TY - JOUR
KW - Delivery of Health Care
KW - Female
KW - Homeless Persons/psychology
KW - Humans
KW - Life Change Events
KW - Male
KW - Mental Disorders/psychology/therapy
KW - Middle Aged
KW - Primary Health Care
KW - Retrospective Studies
AU - J. G. Chrystal
AU - D. L. Glover
AU - A. S. Young
AU - F. Whelan
AU - E. L. Austin
AU - N. K. Johnson
AU - D. E. Pollio
AU - C. L. Holt
AU - E. Stringfellow
AU - A. J. Gordon
AU - T. A. Kim
AU - S. G. Daigle
AU - J. L. Steward
AU - S. G. Kertesz
A1 - 
AB - 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.
BT - PloS one
C5 - Healthcare Disparities
CP - 2
CY - United States
DO - 10.1371/journal.pone.0117395
IS - 2
JF - PloS one
N2 - 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.
PP - United States
PY - 2015
SN - 1932-6203; 1932-6203
T1 - Experience of primary care among homeless individuals with mental health conditions
T2 - PloS one
TI - Experience of primary care among homeless individuals with mental health conditions
U1 - Healthcare Disparities
U2 - 25659142
U3 - 10.1371/journal.pone.0117395
VL - 10
VO - 1932-6203; 1932-6203
Y1 - 2015
ER -