Comparison of Patient Experience Between Primary Care Settings Tailored for Homeless Clientele and Mainstream Care Settings. Issue 6 (June 2021)

• Record Type: Journal Article
• Authors: Kertesz, Stefan G.; deRussy, Aerin J.; Kim, Young-il; Hoge, April E.; Austin, Erika L.; Gordon, Adam J.; Gelberg, Lillian; Gabrielian, Sonya E.; Riggs, Kevin R.; Blosnich, John R.; Montgomery, Ann E.; Holmes, Sally K.; Varley, Allyson L.; Pollio, David E.; Gundlapalli, Adi V.; Jones, Audrey L.
• Is Part Of: Medical care. Volume 59:Issue 6(2021)
• Publication Date: 2021-06
• Subjects: homeless persons -- veterans -- patient satisfaction -- primary care -- survey research; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000001548
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : 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. Abstract : Supplemental Digital Content is available in the text.