Abstract
The delivery of primary care to homeless individuals with mental health conditions presents unique challenges. To inform healthcare improvement, we studied predictors of favorable primary care experience among homeless persons with mental health conditions treated at sites that varied in degree of homeless-specific service tailoring. This was a multi-site, survey-based comparison of primary care experiences at three mainstream primary care clinics of the Veterans Administration (VA), one homeless-tailored VA clinic, and one tailored non-VA healthcare program. Persons who accessed primary care service two or more times from July 2008 through June 2010 (N = 366) were randomly sampled. Predictor variables included patient and organization characteristics suggested by the patient perception model developed by Sofaer and Firminger (2005), with an emphasis on mental health. The primary care experience was assessed with the Primary Care Quality-Homeless (PCQ-H) questionnaire, a validated survey instrument. Multiple regression identified predictors of positive experiences (i.e. higher PCQ-H total score). Significant predictors of a positive experience included a site offering tailored service design, perceived choice among providers, and currently domiciled status. There was an interaction effect between site and severe psychiatric symptoms. For persons with severe psychiatric symptoms, a homeless-tailored service design was significantly associated with a more favorable primary care experience. For persons without severe psychiatric symptoms, this difference was not significant. This study supports the importance of tailored healthcare delivery designed for homeless persons' needs, with such services potentially holding special relevance for persons with mental health conditions. To improve patient experience among the homeless, organizations may want to deliver services that are tailored to homelessness and offer a choice of providers.
Publication types
-
Clinical Trial
-
Multicenter Study
-
Research Support, Non-U.S. Gov't
-
Research Support, U.S. Gov't, Non-P.H.S.
MeSH terms
-
Delivery of Health Care*
-
Female
-
Humans
-
Ill-Housed Persons / psychology*
-
Life Change Events*
-
Male
-
Mental Disorders / psychology*
-
Mental Disorders / therapy
-
Middle Aged
-
Primary Health Care*
-
Retrospective Studies
Grants and funding
Support was provided by the Department of Veterans Affairs, Health Services Research & Development Grants SDR-11-233 and IAA-07-06902, and the Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC). The United States Department of Veterans Affairs Research and Development (R&D) branch funded this project as part of its competitive merit review program. The Department'’s R&D branch functions in a manner similar to the National Institutes of Health (USA), assembling peer review and acting as “funder” and it has no role in design, data collection, analysis or preparation of manuscripts. By regulation the principal investigator must be an employee of the United States Department of Veterans Affairs (typically within a VA Medical Center). Applicable US federal regulations require a formal disclaimer by the author of any VAfunded research, that underscores the separation of the researcher from VA official views: “The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.” Applicants for R&D funds include VA employees (noted with asterisks below) who are eligible to serve as investigator. However, the funder is VA Research and Development. J.G. Chrystal* conceptualized this study, collected data, analyzed and interpreted results, wrote the primary draft of results, and wrote revisions of the article. D.L. Glover* analyzed and interpreted results, and contributed to revisions of the article. A.S. Young* analyzed and interpreted results, and contributed to revisions of the article. F. Whelan* analyzed and interpreted results, and contributed to the primary draft of the article. E.L. Austin* and N.K. Johnson* designed data collection procedures, collected data, analyzed and interpreted results, and contributed to the primary draft of the article. D.E. Pollio designed data collection procedures, analyzed and interpreted results, and contributed to the primary draft of the article. C.L. Holt conceptualized and designed data collection procedures, analyzed and interpreted results, and contributed to the primary draft of the article. E. Stringfellow designed data collection procedures, collected data, analyzed and interpreted results, and contributed to the primary draft of the article. A.J. Gordon* and T.A. Kim conceptualized and designed the primary study, analyzed and interpreted results, and contributed to the primary draft of the article. S.G. Daigle* designed data collection procedures, collected data, analyzed and interpreted results, and contributed to the primary draft of the article. J.L. Steward designed data collection procedures, collected data, and analyzed and interpreted results. S.G. Kertesz* conceptualized and designed the primary study where, designed the data collection procedures, analyzed and interpreted results, and wrote revisions of the article. All authors gave final approval of the article.