Health and Social Care in the Community. 2004;12, 1:63-74.
The objective of the present study was to determine whether provision of health advocacy
for homeless patients would reduce the burden of care for a primary healthcare team.
The impact of a health advocacy intervention was assessed in a quasi- experimental,
three-armed controlled trial. Homeless patients registering at an inner-city health
centre were allocated in alternating periods to health advocacy (with or without outreach
registration) or 'usual care' over a total intake period of 3 years. The client group
were homeless people in hostels or other temporary accommodation in the Liverpool
8 area of the UK. The majority of participants (n = 400) were women (76%) in their
twenties (mean age = 26.6 years). Most (63%) were temporarily housed at either one
of the women's refuges or Liverpool City Council family hostels, and all were registered
with an inner-city health centre. Data on health service utilisation over a 3-month
period was collected for all clients recruited to the study and direct health service
costs were measured. Homeless adults who were proactively registered by the health
advocate on outreach visits to hostels made significantly less use of health centre
resources whilst having more contact with the health advocate than patients who registered
at the health centre at a time of need. There was no reduction in health centre workload
when the offer of health advocacy was made after registration at the health centre.
The additional costs of providing health advocacy were offset by a reduction in demand
for health-centre-based care. The results demonstrate that health advocacy can alter
the pattern of help- seeking by temporarily homeless adults. The intervention was
cost-neutral. The short-term health service workload associated with symptomatic homeless
patients requiring medication was not reduced, but outreach health advocacy was used
successfully to address psycho-social issues and reduce the workload for primary care