Interventions to improve access to primary care for people who are homeless

The risk of bias in the studies was evaluated, and the quality of the evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. [...] In contrast, the Street Health researchers estimated that 9% of the Toronto population did not have a family doctor (on the basis of data from the 2005 Canadian Community Health Survey).10 The Street Health Survey results also showed that people who are homeless do not have a stable, comprehensive source of primary health care.10 For instance, 29% of respondents had no usual source of care and 20% [...] Quality of Evidence The quality of the body of evidence for the outcome “access to a primary health care provider” was examined according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria.18 The overall quality was determined to be high, moderate, low, or very low using a step-wise, structural methodology (details in Appendix 7). [...] Additionally, the RCT evaluated a primary clinic orientation strategy.9 One observational study evaluated the effectiveness of integration of primary care services within locations where other services for people who are homeless are provided,8 and two observational studies evaluated the effectiveness of housing plus supportive services.20,21 The amount of health care and other support provided to [...] Additional information on the study design and methodology, population, interventions, comparators, and outcomes is provided in Appendix 3. Methodologic Quality of Included Studies The risk of bias was considered high in the studies identified (with the exception of the RCT, which we deemed to have a low risk of bias), mainly due to the lack of randomization, heterogeneity in baseline characterist