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Miller JP, Hutton J, Doherty C, Vallesi S, Currie J, Rushworth K, Larkin M, Scott M, Morrow J, Wood L. A scoping review examining patient experience and what matters to people experiencing homelessness when seeking healthcare. BMC Health Serv Res 2024; 24:492. [PMID: 38643146 PMCID: PMC11031864 DOI: 10.1186/s12913-024-10971-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 04/09/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Homelessness is associated with significant health disparities. Conventional health services often fail to address the unique needs and lived experience of homeless individuals and fail to include participatory design when planning health services. This scoping review aimed to examine areas of patient experience that are most frequently reported by people experiencing homelessness when seeking and receiving healthcare, and to identify existing surveys used to measure patient experience for this cohort. METHODS A scoping review was undertaken reported according to the PRISMA-ScR 2020 Statement. Databases were searched on 1 December 2022: MEDLINE, EMBASE, APA PsychINFO and CINAHL. Included studies focused on people experiencing homelessness, healthcare services and patient experience, primary research, published in English from 2010. Qualitative papers and findings were extracted and synthesized against a modified framework based on the National Institute for Health and Care Excellence guidelines for care for people experiencing homelessness, the Institute of Medicine Framework and Lachman's multidimensional quality model. People with lived experience of homelessness were employed as part of the research team. RESULTS Thirty-two studies were included. Of these, 22 were qualitative, seven quantitative and three mixed methods, from the United States of America (n = 17), United Kingdom (n = 5), Australia (n = 5) and Canada (n = 4). Health services ranged from primary healthcare to outpatient management, acute care, emergency care and hospital based healthcare. In qualitative papers, the domains of 'accessible and timely', 'person-centred', and values of 'dignity and respect' and 'kindness with compassion' were most prevalent. Among the three patient experience surveys identified, 'accessible and timely' and 'person-centred' were the most frequent domains. The least frequently highlighted domains and values were 'equitable' and 'holistic'. No questions addressed the 'safety' domain. CONCLUSIONS The Primary Care Quality-Homeless questionnaire best reflected the priorities for healthcare provision that were highlighted in the qualitative studies of people experiencing homelessness. The most frequently cited domains and values that people experiencing homelessness expressed as important when seeking healthcare were reflected in each of the three survey tools to varying degrees. Findings suggest that the principles of 'Kindness and compassion' require further emphasis when seeking feedback on healthcare experiences and the domains of 'safety', 'equitable', and 'efficiency' are not adequately represented in existing patient experience surveys.
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Affiliation(s)
| | - Jennie Hutton
- St Vincent's Hospital Melbourne, Melbourne, Australia.
- The University of Melbourne, Melbourne, Australia.
- Victorian Virtual Emergency Department, Northern Hospital, Melbourne, Australia.
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | | | | | - Jane Currie
- Queensland University of Technology, Brisbane, Australia
| | | | | | - Matthew Scott
- St Vincent's Hospital Melbourne, Melbourne, Australia
- Lived Experience Representative, Melbourne, Australia
| | - James Morrow
- Lived Experience Representative, Melbourne, Australia
| | - Lisa Wood
- The University of Notre Dame Australia, Perth, Australia
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2
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Gin JL, Balut MD, Dobalian A. COVID-19 vaccination uptake and receptivity among veterans enrolled in homelessness-tailored primary health care clinics: provider trust vs. misinformation. BMC PRIMARY CARE 2024; 25:24. [PMID: 38216894 PMCID: PMC10785369 DOI: 10.1186/s12875-023-02251-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Compared to the general population, individuals experiencing homelessness are at greater risk of excess morbidity and mortality from COVID-19 but have been vaccinated at lower rates. The U.S. Department of Veterans Affairs (VA)'s Homeless Patient Aligned Care Team (HPACT) program integrates health care and social services for Veterans experiencing homelessness to improve access to and utilization of care. METHODS This study explores the vaccination uptake behavior and attitudes through a qualitative comparative case study of two HPACT clinics, one in California (CA) and one in North Dakota (ND). Semi-structured telephone interviews were conducted with Veterans enrolled in the two VA HPACT clinics from August to December 2021 with 20 Veterans (10 at each clinic). RESULTS Four themes emerged from the interviews: (1) Vaccination uptake and timing- While half of the Veterans interviewed were vaccinated, ND Veterans were more likely to be vaccinated and got vaccinated earlier than CA Veterans; (2) Housing- Unsheltered or precariously housed Veterans were less likely to be vaccinated; (3) Health Care- Veterans reporting positive experiences with VA health care and those who trusted health providers were more likely to vaccinate than those with negative or nuanced satisfaction with health care; (4) Refusers' Conspiracy Theories and Objectivity Claims- Veterans refusing the vaccine frequently mentioned belief in conspiracy theories while simultaneously asserting their search for objective information from unbiased sources. CONCLUSIONS These findings amplify the importance of improving access to population-tailored care for individuals experiencing homelessness by reducing patient loads, expanding housing program enrollment, and increasing the provider workforce to ensure personalized care. Health care providers, and housing providers, social workers, and peers, who offer information without discrediting or criticizing Veterans' beliefs, are also key to effectively delivering vaccine messaging to this population.
