Comparing Homeless Persons’ Care Experiences in Tailored Versus Nontailored Primary Care Programs

Kertesz, Stefan G.; Holt, Cheryl L.; Steward, Jocelyn; Jones, Richard N.; Roth, David L.; Stringfellow, Erin; Gordon, Adam J.; Kim, Theresa; Austin, Erika L.; Henry, Stephen R; Johnson, Nancy K.; Granstaff, U. Shanette; O’Connell, James J.; Golden, Joya F.; Young, Alexander S.; Davis, Lori L.; Pollio, David E.

doi:10.2105/ajph.2013.301481

Cited by 70 publications

(82 citation statements)

References 37 publications

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“…29 This resulted in a sample that was two-thirds veterans, compared to 12% in the adult homeless population. 71 This purposive site sampling, rather than veteran status per se, likely contributed to the overrepresentation of HCH patients in the high risk group, compared to the VA patients.…”

Section: Discussionmentioning

confidence: 99%

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Substance use among Persons with Homeless Experience in Primary Care

et al. 2016

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Background Community survey data suggest high prevalence of substance use disorders among currently homeless individuals. There is less data regarding illicit drug and alcohol use problems of homeless-experienced persons engaged in primary care. They may have less severe use and require different care responses from primary care teams. Methods We surveyed currently and formerly homeless, i.e., homeless-experienced, persons engaged in primary care at 5 federally-funded programs in the U.S., administering the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). We used the ASSIST definitions of lower, moderate, and high risk to assess a spectrum of lifetime and recent substance use, from any use to likely dependence, and to identify sociodemographic and health status characteristics associated with severity of use. Results Almost one-half of the sample (n = 601) had recently (within the past 3 months) used alcohol, and one-third had recently used an illicit drug. The most commonly used illicit drugs in the past 3 months were cannabis (19%), cocaine (16%), and opioids (7.5%). Over one-half (59%) of respondents had ASSIST-defined moderate or high risk substance use. A significant proportion (31%) of those identified as at moderate risk had no recent substance use, but did report past problematic use. Ten percent of the lower risk group had past problematic use of alcohol. Severity of use was associated with worse health status, but not with housing status or type of homelessness experienced. Conclusions Less severe (moderate risk) use and past problematic use, potentially indicative of remitted substance use disorders, were more common than high risk use in this primary care, homeless-experienced sample. Our findings highlight the urgency of identifying effective ways to reduce risky substance use and prevent relapse in homeless-experienced persons.

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Section: Discussionmentioning

confidence: 99%

“…Eligibility was based on having had at least two primary care visits at the participating sites in the preceding two years, and having experienced homelessness. 29,30 Research associates administered a one-time, in-person standardized survey to participants between January, 2011 and March, 2012. The full sample is used here.…”

Section: Methodsmentioning

confidence: 99%

Substance use among Persons with Homeless Experience in Primary Care

et al. 2016

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“…18,23,24 Equity in access to primary care services is more than just the availability of primary care facilities. Delivery systems must promote equity and improve the quality of care delivered.…”

Section: Providing Culturally Sensitive Health Carementioning

confidence: 99%

Access to Primary Care Services Among the Homeless

White

Newman

2014

J Prim Care Community Health

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Objective: To identify barriers and facilitators to primary care access among the homeless using the Equity of Access to Medical Care Framework and to provide recommendations for medical and public health practitioners to improve health among this underserved population. Methods: A quasi-systematic review of the literature was conducted using the PubMed, CINAHL, and PsycINFO databases. Study elements from articles in the final analysis were extracted and categorized into dimensions of access from the Framework. Results: The review identified multiple barriers to primary care access for the homeless. This included lack of insurance coverage and competing priorities. Facilitators to access included tailored health care delivery systems and having a regular source of care. Conclusion: This review provides evidence that health policy initiatives, patient-centered care, and targeted interventions can assist with improving primary care access among the homeless.

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“…To meet the primary health care needs of the homeless population many bigger cities have developed systems with targeted primary health care for homeless and some studies suggest that these are more efficient in reaching the homeless population [27, 28]. There is suggestive evidence that tailored primary health care services for homeless persons improve the delivery of care at the right level and reduce the number of nonacute ED visits [29, 30].…”

Section: Introductionmentioning

confidence: 99%

Mental disorders and the use of primary health care services among homeless shelter users in the Helsinki metropolitan area, Finland

Stenius-Ayoade

Haaramo

Erkkila³

et al. 2017

BMC Health Serv Res

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BackgroundHomelessness is associated with increased morbidity, mortality and health care use. The aim of this study was to examine the role of mental disorders in relation to the use of 1) daytime primary health care services and 2) after hours primary health care emergency room (PHER) services among homeless shelter users in the Helsinki Metropolitan Area, Finland.MethodsThe study cohort consists of all 158 homeless persons using the four shelters operating in the study area during two selected nights. The health records were analyzed over a period of 3 years prior to the sample nights and data on morbidity and primary health care visits were gathered. We used negative binomial regression to estimate the association between mental disorders and daytime visits to primary health care and after hours visits to PHERs.ResultsDuring the 3 years the 158 homeless persons in the cohort made 1410 visits to a physician in primary health care. The cohort exhibited high rates of mental disorders, including substance use disorders (SUDs); i.e. 141 persons (89%) had a mental disorder. We found dual diagnosis, defined as SUD concurring with other mental disorder, to be strongly associated with daytime primary health care utilization (IRR 11.0, 95% CI 5.9–20.6) when compared with those without any mental disorder diagnosis. The association was somewhat weaker for those with only SUDs (IRR 4.9, 95% CI 2.5–9.9) or with only other mental disorders (IRR 5.0, 95% CI 2.4–10.8). When focusing upon the after hours visits to PHERs we observed that both dual diagnosis (IRR 14.1, 95% CI 6.3–31.2) and SUDs (11.5, 95% CI 5.7–23.3) were strongly associated with utilization of PHERs compared to those without any mental disorder. In spite of a high numbers of visits, we found undertreatment of chronic conditions such as hypertension and diabetes.ConclusionsDual diagnosis is particularly strongly associated with primary health care daytime visits among homeless persons staying in shelters, while after hours visits to primary health care level emergency rooms are strongly associated with both dual diagnosis and SUDs. Active treatment for SUDs could reduce the amount of emergency visits made by homeless shelter users.

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Comparing Homeless Persons’ Care Experiences in Tailored Versus Nontailored Primary Care Programs

Abstract: Tailored primary care service design was associated with a superior service experience for patients who experienced homelessness.

Cited by 70 publications

References 37 publications

Substance use among Persons with Homeless Experience in Primary Care

Substance use among Persons with Homeless Experience in Primary Care

Access to Primary Care Services Among the Homeless

Mental disorders and the use of primary health care services among homeless shelter users in the Helsinki metropolitan area, Finland

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