Building Care Systems to Improve Access for High-Risk and Vulnerable Veteran Populations

O’Toole, Thomas; Pirraglia, Paul A.; Dosa, David; Bourgault, Claire; Redihan, Stephen G.; O’Toole, Mary; Blumen, Jonathan

doi:10.1007/s11606-011-1818-2

Cited by 48 publications

(53 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Changes in service delivery resulting from the VHA’s integrated health care model have led to improved recognition of mental health issues in primary care patients, delivery of evidence-based care, and patient engagement in mental health services 61. In addition, among high-risk, complex patients, the patient-centered medical home system seems to be associated with improved chronic disease management and outcomes 62. Furthermore, establishing a health behavior coordinator position at each Veterans Affairs hospital has helped to implement integrated care in veteran’s services by providing training to primary care physicians, physicians’ assistants, nurses, and other health care providers.…”

Section: Discussionmentioning

confidence: 99%

Relationship between depression and medication adherence in cardiovascular disease: the perfect challenge for the integrated care team

Goldstein¹,

Gathright²,

Garcia³

2017

PPA

View full text Add to dashboard Cite

Many individuals with cardiovascular disease (CVD) experience depression that is associated with poor health outcomes, which may be because of medication nonadherence. Several factors influence medication adherence and likely influence the relationship between depression and medication adherence in CVD patients. This comprehensive study reviews the existing literature on depression and medication adherence in CVD patients, addresses the methods of and problems with measuring medication adherence, and explains why the integrated care team is uniquely situated to improve the outcomes in depressed CVD patients. This paper also explores how the team can collaboratively target depressive symptoms and medication-taking behavior in routine clinical care. Finally, it suggests the limitations to the integrated care approach, identifies targets for future research, and discusses the implications for CVD patients and their families.

show abstract

Section: Discussionmentioning

confidence: 99%

Relationship between depression and medication adherence in cardiovascular disease: the perfect challenge for the integrated care team

Goldstein¹,

Gathright²,

Garcia³

2017

PPA

View full text Add to dashboard Cite

show abstract

“…A more tailored approach to homeless Veteran care delivery (e.g., specialized PACT teams or primary care clinical environments) might also be warranted for homeless Veterans with MHSUDs (Gabrielian, Yuan, Andersen, Rubenstein, & Gelberg, 2014; Kertesz et al, 2013; O’Toole, Johnson, Borgia, et al, 2015; O’Toole et al, 2011; Steward et al, 2016; Tsai & Rosenheck, 2015). For example, VHA initiated homeless-tailored PACTs in 2012 to reduce impediments to care processes (e.g., transportation, insurance, clinic hours) and facilitate care (e.g., provide outreach services, hygiene products) for homeless Veterans.…”

Section: Discussionmentioning

confidence: 99%

“…VHA has been at the forefront of primary care redesign efforts that could improve homeless persons’ experiences with care (Nelson et al, 2014; O’Toole et al, 2011; Rosland et al, 2013). In 2010, VHA began reorganizing primary care providers and staff into Patient-Aligned Care Teams (PACTs) in an effort to deliver efficient, well-coordinated, comprehensive, patient-centered care.…”

mentioning

confidence: 99%

A national evaluation of homeless and nonhomeless veterans’ experiences with primary care.

Jones¹,

Hausmann²,

Haas³

et al. 2017

Psychological Services

View full text Add to dashboard Cite

Persons who are homeless, particularly those with mental health and/or substance use disorders (MHSUDs), often do not 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 non-homeless 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 Healthcare 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 to their non-homeless counterparts, homeless Veterans were younger, more likely to be non-Hispanic Black and non-married; 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 non-homeless Veterans. Homeless persons with MHSUDs may need specific services that mitigate negative care experiences and encourage their continuation in longitudinal primary care services.

show abstract

“…7 This model is thought to be particularly helpful in managing care and addressing social determinants of health for vulnerable patients, such as those with MHSUDs. 8 For example, the PCMH model has been associated with increased visits to mental health specialists, improved adherence to psychiatric medications, and greater mental health recovery for patients with MHSUDs. [9][10][11][12][13] Despite evidence suggesting that the PCMH model can benefit patients with MHSUDs, a paucity of data exists regarding patient experiences with care in the PCMH.…”

Section: Introductionmentioning

confidence: 99%

Racial/Ethnic Differences in Primary Care Experiences in Patient-Centered Medical Homes among Veterans with Mental Health and Substance Use Disorders

et al. 2016

View full text Add to dashboard Cite

BACKGROUND: Patient-Centered Medical Homes (PCMH) may be effective in managing care for racial/ ethnic minorities with mental health and/or substance use disorders (MHSUDs). How such patients experience care in PCMH settings is relatively unknown. OBJECTIVE: We aimed to examine racial/ethnic differences in experiences with primary care in PCMH settings among Veterans with MHSUDs. DESIGN: We used multinomial regression methods to estimate racial/ethnic differences in PCMH experiences reported on a 2013 national survey of Veterans Affairs patients. Both Blacks and Hispanics reported more positive (RDs = 2.3; 4.2) and fewer negative (RDs = −1.8; -1.9) provider ratings, and more positive experiences with decision making (RDs = 2.4; 3.0). Blacks reported more positive (RD = 3.9) and fewer negative (RD = −5.1) experiences with selfmanagement support. CONCLUSIONS: In a national sample of Veterans with MHSUDs, potential deficiencies were observed in access, self-management support, and comprehensiveness. Racial/ethnic minorities reported worse experiences than Whites with access, comprehensiveness, communication, and office staff helpfulness/courtesy.KEY WORDS: patient-centered medical home; health care experience; race and ethnicity; mental health services.

show abstract

Building Care Systems to Improve Access for High-Risk and Vulnerable Veteran Populations

Cited by 48 publications

References 22 publications

Relationship between depression and medication adherence in cardiovascular disease: the perfect challenge for the integrated care team

Relationship between depression and medication adherence in cardiovascular disease: the perfect challenge for the integrated care team

A national evaluation of homeless and nonhomeless veterans’ experiences with primary care.

Racial/Ethnic Differences in Primary Care Experiences in Patient-Centered Medical Homes among Veterans with Mental Health and Substance Use Disorders

Contact Info

Product

Resources

About