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Affiliation(s)
- June L Gin
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA, 91343, USA.
| | - Michelle D Balut
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA, 91343, USA
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA, 91343, USA
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, 202 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43210, USA
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3
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Tsai J, Havlik J, Howell BA, Johnson E, Rosenthal D. Primary Care for Veterans Experiencing Homelessness: a Narrative Review of the Homeless Patient Aligned Care Team (HPACT) Model. J Gen Intern Med 2023; 38:765-783. [PMID: 36443628 PMCID: PMC9971390 DOI: 10.1007/s11606-022-07970-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022]
Abstract
In 2011, the U.S. Department of Veterans Health (VA) implemented a homeless-tailored primary care medical home model called the Homeless Patient Aligned Care Teams (HPACTs). The impact of HPACTs on health and healthcare outcomes of veterans experiencing homelessness has not been adequately synthesized. This narrative review summarized peer-reviewed studies published in databases Ovid MEDLINE, Ovid EMBASE, and APA PsycInfo from 1946 to February 2022. Only original research studies that reported outcomes of the HPACT model were included in the review. Of 575 studies that were initially identified and screened, 26 studies met inclusion criteria and were included in this review. Included studies were categorized into studies that described the following: (1) early HPACT pilot implementation; (2) HPACT's association with service quality and utilization; and (3) specialized HPACT programs. Together, studies in this review suggest HPACT is associated with reductions in emergency department utilization and improvements in primary care utilization, engagement, and positive patient experiences; however, the methodological rigor of the included studies was low, and thus, these findings should only be considered preliminary. There is a need for randomized controlled trials assessing the impact of the PACT model on key outcomes of interest, as well as to determine whether the model is a viable way to manage healthcare for persons experiencing homelessness outside of the VA system.
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Affiliation(s)
- Jack Tsai
- Office of Homeless Programs, U.S. Department of Veterans Affairs, Washington D.C., USA.
- University of Texas Health Science Center at Houston, School of Public Health, 1200 Pressler St, Houston, TX, 77030, USA.
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - John Havlik
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Benjamin A Howell
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Erin Johnson
- Office of Homeless Programs, U.S. Department of Veterans Affairs, Washington D.C., USA
| | - David Rosenthal
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- 4Catalyzer Inc., CT, Guilford, USA
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Ramirez J, Petruzzi LJ, Mercer T, Gulbas LE, Sebastian KR, Jacobs EA. Understanding the primary health care experiences of individuals who are homeless in non-traditional clinic settings. BMC PRIMARY CARE 2022; 23:338. [PMID: 36572847 PMCID: PMC9792313 DOI: 10.1186/s12875-022-01932-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/28/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Despite the widespread implementation of Health Care for the Homeless programs that focus on comprehensive, integrated delivery systems of health care for people experiencing homelessness, engaging and retaining people experiencing homelessness in primary care remains a challenge. Few studies have looked at the primary care delivery model in non-traditional health care settings to understand the facilitators and barriers to engagement in care. The objective of our study was to explore the clinic encounters of individuals experiencing homelessness receiving care at two different sites served under a single Health Care for the Homeless program. METHODS Semi-structured interviews were conducted with people experiencing homelessness for an explorative qualitative study. We used convenience sampling to recruit participants who were engaged in primary care at one of two sites: a shelter clinic, n = 16, and a mobile clinic located in a church, n = 15. We then used an iterative, thematic approach to identify emergent themes and further mapped these onto the Capability-Opportunity-Motivation model. RESULTS Care accessibility, quality and integration were themes that were often identified by participants as being important facilitators to care. Psychological capability and capacity became important barriers to care in instances when patients had issues with memory or difficulty with perceiving psychological safety in healthcare settings. Motivation for engaging and continuing in care often came from a team of health care providers using shared decision-making with the patient to facilitate change. CONCLUSION To optimize health care for people experiencing homelessness, clinical interventions should: (1) utilize shared-decision making during the visit, (2) foster a sense of trust, compassion, and acceptance, (3) emphasize continuity of care, including consistent providers and staff, and (4) integrate social services into Health Care for the Homeless sites.
