TY - JOUR
KW - Homeless Persons
KW - Humans
KW - Mental Disorders/therapy
KW - Patient Care Team
KW - Primary Health Care
KW - Surveys and Questionnaires
KW - homelessness
KW - patient experience
KW - primary care
KW - serious mental illness
KW - Veterans
AU - S. Gabrielian
AU - A. L. Jones
AU - A. E. Hoge
AU - A. J. deRussy
AU - Y. I. Kim
AU - A. E. Montgomery
AU - J. R. Blosnich
AU - A. J. Gordon
AU - L. Gelberg
AU - E. L. Austin
AU - D. Pollio
AU - S. K. Holmes
AU - A. L. Varley
AU - S. G. Kertesz
A1 - 
AB - OBJECTIVES: Patients experiencing homelessness (PEH) with serious mental illness (SMI) have poor satisfaction with primary care. We assessed if primary care teams tailored for homeless patients (Homeless-Patient Aligned Care Teams (H-PACTs)) provide this population with superior experiences than mainstream primary care and explored whether integrated behavioral health and social services were associated with favorable experiences. METHODS: We surveyed VA PEH with SMI (n = 1095) to capture the valence of their primary care experiences in 4 domains (Access/Coordination, Patient-Clinician Relationships, Cooperation, and Homeless-Specific Needs). We surveyed clinicians (n = 52) from 29 H-PACTs to elucidate if their clinics had embedded mental health, addiction, social work, and/or housing services. We counted these services in each H-PACT (0-4) and classified H-PACTs as having high (3-4) versus low (0-2) service integration. We controlled for demographics, housing history, and needs in comparing H-PACT versus mainstream experiences; and experiences in high versus low integration H-PACTs. RESULTS: Among respondents, 969 (91%) had complete data and 626 (62%) were in H-PACTs. After covariate adjustment, compared to mainstream respondents, H-PACT respondents were more likely (P < .01) to report favorable experiences (AORs = 1.7-2.1) and less likely to report unfavorable experiences (AORs = 0.5-0.6) in all 4 domains. Of 29 H-PACTs, 27.6% had high integration. High integration H-PACT respondents were twice as likely as low integration H-PACT respondents to report favorable access/coordination experiences (AOR = 1.7). CONCLUSIONS: Homeless-tailored clinics with highly-integrated services were associated with better care experiences among PEH with SMI. These observational data suggest that tailored primary care with integrated services may improve care perceptions among complex patients.
AD - VA Greater Los Angeles Health Care System, Los Angeles, CA, USA.; University of California Los Angeles, Los Angeles, CA, USA.; VA Salt Lake City Health Care System, Salt Lake City, UT, USA.; University of Utah School of Medicine, Salt Lake City, UT, USA.; Birmingham VA Medical Center, Birmingham, AL, USA.; Birmingham VA Medical Center, Birmingham, AL, USA.; Birmingham VA Medical Center, Birmingham, AL, USA.; University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.; Birmingham VA Medical Center, Birmingham, AL, USA.; University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA.; VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.; University of Southern California, Los Angeles, CA, USA.; VA Salt Lake City Health Care System, Salt Lake City, UT, USA.; University of Utah School of Medicine, Salt Lake City, UT, USA.; VA Greater Los Angeles Health Care System, Los Angeles, CA, USA.; University of California Los Angeles, Los Angeles, CA, USA.; Birmingham VA Medical Center, Birmingham, AL, USA.; University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA.; University of Alabama at Birmingham College of Letters and Sciences, Birmingham, AL, USA.; Birmingham VA Medical Center, Birmingham, AL, USA.; Birmingham VA Medical Center, Birmingham, AL, USA.; Birmingham VA Medical Center, Birmingham, AL, USA.; University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
BT - Journal of primary care & community health
C5 - Education & Workforce; Healthcare Disparities
DO - 10.1177/2150132721993654
JF - Journal of primary care & community health
LA - eng
M1 - Journal Article
N2 - OBJECTIVES: Patients experiencing homelessness (PEH) with serious mental illness (SMI) have poor satisfaction with primary care. We assessed if primary care teams tailored for homeless patients (Homeless-Patient Aligned Care Teams (H-PACTs)) provide this population with superior experiences than mainstream primary care and explored whether integrated behavioral health and social services were associated with favorable experiences. METHODS: We surveyed VA PEH with SMI (n = 1095) to capture the valence of their primary care experiences in 4 domains (Access/Coordination, Patient-Clinician Relationships, Cooperation, and Homeless-Specific Needs). We surveyed clinicians (n = 52) from 29 H-PACTs to elucidate if their clinics had embedded mental health, addiction, social work, and/or housing services. We counted these services in each H-PACT (0-4) and classified H-PACTs as having high (3-4) versus low (0-2) service integration. We controlled for demographics, housing history, and needs in comparing H-PACT versus mainstream experiences; and experiences in high versus low integration H-PACTs. RESULTS: Among respondents, 969 (91%) had complete data and 626 (62%) were in H-PACTs. After covariate adjustment, compared to mainstream respondents, H-PACT respondents were more likely (P < .01) to report favorable experiences (AORs = 1.7-2.1) and less likely to report unfavorable experiences (AORs = 0.5-0.6) in all 4 domains. Of 29 H-PACTs, 27.6% had high integration. High integration H-PACT respondents were twice as likely as low integration H-PACT respondents to report favorable access/coordination experiences (AOR = 1.7). CONCLUSIONS: Homeless-tailored clinics with highly-integrated services were associated with better care experiences among PEH with SMI. These observational data suggest that tailored primary care with integrated services may improve care perceptions among complex patients.
PY - 2021
SN - 2150-1327; 2150-1319; 2150-1319
SP - 2150132721993654
T1 - Enhancing Primary Care Experiences for Homeless Patients with Serious Mental Illness: Results from a National Survey
T2 - Journal of primary care & community health
TI - Enhancing Primary Care Experiences for Homeless Patients with Serious Mental Illness: Results from a National Survey
U1 - Education & Workforce; Healthcare Disparities
U2 - 33543675
U3 - 10.1177/2150132721993654
VL - 12
VO - 2150-1327; 2150-1319; 2150-1319
Y1 - 2021
Y2 - Jan-Dec
ER -