Enhancing Primary Care Experiences for Homeless Patients with Serious Mental Illness: Results from a National Survey.

Autor:	Gabrielian S; VA Greater Los Angeles Health Care System, Los Angeles, CA, USA.; University of California Los Angeles, Los Angeles, CA, USA., Jones AL; VA Salt Lake City Health Care System, Salt Lake City, UT, USA.; University of Utah School of Medicine, Salt Lake City, UT, USA., Hoge AE; Birmingham VA Medical Center, Birmingham, AL, USA., deRussy AJ; Birmingham VA Medical Center, Birmingham, AL, USA., Kim YI; Birmingham VA Medical Center, Birmingham, AL, USA.; University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA., Montgomery AE; Birmingham VA Medical Center, Birmingham, AL, USA.; University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA., Blosnich JR; VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.; University of Southern California, Los Angeles, CA, USA., Gordon AJ; VA Salt Lake City Health Care System, Salt Lake City, UT, USA.; University of Utah School of Medicine, Salt Lake City, UT, USA., Gelberg L; VA Greater Los Angeles Health Care System, Los Angeles, CA, USA.; University of California Los Angeles, Los Angeles, CA, USA., Austin EL; Birmingham VA Medical Center, Birmingham, AL, USA.; University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA., Pollio D; University of Alabama at Birmingham College of Letters and Sciences, Birmingham, AL, USA., Holmes SK; Birmingham VA Medical Center, Birmingham, AL, USA., Varley AL; Birmingham VA Medical Center, Birmingham, AL, USA., Kertesz SG; Birmingham VA Medical Center, Birmingham, AL, USA.; University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
Jazyk:	angličtina
Zdroj:	Journal of primary care & community health [J Prim Care Community Health] 2021 Jan-Dec; Vol. 12, pp. 2150132721993654.
DOI:	10.1177/2150132721993654
Abstrakt:	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.
Databáze:	MEDLINE
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