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Affiliation(s)
- Jahanett Ramirez
- grid.89336.370000 0004 1936 9924The Steve Hicks School of Social Work at the University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712 USA
| | - Liana J. Petruzzi
- grid.89336.370000 0004 1936 9924Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX USA
| | - Timothy Mercer
- grid.89336.370000 0004 1936 9924Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX USA ,grid.89336.370000 0004 1936 9924Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX USA ,CommUnityCare Health Centers, Austin, TX USA
| | - Lauren E. Gulbas
- grid.89336.370000 0004 1936 9924The Steve Hicks School of Social Work at the University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX 78712 USA
| | - Katherine R. Sebastian
- grid.89336.370000 0004 1936 9924Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX USA
| | - Elizabeth A. Jacobs
- grid.89336.370000 0004 1936 9924Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX USA ,grid.416311.00000 0004 0433 3945Maine Medical Center Research Institute, MaineHealth Institute for Research, Scarborough, ME USA
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Subedi K, Acharya B, Ghimire S. Factors Associated With Hospital Readmission Among Patients Experiencing Homelessness. Am J Prev Med 2022; 63:362-370. [PMID: 35367105 PMCID: PMC9398926 DOI: 10.1016/j.amepre.2022.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Homelessness is associated with increased acute care utilization and poor healthcare outcomes. This study aims to compare hospital readmission rates among patients experiencing homelessness and patients who are not homeless and assess the impact of different clinical and demographic characteristics on acute care utilization among patients experiencing homelessness. METHODS This was a retrospective study of patients encountered in 2018 and 2019 at ChristianaCare Health Systems. The analysis was done in August 2021. The prevalence of major chronic conditions among patients experiencing homelessness (n=1,329) and those not experiencing it (n=143,360) was evaluated. Patients experiencing homelessness were matched with nonhomeless patients using 1:1 propensity score matching. Time-to-event analysis approaches were used to analyze time-to-readmission and 30-day readmission rates. RESULTS The 30-day readmission rates were 42.8% among patients experiencing homelessness and 19.9% among matched patients not experiencing homelessness. The hazard of 30-day readmission among patients experiencing homelessness was 2.6 (95% CI=1.93, 3.53) times higher than that among the matched nonhomeless cohort. In patients experiencing homelessness, drug use disorder, major depressive disorder, chronic kidney disease, obesity, arthritis, HIV/AIDS, and epilepsy were associated with shortened time to readmission. Moreover, Black racial identity was associated with shortened time to readmission. CONCLUSIONS Patients experiencing homelessness had higher acute care utilization than those not experiencing homelessness. Black racial identity and several comorbidities were associated with increased acute care utilization among patients experiencing homelessness. Efforts to address upstream social determinants of health, destigmatization, and healthcare management accounting for the whole spectrum of clinical comorbidities might be important in promoting the health of people experiencing homelessness.
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Affiliation(s)
- Keshab Subedi
- Institute for Research on Equity and Community Health, ChristianaCare Health Systems, Wilmington, Delaware.
| | - Binod Acharya
- Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania
| | - Shweta Ghimire
- Center for Bioinformatics & Computational Biology, University of Delaware, Newark, Delaware
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Baggett TP, Barbosa Teixeira J, Rodriguez EC, Anandakugan N, Sporn N, Chang Y, Percac-Lima S, Park ER, Rigotti NA. Patient navigation to promote lung cancer screening in a community health center for people experiencing homelessness: Protocol for a pragmatic randomized controlled trial. Contemp Clin Trials 2022; 113:106666. [PMID: 34971796 DOI: 10.1016/j.cct.2021.106666] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/13/2021] [Accepted: 12/23/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Lung cancer is a major cause of death among people experiencing homelessness, with mortality rates more than double those in the general population. Lung cancer screening (LCS) with low-dose computed tomography (LDCT) could reduce lung cancer deaths in this population, although the circumstances of homelessness present multiple barriers to LCS LDCT completion. Patient navigation is a promising strategy for overcoming these barriers. METHODS The Investigating Navigation to Help Advance Lung Equity (INHALE) Study is a pragmatic randomized controlled trial of patient navigation for LCS among individuals receiving primary care at Boston Health Care for the Homeless Program (BHCHP). Three hundred BHCHP patients who meet Medicare/Medicaid criteria for LCS will be randomized 2:1 to usual care with (n = 200) or without (n = 100) LCS navigation. Following a structured, theory-based protocol, the patient navigator assists with each step in the LCS process, providing lung cancer education, facilitating shared decision-making visits with primary care providers (PCPs), assisting in making and attending LCS LDCT appointments, arranging follow-up when needed, and offering tobacco cessation support for smokers. The primary outcome is receipt of LCS LDCT at 6 months. Using a sequential explanatory mixed methods approach, qualitative interviews with participants and PCPs will aid in interpreting and contextualizing the trial results. DISCUSSION This trial will produce the first experimental evidence on patient navigation for cancer screening in a homeless health care setting. Results could inform cancer health equity efforts at the 299 Health Care for the Homeless programs that serve over 900,000 patients annually in the US.
