Perceptions of Care Coordination Among Homeless Veterans Receiving Medical Care in the Veterans Health Administration and Community Care Settings: Results From a National Survey
| Autor: | Sonya Gabrielian, Audrey L. Jones, Aerin DeRussy, Ann Elizabeth Montgomery, John R. Blosnich, Young-il Kim, April E. Hoge, Stefan G. Kertesz, Erika L. Austin, Adam J. Gordon, Lillian Gelberg, Allyson L. Varley |
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| Rok vydání: | 2021 |
| Předmět: |
Research design
Adult Male medicine.medical_specialty Referral MEDLINE Health Services Accessibility Article 03 medical and health sciences Social support 0302 clinical medicine Surveys and Questionnaires Health care medicine Humans 030212 general & internal medicine Community Health Services Depression (differential diagnoses) health care economics and organizations Aged Veterans Primary Health Care business.industry 030503 health policy & services Public Health Environmental and Occupational Health Odds ratio Middle Aged United States United States Department of Veterans Affairs Cross-Sectional Studies Patient Satisfaction Family medicine Ill-Housed Persons Female 0305 other medical science business Retirement age |
| Zdroj: | Med Care |
| ISSN: | 1537-1948 |
| Popis: | Background Initiatives to expand Veterans' access to purchased health care outside Veterans Health Administration (VHA) facilities ("community care") present care coordination challenges for Veterans experiencing homelessness. Objective Among Veterans with homeless experiences, to evaluate community care use and satisfaction, and compare perceptions of care coordination among Veterans using VHA services and community care to those using VHA services without community care. Research design Cross-sectional analysis of responses to a 2018 mailed survey. Subjects VHA outpatients with homeless experiences. Measures Self-reported use of community care, Likert-style ratings of satisfaction with that care, and Access/Coordination experiences from the Primary Care Quality-Homeless (PCQ-H) survey. Results Of 4777 respondents, 1325 (26.7%) reported using community care; most of this subsample affirmed satisfaction with the community care they received (83%) and its timeliness (75%). After covariate adjustment, Veteran characteristics associated with greater community care use included female sex, being of retirement age and nonmarried, and having higher education, more financial hardship, ≥3 chronic conditions, psychological distress, depression, and posttraumatic stress disorder. Satisfaction with community care was lower among patients with travel barriers, psychological distress, and less social support. Compared with those using the VHA without community care, Veterans using VHA services and community care were more likely to report unfavorable access/coordination experiences [odds ratio (OR)=1.34, confidence interval (CI)=1.15-1.57]. This included hassles following referral (OR=1.37, CI=1.14-1.65) and perceived delays in receiving health care (OR=1.38, CI=1.19-1.61). Conclusions Veterans with homeless experiences value community care options. Potential access benefits are balanced with risks of unfavorable coordination experiences for vulnerable Veterans with limited resources. |
| Databáze: | OpenAIRE |
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