Comparison of Patient Experience Between Primary Care Settings Tailored for Homeless Clientele and Mainstream Care Settings

Bibliographic Data

ID9102277
AuthorsStefan G Kertesz (0000-0001-6101-8421, Birmingham Veterans Affairs Medical Center, corresponding author), Aerin J Derussy (0000-0001-8960-6946, Birmingham Veterans Affairs Medical Center, corresponding author), Young-Il Kim (0000-0001-6806-4551, Birmingham Veterans Affairs Medical Center), Young Il Kim (0000-0001-9221-3238, University of Alabama at Birmingham, corresponding author), April E Hoge (Birmingham Veterans Affairs Medical Center, corresponding author), Erika L Austin (Birmingham Veterans Affairs Medical Center, corresponding author), Adam J Gordon (0000-0002-2453-8871, VA Salt Lake City Health Care System), Lillian Gelberg (0000-0001-9772-0116, VA Greater Los Angeles Healthcare System), Sonya Gabrielian (0000-0002-1790-4271, University of California, Los Angeles), Sonya E Gabrielian (VA Greater Los Angeles Healthcare System), Kevin R Riggs (0000-0002-0015-5809, Birmingham Veterans Affairs Medical Center, corresponding author), John R Blosnich (0000-0001-7663-3638, University of Southern California, Los Angeles CA, corresponding author), Ann Elizabeth Montgomery (0000-0002-4420-3526, University of Alabama at Birmingham, corresponding author), Sally K Holmes (Birmingham Veterans Affairs Medical Center, corresponding author), Allyson L Varley (0000-0002-1851-6502, Birmingham Veterans Affairs Medical Center, corresponding author), David E Pollio (0000-0002-4695-8498, Birmingham Veterans Affairs Medical Center, corresponding author), Adi V Gundlapalli (0000-0002-7423-7903, University of Utah School of Medicine, Salt Lake City, UT), Audrey L Jones (0000-0003-1533-7469, University of Utah School of Medicine, Salt Lake City, UT)
Year2021
Volume59
Issue6
Pages495-503
Publication date2021-06-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000001548
PMID33827104
OpenAlexW3142975558
LanguageEN
Citations received9
References cited41

BACKGROUND: More than 1 million Americans receive primary care from federal homeless health care programs yearly. Vulnerabilities that can make care challenging include pain, addiction, psychological distress, and a lack of shelter. Research on the effectiveness of tailoring services for this population is limited. OBJECTIVE: The aim was to examine whether homeless-tailored primary care programs offer a superior patient experience compared with nontailored ("mainstream") programs overall, and for highly vulnerable patients. RESEARCH DESIGN: National patient survey comparing 26 US Department of Veterans Affairs (VA) Medical Centers' homeless-tailored primary care ("H-PACT"s) to mainstream primary care ("mainstream PACT"s) at the same locations. PARTICIPANTS: A total of 5766 homeless-experienced veterans. MEASURES: Primary care experience on 4 scales: Patient-Clinician Relationship, Cooperation, Accessibility/Coordination, and Homeless-Specific Needs. Mean scores (range: 1-4) were calculated and dichotomized as unfavorable versus not. We counted key vulnerabilities (chronic pain, unsheltered homelessness, severe psychological distress, and history of overdose, 0-4), and categorized homeless-experienced veterans as having fewer (≤1) and more (≥2) vulnerabilities. RESULTS: H-PACTs outscored mainstream PACTs on all scales (all P<0.001). Unfavorable care experiences were more common in mainstream PACTs compared with H-PACTs, with adjusted risk differences of 11.9% (95% CI=6.3-17.4), 12.6% (6.2-19.1), 11.7% (6.0-17.3), and 12.6% (6.2-19.1) for Relationship, Cooperation, Access/Coordination, and Homeless-Specific Needs, respectively. For the Relationship and Cooperation scales, H-PACTs were associated with a greater reduction in unfavorable experience for patients with ≥2 vulnerabilities versus ≤1 (interaction P<0.0001). CONCLUSIONS: Organizations that offer primary care for persons experiencing homelessness can improve the primary care experience by tailoring the design and delivery of services

Distress · Environmental health · Family medicine · Health care · Mainstream · Political science · Population · Primary care · Psychiatry · Veterans Affairs · Clinical Psychology · Food Security and Health in Diverse Populations · Geriatric Care and Nursing Homes · Homelessness and Social Issues · Medicine · Nursing · Psychology