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Affiliation(s)
- Travis P Baggett
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Institute for Research, Quality & Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, MA, United States of America.
| | - Joana Barbosa Teixeira
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Elijah C Rodriguez
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; New York University Grossman School of Medicine, New York, NY, United States of America
| | - Nillani Anandakugan
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Nora Sporn
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Sanja Percac-Lima
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Elyse R Park
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Nancy A Rigotti
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
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7
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Gabrielian S, Jones AL, Hoge AE, deRussy AJ, Kim YI, Montgomery AE, Blosnich JR, Gordon AJ, Gelberg L, Austin EL, Pollio D, Holmes SK, Varley AL, Kertesz SG. Enhancing Primary Care Experiences for Homeless Patients with Serious Mental Illness: Results from a National Survey. J Prim Care Community Health 2021; 12:2150132721993654. [PMID: 33543675 PMCID: PMC7871055 DOI: 10.1177/2150132721993654] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
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.
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Affiliation(s)
- Sonya Gabrielian
- VA Greater Los Angeles Health Care System, Los Angeles, CA, USA.,University of California Los Angeles, Los Angeles, CA, USA
| | - Audrey L Jones
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - April E Hoge
- Birmingham VA Medical Center, Birmingham, AL, USA
| | | | - Young-Il Kim
- Birmingham VA Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Ann Elizabeth Montgomery
- Birmingham VA Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - John R Blosnich
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,University of Southern California, Los Angeles, CA, USA
| | - Adam J Gordon
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lillian Gelberg
- VA Greater Los Angeles Health Care System, Los Angeles, CA, USA.,University of California Los Angeles, Los Angeles, CA, USA
| | - Erika L Austin
- Birmingham VA Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - David Pollio
- University of Alabama at Birmingham College of Letters and Sciences, Birmingham, AL, USA
| | | | | | - Stefan G Kertesz
- Birmingham VA Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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Codell N, Kelley AT, Jones AL, Dungan MT, Valentino N, Holtey AI, Knight TJ, Butz A, Gallop C, Erickson S, Patton J, Hyte-Richins LJ, Rollins BZ, Gordon AJ. Aims, development, and early results of an interdisciplinary primary care initiative to address patient vulnerabilities. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:160-169. [PMID: 33301347 DOI: 10.1080/00952990.2020.1832507] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Addressing substance use disorders and social determinants of poor health at a population level is a major national healthcare priority. One promising model to improve healthcare outcomes for patients with these conditions is the Vulnerable Veteran Innovative Patient-Aligned Care Team (PACT) Initiative, or VIP - an interdisciplinary, team-based primary care delivery model designed to address the needs of vulnerable patients in the Veterans Health Administration. VIP establishes a single, integrated primary care environment for the management of substance use disorders, mental illness, social determinants of poor health, and complexities in care resulting from the co-occurrence of these conditions. We describe the origination, goals, and evolution of VIP to provide an example of how clinics and health systems can address vulnerable patient populations within a primary care clinic framework. While ongoing evaluation will be essential to understand its impact on patient outcomes and its sustainability and scalability in the future, VIP holds promise as a novel model to improve care for patients with addiction and other vulnerabilities.
