Healthcare First: Delivering Immediate, Non-Contingent, and Coordinated Services Through the Street Medicine Model.

Abstract

BACKGROUND: People experiencing homelessness (PEH) face disproportionate morbidity and mortality due to structural barriers that restrict healthcare access. Conventional health systems often exacerbate these inequities through conditional treatment models requiring readiness, compliance, or abstinence. Street medicine - interdisciplinary teams delivering care directly in community settings - has emerged as a critical response. Despite its growth, limited qualitative research explores patient perspectives on how street medicine structures care to counter systemic exclusion. This study examines the experiences of unhoused patients receiving street medicine care in Bakersfield, California. METHODS: Between March and May 2025, we conducted 10 semi-structured interviews with individuals receiving street medicine services in Bakersfield, California. Eligible participants were aged ≥ 18, English-speaking, and had received care within six months. Using a constructivist grounded theory approach, interviews were audio-recorded, transcribed, and analyzed iteratively in ATLAS.ti. Coding and memo writing were used to develop a conceptual model describing how street medicine structures healthcare delivery and engagement. RESULTS: Participants described street medicine as characterized by three interrelated mechanisms: (1) immediate, non-contingent access fostering trust and engagement; (2) integration of harm-reduction principles across medical and behavioral services; and (3) embedded navigation reframing adherence as a system-supported process. Collectively, these processes aligned with a Healthcare First model that parallels Housing First by emphasizing immediacy, choice, and voluntary engagement. CONCLUSIONS: Street medicine reframed healthcare as a right rather than a conditional service, countering structural exclusion through accessibility, consistency, and dignity. Findings underscore the importance of institutionalizing Healthcare First principles to promote equity and continuity of care for PEH.