Delivering primary care to homeless persons: a policy analysis approach to evaluating the options

Homeless persons are numerous, carry a significant burden of illness and face challenges in accessing care. A search of the literature revealed insufficient empirical sources to permit the use of standard systematic review methodology to determine the most effective way to deliver point-of-first-contact healthcare to homeless people. Instead, we used a policy analysis approach. We found that the dominant model of primary care in Canada performs poorly when assessed on 13 evaluation criteria. While there is variable performance on individual measures, the three alternative models - targeted standard facility/clinic site, fixed outreach site and mobile outreach service - all perform well. Our findings suggest that some factor other than performance on the specified measures, such as costs, feasibility, geographical fit or local preferences, should be used to choose a specific model. Our analysis clearly indicates that the status quo model of primary care is inadequate to meet the needs of homeless people.