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Affiliation(s)
- Nodira Codell
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - A Taylor Kelley
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA.,Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Audrey L Jones
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Matthew T Dungan
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Natalie Valentino
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Ana I Holtey
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Tania J Knight
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Amy Butz
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Christina Gallop
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sean Erickson
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Jeremy Patton
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Laura Jane Hyte-Richins
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Benjamin Z Rollins
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Adam J Gordon
- Vulnerable Veteran Innovative PACT (VIP) Initiative; Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA.,Greater Intermountain Node (GIN) of the NIDA Clinical Trials Network, University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
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9
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Whisler A, Dosani N, To MJ, O’Brien K, Young S, Hwang SW. The effect of a Housing First intervention on primary care retention among homeless individuals with mental illness. PLoS One 2021; 16:e0246859. [PMID: 33571302 PMCID: PMC7877594 DOI: 10.1371/journal.pone.0246859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 01/27/2021] [Indexed: 11/22/2022] Open
Abstract
Background Primary care retention, defined as ongoing periodic contact with a consistent primary care provider, is beneficial for people with serious chronic illnesses. This study examined the effect of a Housing First intervention on primary care retention among homeless individuals with mental illness. Methods Two hundred individuals enrolled in the Toronto site of the At Home Project and randomized to Housing First or Treatment As Usual were studied. Medical records were reviewed to determine if participants were retained in primary care, defined as having at least one visit with the same primary care provider in each of two consecutive six-month periods during the 12 month period preceding and following randomization. Results Medical records were obtained for 47 individuals randomized to Housing First and 40 individuals randomized to Treatment As Usual. During the one year period following randomization, the proportion of Housing First and Treatment As Usual participants retained in primary care was not significantly different (38.3% vs. 47.5%, p = 0.39). The change in primary care retention rates from the year preceding randomization to the year following randomization was +10.6% in the Housing First group and -5.0% in the Treatment As Usual group. Conclusion Among homeless individuals with mental illness, Housing First did not significantly affect primary care retention over the follow-up period. These findings suggest Housing First interventions may need to place greater emphasis on connecting clients with primary care providers.
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Affiliation(s)
- Adam Whisler
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Naheed Dosani
- Inner City Health Associates, Toronto, Ontario, Canada
- Department of Family & Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Division of Palliative Care, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Division of Palliative Care, William Osler Health System, Brampton, Ontario, Canada
- * E-mail:
| | - Matthew J. To
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Kristen O’Brien
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Samantha Young
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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10
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Pereira LP, Wetzel C, Pavani FM, Olschowsky A, Moraes BM, Klein E. Entrevista narrativa com pessoas em situação de rua com transtornos mentais: relato de experiência. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo relatar a experiência do uso da entrevista narrativa com pessoas em situação de rua com transtornos mentais. Método relato de experiência realizada em uma capital do Sul do Brasil. A coleta de dados ocorreu de julho a outubro de 2019. Resultados a aplicação da entrevista narrativa desenvolveu-se em duas etapas: aproximação com o campo e seleção dos participantes; e construção da narrativa. A primeira envolveu uma inserção em um Consultório na Rua e possibilitou a identificação e o desenvolvimento de vínculo com os usuários. A segunda ocorreu com o desenvolvimento da entrevista narrativa e envolveu os seguintes passos: contato e negociação, história principal e fase de questionamentos. Conclusão a entrevista narrativa se apresenta como ferramenta metodológica com potencial para a construção de itinerários terapêuticos de pessoas em situação de rua com transtornos mentais, contextualizando suas opções na busca pelo seu cuidado na perspectiva de suas histórias de vida. Implicação para a prática a entrevista narrativa possibilita fazer-se ouvir em histórias frequentemente negligenciadas. Por ter como foco central a construção de sentidos por parte de quem vivencia determinada realidade, permitiu a reconstrução desses, possibilitando novos olhares e insights em relação à própria experiência de quem relatava.
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Affiliation(s)
| | | | | | | | | | - Evelyn Klein
- Universidade Federal do Rio Grande do Sul, Brasil
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11
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Challenges of caring for homeless patients with rheumatic and musculoskeletal disorders in Los Angeles. Clin Rheumatol 2020; 40:413-420. [PMID: 33200302 PMCID: PMC7668283 DOI: 10.1007/s10067-020-05505-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/22/2020] [Accepted: 11/08/2020] [Indexed: 01/15/2023]
Abstract
Homelessness is a public health crisis. Homeless individuals have significantly worse health outcomes than the general population. We have begun examining challenges of caring for homeless patients with rheumatic and musculoskeletal diseases. Difficulties include physical environment, food and financial insecurity, access to healthcare, low health literacy, and comorbid mental illness, and substance abuse. Based on known prevalences of rheumatic and musculoskeletal diseases (RMSDs), we extrapolate that there are thousands of homeless with rheumatoid arthritis (RA), systemic lupus erythematosus, psoriatic arthritis, gout, and osteoarthritis. We present preliminary observations of disparities in the care of homeless patients with RA seen at the Los Angeles County Medical Center of the Keck School of Medicine of the University of Southern California. They tended to be African American males, missed appointments, utilized emergency services frequently, tended not to be on medications, and exhibited severe disease. We reviewed the available literature on homelessness and homeless healthcare to consider what further studies might be helpful and what interventions might improve the care of patients with RMSDs. We identified several aspirational and practical recommendations. These include ensuring access to healthcare for the homeless (indeed for all); reducing disparities through policy, tailored care, and enhanced social services; and recognizing and treating disease early. Developing better approaches for the care of these homeless has obvious and important implications for other underserved populations needing rheumatologic care, patients with early arthritis, or situations where rheumatologists are unavailable. We believe that physicians have a special responsibility to mitigate inequities in this particularly disadvantaged population.
