{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:30:23Z","timestamp":1785774623331,"version":"3.56.0"},"reference-count":30,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2021,12,3]],"date-time":"2021-12-03T00:00:00Z","timestamp":1638489600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100020489","name":"Rosemary Bryant Foundation","doi-asserted-by":"publisher","award":["B27420"],"award-info":[{"award-number":["B27420"]}],"id":[{"id":"10.13039\/501100020489","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>People who are homeless experience significantly poorer health than the general population and often face multifaceted challenges engaging with public healthcare services. Mission Health Nurse-led Clinic (MHNC) was established in 2019 to meet the healthcare needs of this marginalised population in Launceston, Tasmania. This study examines barriers to healthcare access amongst individuals who experience homelessness, client and staff perceptions of the MHNC services and explored opportunities for service expansion. Descriptive statistics were drawn from administrative data, and all interviews were thematically analysed. A total of 426 presentations were reported for 174 individuals experiencing homelessness over 26 months. The median client age was 42 years and 60.9% were male; A total of 38.5% were homeless or lived in a supported accommodation. The predominant reasons for clinic visits included prescription requests (25.3%) and immunisations (20.1%). A total of 10 clients and 5 City Mission staff were interviewed with three themes emerging from the findings: personal vulnerability, disconnectedness and acceptability of the MHNC. The MHNC services were reported to be highly appreciated by all clients. Mental health and allied health, extra operating hours and maintaining the flexibility of walk-in appointments were suggested as expansion areas for the service and were highlighted as ways to increase engagement for improved health outcomes. Continued partnerships with interprofessional primary healthcare providers would contribute to addressing unmet healthcare needs in this vulnerable population.<\/jats:p>","DOI":"10.3390\/ijerph182312770","type":"journal-article","created":{"date-parts":[[2021,12,5]],"date-time":"2021-12-05T21:01:45Z","timestamp":1638738105000},"page":"12770","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Development and Initial Evaluation of a Nurse-Led Healthcare Clinic for Homeless and At-Risk Populations in Tasmania, Australia: A Collaborative Initiative"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2243-7716","authenticated-orcid":false,"given":"Grace","family":"Bennett-Daly","sequence":"first","affiliation":[{"name":"School of Nursing, University of Tasmania, Newnham, Launceston, TAS 7248, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Unwin","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Tasmania, Newnham, Launceston, TAS 7248, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4485-0421","authenticated-orcid":false,"given":"Ha","family":"Dinh","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Tasmania, Newnham, Launceston, TAS 7248, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Dowlman","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Tasmania, Newnham, Launceston, TAS 7248, Australia"},{"name":"Mission Health Nurse-Led Clinic, Launceston, TAS 7250, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leigh","family":"Harkness","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Tasmania, Newnham, Launceston, TAS 7248, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Laidlaw","sequence":"additional","affiliation":[{"name":"Mission Health Nurse-Led Clinic, Launceston, TAS 7250, Australia"},{"name":"Kings Meadows Medical Centre, Kings Meadows, TAS 7249, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4026-6842","authenticated-orcid":false,"given":"Kathleen","family":"Tori","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Tasmania, Newnham, Launceston, TAS 7248, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,3]]},"reference":[{"key":"ref_1","unstructured":"AIHW (2020). Health of People Experiencing Homelessness."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"230","DOI":"10.5694\/mja17.01264","article-title":"Homeless health care: Meeting the challenges of providing primary care","volume":"209","author":"Davies","year":"2018","journal-title":"Med. J. Aust."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/10530789.2018.1534427","article-title":"Women and homelessness, a complex multidimensional issue: Findings from a scoping review","volume":"28","author":"Phipps","year":"2019","journal-title":"J. Soc. Distress Homeless"},{"key":"ref_4","first-page":"26","article-title":"Factors associated with access to care and healthcare utilization in the homeless population of England","volume":"39","author":"Fok","year":"2017","journal-title":"J. Public Health"},{"key":"ref_5","first-page":"345","article-title":"A general practitioner and nurse led approach to improving hospital care for homeless people","volume":"28","author":"Hewett","year":"2012","journal-title":"BMJ"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1007\/s10900-016-0274-7","article-title":"Healthcare barriers and utilization among adolescents and young adults accessing services for homeless and runaway youth","volume":"42","author":"Chelvakumar","year":"2017","journal-title":"J. Community Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.habitatint.2016.03.004","article-title":"Developing a global framework for conceptualising and measuring homelessness","volume":"55","author":"Culhane","year":"2016","journal-title":"Habitat Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/S2213-2600(20)30160-0","article-title":"Efforts escalate to protect homeless people from COVID-19 in UK","volume":"8","author":"Kirby","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1111\/cdoe.12444","article-title":"Barriers and enablers to accessing dental services for people experiencing homelessness: A systematic review","volume":"47","author":"Paisi","year":"2019","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Keogh, C., O\u2019Brien, K.K., Hoban, A., O\u2019Carroll, A., and Fahey, T. (2015). Health and use of health services of people who are homeless and at risk of homelessness who receive free primary health care in Dublin. BMC Health Serv. Res., 15.","DOI":"10.1186\/s12913-015-0716-4"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1111\/1475-6773.12009","article-title":"Health status and health care experiences among homeless patients in federally supported health centers: Findings from the 2009 patient survey","volume":"48","author":"Baggett","year":"2013","journal-title":"Health Serv. