, experiences and outcomes of care; and provide the best value for money.

Public and Patient Involvement and Engagement is central to this proposal and the PhD will build on strong partnerships with voluntary sector as well as working in partnership with a lived experience advisory group at all stages of the research

The research will co-produce evidence-based recommendations around how best to deliver integrated care and mental health support, as well as guidance and interventions that tackle inequalities in patient safety in this context.

Caroline Sanders https://research.manchester.ac.uk/en/persons/caroline.sanders

Thomas Allen https://research.manchester.ac.uk/en/persons/thomas.allen

Kelly Howells https://research.manchester.ac.uk/en/persons/kelly.howells

Eligibility 

Applicants must have obtained or be about to obtain a First or Upper Second class UK honours degree, or the equivalent qualifications gained outside the UK, in a relevant discipline, Social Science or health related.

Before you Apply 

Applicants must make direct contact with the primary supervisor before applying to discuss their interest in the project. It is your responsibility to make arrangements to meet with potential supervisors, prior to submitting a formal online application.  

How to Apply 

To be considered for this project you MUST submit a formal online application form - full details on how to apply can be found on the BRC website https://www.bmh.manchester.ac.uk/study/research/funded-programmes/manchester-brc-phd-studentships/ 

Your application form must be accompanied by a number of supporting documents by the advertised deadlines. Without all the required documents submitted at the time of application, your application will not be processed and we cannot accept responsibility for late or missed deadlines. Incomplete applications will not be considered. If you have any queries regarding making an application please contact our admissions team.

Equality, Diversity and Inclusion  

Equality, diversity and inclusion is fundamental to the success of The University of Manchester, and is at the heart of all of our activities. The full Equality, diversity and inclusion statement can be found on the website https://www.bmh.manchester.ac.uk/study/research/apply/equality-diversity-inclusion/  

Mathematics (25)

Funding Notes

This studentship covers tuition fees and stipend and is open to both the UK and international applicants. We are able to offer a limited number of studentships to applicants outside the UK. Therefore, full studentships will only be awarded to exceptional quality candidates, due to the competitive nature of this scheme.

References

1. Shelter. Far from Alone: Homelessness in Britain in 2017, London. 2017.
2. Fitzpatrick S, Pawson H, Bramley G, Wood J, Watts B, Stephens M, et al. The homelessness monitor: England 2019. London: Crisis. 2019.
3. Shelter. Homelessness in England 2021. 2021.
4. Aldridge RW, Story A, Hwang SW, Nordentoft M, Luchenski SA, Hartwell G, et al. Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. The Lancet. 2018;391(10117):241-50.
5. Hanlon P, Yeoman L, Esiovwa R, Gibson L, Williamson AE, Mair FS, et al. Interventions by healthcare professionals to improve management of physical long-term conditions in adults who are homeless: a systematic review protocol. BMJ open. 2017;7(8):e016756.
6. Lewer D, Menezes D, Cornes M, Blackburn R, Byng R, Clark M, et al. Hospital Readmissions Among People Experiencing Homelessness: A Cohort Study of Linked Hospitalisation and Mortality Data in England for 3,222 Homeless Inpatients. 2019.
7. Howells K, Amp M, Burrows M, Brown J, Brennan R, Dickinson J, et al. Remote primary care during the COVID-19 pandemic for people experiencing homelessness: a qualitative study. British Journal of General Practice. 2022;72(720):e492-e500.
8. Brennan R. Delivering Healthcare to Homeless People: lessons from Scandinavia and the USA. Winston Churchill Trust. 2018.
9. Albertson S, Murray T, Triboletti J, Pence L, Gonzalvo J, Meredith A, et al. Implementation of primary care clinical pharmacy services for adults experiencing homelessness. JOURNAL OF THE AMERICAN PHARMACISTS ASSOCIATION. 2021;61(1):E80-E4.
10. Gunner E, Chandan SK, Marwick S, Saunders K, Burwood S, Yahyouche A, et al. Provision and accessibility of primary healthcare services for people who are homeless: a qualitative study of patient perspectives in the UK. British Journal of General Practice. 2019;69(685):e526-e36.
11. Smith KG, Paudyal V, MacLure K, Forbes-McKay K, Buchanan C, Wilson L, et al. Relocating patients from a specialist homeless healthcare centre to general practices: a multi-perspective study. Br J Gen Pract. 2018;68(667):e105-e13.
12. Reilly J, Hassanally K, Budd J, Mercer S. Accident and emergency department attendance rates of people experiencing homelessness by GP registration. BJGP open. 2020;4(5).
13. Moss C, Sutton M, Cheraghi-Sohi S, Sanders C, Allen T. Comparative 4-year risk and type of hospital admission among homeless and housed emergency department attendees: longitudinal study of hospital records in England 2013–2018. BMJ open. 2021;11(7):e049811.
14. Elwell-Sutton T, Fok J, Albanese F et al. Factors associated with access to care and healthcare utilization in the homeless population of England. Journal of Public Health. 2017;39(1):26-33.
15. Bowen M, Marwick S, Marshall T et al. Multimorbidity and emergency department visits by a homeless population. British Journal of General Practice. 2019;69(685):e515-e25.
16. Jego M, Grassineau D, Balique H, Loundou A, Sambuc R, Daguzan A, et al. Improving access and continuity of care for homeless people: how could general practitioners effectively contribute? Results from a mixed study. BMJ open. 2016;6(11).
17. Clark E, Player E, Gillam T, Hanson S, Steel N. Evaluating a specialist primary care service for patients experiencing homelessness: a qualitative study. BJGP open. 2020;4(3).
18. NICE. Integrated health and social care for people experiencing homelessness 2022.