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12
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Dickins KA, Buchholz SW, Ingram D, Braun LT, Hamilton RJ, Earle M, Karnik NS. Supporting Primary Care Access and Use among Homeless Persons. SOCIAL WORK IN PUBLIC HEALTH 2020; 35:335-357. [PMID: 32865153 DOI: 10.1080/19371918.2020.1809589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
With the implementation of the Affordable Care Act (ACA), many homeless persons who previously lacked health insurance gained medical coverage. This paper describes the experiences of homeless persons in accessing and using primary care services, post-implementation of the ACA. Twenty-six semi-structured interviews were completed with homeless persons and primary care providers/staff. Via thematic analysis, themes were identified, categorized by: factors which influence primary care access and use patterns, and strategies to promote consistent primary care use. Maintaining insurance and leveraging systems-based strategies to support primary care access and use may address health disparities and promote health equity.
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Affiliation(s)
- Kirsten A Dickins
- Massachusetts General Hospital, Yvonne L. Munn Center for Nursing Research , Boston, Massachusetts, USA
| | | | - Diana Ingram
- Rush University College of Nursing , Chicago, Illinois, USA
| | - Lynne T Braun
- Rush University College of Nursing , Chicago, Illinois, USA
| | | | - Melinda Earle
- Rush University College of Nursing , Chicago, Illinois, USA
| | - Niranjan S Karnik
- Rush Medical College Department of Psychiatry, Rush University College of Nursing , Chicago, Illinois, USA
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13
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Abstract
Nurses interact with patients across many settings. This article discusses concerns for patients considered homeless and the role of nurses in addressing their healthcare needs.
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14
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Patrício ACFDA, Silva RARD, Araújo RFD, Silva RFD, Nascimento GTDS, Rodrigues TDDB, Leite MAP. Common mental disorders and resilience in homeless persons. Rev Bras Enferm 2019; 72:1526-1533. [DOI: 10.1590/0034-7167-2018-0541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 02/03/2019] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: To identify common mental disorders and resilience in homeless persons. Method: Cross-sectional study with 49 homeless persons, assisted in the Casa da Acolhida Adulta and the Specialized Reference Center in a municipality in the Northeast of Brazil. Data collection performed between February and March 2018, using SRQ20 scales for common mental disorders and another for Resilience. Kruskal Wallis test, Student’s T-test and Chi-Square test were used. Results: In the study, 61.2% (30) participants have poor sleep; 69.4% (34) feel nervous, tense or worried; 71.4% (35) feel unhappy; 63.3% are unable to play a useful role in their lives; 71.4% (35) have common mental disorders, and 44.9% (22) presented low resilience. Resilience influences common mental disorders, which, in turn, are influenced by gender and age. Conclusion: Professionals who assist homeless persons need to have a look directed at common mental disorders and resilience.
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15
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Wijk LBV, Mângia EF. [Psychosocial care and healthcare for the homeless population: an integrative review]. CIENCIA & SAUDE COLETIVA 2019; 24:3357-3368. [PMID: 31508756 DOI: 10.1590/1413-81232018249.29872017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 02/15/2018] [Indexed: 11/22/2022] Open
Abstract
The homeless population has physical and mental health issues and is exposed to conditions that lead to vulnerabilities, premature mortality, difficulty of access to basic services, all of which demands intersectoral actions. Outreach homeless clinics are components of Primary Health Care of the psychosocial health services network and play an important role in healthcare for this group. The goals of this integrative review are to assess health actions directed to this population, identify if actions result from dialogue between health service providers and the population attended and if such actions are sufficient to cater to their needs. Initially, 264 related papers were located, 27 of which were pre-selected and a further 11 were selected using pre-defined criteria. The findings were divided into 3 categories: 1) Characteristics of health actions seeking to cater to the needs of the homeless population; 2) Factors limiting health actions that restrict the care to the needs of this population; 3) Participation of the homeless population in the planning and execution of actions provided by the health services. The studies show advances in access to basic rights and provide input that support initiatives to enhance and strengthen the provision of intersectoral care to this population.
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Affiliation(s)
- Lívia Bustamante van Wijk
- Faculdade de Medicina, Universidade de São Paulo. Rua Cipotânea 51, Butantã. 05360-160 São Paulo SP Brasil.
| | - Elisabete Ferreira Mângia
- Faculdade de Medicina, Universidade de São Paulo. Rua Cipotânea 51, Butantã. 05360-160 São Paulo SP Brasil.