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/S0140-6736(17)31959-1","article-title":"What works in inclusion health: Overview of effective interventions for marginalised and excluded populations","volume":"391","author":"Luchenski","year":"2018","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1111\/j.1745-7599.2012.00756.x","article-title":"Medication adherence among homeless patients: A pilot study of cell phone effectiveness","volume":"24","author":"Burda","year":"2012","journal-title":"J. Am. Acad. Nurse Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1097\/NNR.0000000000000083","article-title":"Nursing case management, peer coaching, and hepatitis a and B vaccine completion among homeless men recently released on parole: Randomized clinical trial","volume":"64","author":"Nyamathi","year":"2015","journal-title":"Nurs. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1093\/ntr\/ntv062","article-title":"Homeless clients benefit from smoking cessation treatment delivered by a homeless persons\u2019 program","volume":"17","author":"Segan","year":"2015","journal-title":"Nicotine Tob. Res."},{"key":"ref_16","unstructured":"Creswell, J.W., and Clark, V.L.P. (2017). Designing and Conducting Mixed Methods Research, Sage Publications."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1177\/1049732315617444","article-title":"Sample size in qualitative interview studies: Guided by information power","volume":"26","author":"Malterud","year":"2016","journal-title":"Qual. Health Res."},{"key":"ref_18","unstructured":"Braun, V., and Clarke, V. (2013). Successful Qualitative Research: A Practical Guide for Beginners, Sage."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1177\/1359105307080593","article-title":"Health inequalities and homelessness: Considering material, spatial and relational dimensions","volume":"12","author":"Hodgetts","year":"2007","journal-title":"J. Health Psychol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1111\/inr.12419","article-title":"Nurse-led primary health care for homeless men: A multimethods descriptive study","volume":"65","author":"Roche","year":"2018","journal-title":"Int. Nurs. Rev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1111\/phn.12552","article-title":"A systematic review of nurse-led interventions with populations experiencing homelessness","volume":"36","author":"Weber","year":"2019","journal-title":"Public Health Nurs."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1111\/imj.14139","article-title":"Medical complications of homelessness: A neglected side of men\u2019s health","volume":"49","author":"Brown","year":"2019","journal-title":"Intern. Med. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2096","DOI":"10.1111\/jan.12675","article-title":"The perceptions of homeless people regarding their healthcare needs and experiences of receiving health care","volume":"71","author":"Rae","year":"2015","journal-title":"J. Adv. Nurs."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1080\/10530789.2019.1567978","article-title":"Rural homelessness: Its effect on healthcare access, healthcare outcomes, mobility, and perspectives of novel technologies","volume":"28","author":"Easterday","year":"2019","journal-title":"J. Soc. Distress Homeless"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/1475-9276-12-18","article-title":"Patient-centred access to health care: Conceptualising access at the interface of health systems and populations","volume":"12","author":"Levesque","year":"2013","journal-title":"Int. J. Equity Health"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Jennings, N., Lowe, G., and Tori, K. (2021). Nurse practitioner locums: A plausible solution for augmenting health care access for rural communities. Aust. J. Prim. Health, in press.","DOI":"10.1071\/PY20103"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"42","DOI":"10.37464\/2017.344.1530","article-title":"Managing medical service delivery gaps in a socially disadvantaged rural community: A nurse practitioner led clinic","volume":"34","author":"Kelly","year":"2017","journal-title":"Aust. J. Adv. Nurs."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e007167","DOI":"10.1136\/bmjopen-2014-007167","article-title":"Cost-effectiveness of nurse practitioners in primary and specialised ambulatory care: Systematic review","volume":"5","author":"Harbman","year":"2015","journal-title":"BMJ Open"},{"key":"ref_29","unstructured":"KPMG-International (2018). Cost Benefit Analysis of Nurse Practitioner Models of Care: KPMG International, Commissioned by the Department of Health, KPMG International."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1111\/jan.12954","article-title":"Substitution of general practitioners by nurse practitioners in out-of-hours primary care: A quasi-experimental study","volume":"72","author":"Schoonhoven","year":"2016","journal-title":"J. Adv. Nurs."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/23\/12770\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:39:35Z","timestamp":1760168375000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/23\/12770"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,3]]},"references-count":30,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["ijerph182312770"],"URL":"https:\/\/doi.org\/10.3390\/ijerph182312770","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,3]]}}}