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Clinical Trial
. 2015 Feb 6;10(2):e0117395.
doi: 10.1371/journal.pone.0117395. eCollection 2015.

Experience of primary care among homeless individuals with mental health conditions

Joya G Chrystal  1 , Dawn L Glover  1 , Alexander S Young  2 , Fiona Whelan  3 , Erika L Austin  4 , Nancy K Johnson  4 , David E Pollio  5 , Cheryl L Holt  6 , Erin Stringfellow  7 , Adam J Gordon  8 , Theresa A Kim  9 , Shanette G Daigle  4 , Jocelyn L Steward  4 , Stefan G Kertesz  10
Affiliations
Clinical Trial

Experience of primary care among homeless individuals with mental health conditions

Joya G Chrystal et al. PLoS One. .

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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist. While the authorship team has no commercial conflict of interest, the production of a manuscript regarding patient experiences may require acknowledging that most authors have employment relationships with the entities studied in this paper (4 VA healthcare centers and 1 independent nonprofit Health Care for the Homeless Program). Essentially, all but three authors currently have or previously enjoyed a direct employment relationship with either one of the 4 VA institutions or the single non-VA Healthcare for the Homeless Program in this study. Among the remaining three individuals (Holt, Pollio, Whelan), all received some form of compensation for research services from one of the institutions in this study. The authors are required to note that opinions expressed are those of the authors and do not represent positions of the Department of Veterans Affairs or any other entity of the United States federal government.

Figures

Fig 1
Fig 1. Adapted conceptual framework for predictors of patient care experiences among individual experiencing homelessness.
This framework was adapted from Shosanna Sofaer and Kirsten Firminger model of patient perceptions. For the purpose of our analysis, we retained some original variables as well as the general relationship expressed in this model, although the variables are specific to our sample population.
See this image and copyright information in PMC

References

    1. Gelberg L, Andersen RM, Leake BD (2000) The behavioral model for vulnerable populations: application to medical care use and outcomes for homeless people. Health Serv Res 34(6): 1273–302. - PMC - PubMed
    1. Fazel S, Khosla V, Doll H, Geddes J (2008) The prevalence of mental disorders among the homeless in western countries: systematic review and meta-regression analysis. PLOS Med 10.1371/journal.pmed.0050225 - DOI - PMC - PubMed
    1. U.S. Department of Housing and Urban Development (2010) The 2010 annual homeless assessment report to congress Available: https://www.onecpd.info/resources/documents/2010HomelessAssessmentReport.... Accessed 2013 Nov 26.
    1. Gallagher T, Andersen R, Koegel P, Gelberg L (1997) Determinants of regular source of care among homeless adults in Los Angeles. Med Care 35(8): 814–830. - PubMed
    1. Killbourne AM, McCarthy JF, Post EP, Welsh D, Pincus HA, et al. (2006) Access to and satisfaction with care comparing patients with and without serious mental illness. Int J Psychiatry Med 36(4): 383–399. - PubMed

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