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16
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Anderson M, Revie CW, Quail JM, Wodchis W, de Oliveira C, Osman M, Baetz M, McClure J, Stryhn H, Buckeridge D, Neudorf C. The effect of socio-demographic factors on mental health and addiction high-cost use: a retrospective, population-based study in Saskatchewan. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2018; 109:810-820. [PMID: 29981109 PMCID: PMC6267642 DOI: 10.17269/s41997-018-0101-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/07/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE A small proportion of the population accounts for the majority of healthcare costs. Mental health and addiction (MHA) patients are consistently high-cost. We aimed to delineate factors amenable to public health action that may reduce high-cost use among a cohort of MHA clients in Saskatoon, Saskatchewan. METHODS We conducted a population-based retrospective cohort study. Administrative health data from fiscal years (FY) 2009-2015, linked at the individual level, were analyzed (n = 129,932). The outcome of interest was ≥ 90th percentile of costs for each year under study ('persistent high-cost use'). Descriptive analyses were followed by logistic regression modelling; the latter excluded long-term care residents. RESULTS The average healthcare cost among study cohort members in FY 2009 was ~ $2300; for high-cost users it was ~ $19,000. Individuals with unstable housing and hospitalization(s) had increased risk of persistent high-cost use; both of these effects were more pronounced as comorbidities increased. Patients with schizophrenia, particularly those under 50 years old, had increased probability of persistent high-cost use. The probability of persistent high-cost use decreased with good connection to a primary care provider; this effect was more pronounced as the number of mental health conditions increased. CONCLUSION Despite constituting only 5% of the study cohort, persistent high-cost MHA clients (n = 6455) accounted for ~ 35% of total costs. Efforts to reduce high-cost use should focus on reduction of multimorbidity, connection to a primary care provider (particularly for those with more than one MHA), young patients with schizophrenia, and adequately addressing housing stability.
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Affiliation(s)
- Maureen Anderson
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada.
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241 - 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada.
| | - Crawford W Revie
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada
| | - Jacqueline M Quail
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241 - 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada
- College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Walter Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada
- Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, M6J 1H4, Canada
| | - Meriç Osman
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241 - 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada
| | - Marilyn Baetz
- College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
- Saskatoon Health Region, #101-310 Idylwyld Drive North, Saskatoon, SK, S7L 0Z2, Canada
| | - J McClure
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada
| | - Henrik Stryhn
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada
| | - David Buckeridge
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada
| | - Cordell Neudorf
- College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
- Saskatoon Health Region, #101-310 Idylwyld Drive North, Saskatoon, SK, S7L 0Z2, Canada
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17
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Jones AL, Hausmann LRM, Haas GL, Mor MK, Cashy JP, Schaefer JH, Gordon AJ. A national evaluation of homeless and nonhomeless veterans' experiences with primary care. Psychol Serv 2018; 14:174-183. [PMID: 28481602 DOI: 10.1037/ser0000116] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Persons who are homeless, particularly those with mental health and/or substance use disorders (MHSUDs), often do not access or receive continuous primary care services. In addition, negative experiences with primary care might contribute to homeless persons' avoidance and early termination of MHSUD treatment. The patient-centered medical home (PCMH) model aims to address care fragmentation and improve patient experiences. How homeless persons with MHSUDs experience care within PCMHs is unknown. This study compared the primary care experiences of homeless and nonhomeless veterans with MHSUDs receiving care in the Veterans Health Administration's medical home environment, called Patient Aligned Care Teams. The sample included VHA outpatients who responded to the national 2013 PCMH-Survey of Health Care Experiences of Patients (PCMH-SHEP) and had a past-year MSHUD diagnosis. Veterans with evidence of homelessness (henceforth "homeless") were identified through VHA administrative records. PCMH-SHEP survey respondents included 67,666 veterans with MHSUDs (9.2% homeless). Compared with their nonhomeless counterparts, homeless veterans were younger, more likely to be non-Hispanic Black and nonmarried, had less education, and were more likely to live in urban areas. Homeless veterans had elevated rates of most MHSUDs assessed, indicating significant co-occurrence. After controlling for these differences, homeless veterans reported more negative and fewer positive experiences with communication; more negative provider ratings; and more negative experiences with comprehensiveness, care coordination, medication decision-making, and self-management support than nonhomeless veterans. Homeless persons with MHSUDs may need specific services that mitigate negative care experiences and encourage their continuation in longitudinal primary care services. (PsycINFO Database Record
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Affiliation(s)
- Audrey L Jones
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System
| | - Leslie R M Hausmann
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System
| | - Gretchen L Haas
- VISN 4 Mental Illness Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System
| | - Maria K Mor
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System
| | - John P Cashy
- VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System
| | - James H Schaefer
- Department of Veterans Affairs Office of Analytics and Business Intelligence
| | - Adam J Gordon
- VA Center for Health Equity Research and Promotion, VISN4 Mental Illness Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System
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18
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Jego M, Abcaya J, Ștefan DE, Calvet-Montredon C, Gentile S. Improving Health Care Management in Primary Care for Homeless People: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E309. [PMID: 29439403 PMCID: PMC5858378 DOI: 10.3390/ijerph15020309] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 02/04/2018] [Accepted: 02/07/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. We aimed to describe the main characteristics of the primary care programs that take care of homeless people, and to identify which could be most relevant. METHODS We performed a literature review that included articles which described and evaluated primary care programs for homeless people. RESULTS Most of the programs presented a team-based approach, multidisciplinary and/or integrated care. They often proposed co-located services between somatic health services, mental health services and social support services. They also tried to answer to the specific needs of homeless people. Some characteristics of these programs were associated with significant positive outcomes: tailored primary care organizations, clinic orientation, multidisciplinary team-based models which included primary care physicians and clinic nurses, integration of social support, and engagement in the community's health. CONCLUSIONS Primary health care programs that aimed at taking care of the homeless people should emphasize a multidisciplinary approach and should consider an integrated (mental, somatic and social) care model.
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Affiliation(s)
- Maeva Jego
- EA 3279 Research Unit-Public Health, Chronic Diseases and Quality of Life, Faculty of Medicine, Aix-Marseille University, 27 Bd Jean Moulin, 13385 Marseille CEDEX 5, France.
- Department of General Practice, Faculty of Medicine, Aix-Marseille University, 27 Bd Jean Moulin, 13385 Marseille CEDEX 5, France.
| | - Julien Abcaya
- Department of General Practice, Faculty of Medicine, Aix-Marseille University, 27 Bd Jean Moulin, 13385 Marseille CEDEX 5, France.
| | - Diana-Elena Ștefan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 37 Street Dionisie Lupu, Sector 1, 030167 Bucharest, Romania.
| | - Céline Calvet-Montredon
- Department of General Practice, Faculty of Medicine, Aix-Marseille University, 27 Bd Jean Moulin, 13385 Marseille CEDEX 5, France.
| | - Stéphanie Gentile
- EA 3279 Research Unit-Public Health, Chronic Diseases and Quality of Life, Faculty of Medicine, Aix-Marseille University, 27 Bd Jean Moulin, 13385 Marseille CEDEX 5, France.
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Wijk LBV, Mângia EF. O cuidado a Pessoas em Situação de Rua pela Rede de Atenção Psicossocial da Sé. SAÚDE EM DEBATE 2017. [DOI: 10.1590/0103-1104201711511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Este estudo qualitativo teve como objetivos conhecer as ações dirigidas às Pessoas em Situação de Rua que apresentam transtorno mental, desenvolvidas por dois serviços da Rede de Atenção Psicossocial da Sé; identificar obstáculos e pontos de força presentes no cotidiano de trabalho; e conhecer a opinião dos usuários sobre o cuidado recebido. A maioria das ações oferecidas pelos serviços encontra-se alinhada às diretrizes das políticas públicas, considera as características da população e busca responder às suas necessidades. O vínculo entre profissionais e usuários foi compreendido como essencial, mas há sobrecarga e risco de adoecimento dos profissionais.
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20
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Salem BE, Kwon J, Ames M. On the Frontlines: Perspectives of Providers Working With Homeless Women. West J Nurs Res 2017; 40:665-687. [PMID: 28322658 DOI: 10.1177/0193945916689081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Homeless service providers (HSPs) are on the frontlines of caring for the most vulnerable populations to help them navigate out of homelessness and access health and social services. The purpose of this qualitative study was to understand, from the perspectives of HSPs ( N = 19; age range, 27-58 years; SD = 10.37), their account and experiences in working with homeless women (HW), and opportunities for intervention development and integration. Five focus groups were conducted with HSPs in Central City East, Los Angeles. Five main themes emerged which included (a) seeking to establish a therapeutic relationship, (b) internal and external drivers of change, (c) navigating systems, (d) targeted outreach, and (e) program design recommendations. Within these themes, individual- and structural-level characteristics emerged. To better equip HW, HSPs' perspectives need to be considered in future interventions to aid women traverse homelessness.
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Affiliation(s)
| | - Jordan Kwon
- 1 University of California, Los Angeles, USA
| | - Masha Ames
- 1 University of California, Los Angeles, USA
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