Experience of Primary Care among Homeless Individuals with Mental Health Conditions

Abstract

The delivery of primary care to homeless individuals with mental health conditions presents unique challenges. To inform healthcare improvement, we studied predictors of favorable primary care experience among homeless persons with mental health conditions treated at sites that varied in degree of homeless-specific service tailoring. This was a multi-site, survey-based comparison of primary care experiences at three mainstream primary care clinics of the Veterans Administration (VA), one homeless-tailored VA clinic, and one tailored non-VA healthcare program. Persons who accessed primary care service two or more times from July 2008 through June 2010 (N = 366) were randomly sampled. Predictor variables included patient and organization characteristics suggested by the patient perception model developed by Sofaer and Firminger (2005), with an emphasis on mental health. The primary care experience was assessed with the Primary Care Quality-Homeless (PCQ-H) questionnaire, a validated survey instrument. Multiple regression identified predictors of positive experiences (i.e. higher PCQ-H total score). Significant predictors of a positive experience included a site offering tailored service design, perceived choice among providers, and currently domiciled status. There was an interaction effect between site and severe psychiatric symptoms. For persons with severe psychiatric symptoms, a homeless-tailored service design was significantly associated with a more favorable primary care experience. For persons without severe psychiatric symptoms, this difference was not significant. This study supports the importance of tailored healthcare delivery designed for homeless persons’ needs, with such services potentially holding special relevance for persons with mental health conditions. To improve patient experience among the homeless, organizations may want to deliver services that are tailored to homelessness and offer a choice of providers.

Factors Associated to Health Needs from Homeless Perspective in Spain

“…Drug and alcohol dependence, mental health conditions and dual diagnosis are reported as the most common health needs among homeless (Martens, 2001;Wiersma et al, 2010). Stigma, prejudice and the inadequacy and complexity of services that they have to use, as opening hours -transportation and difficulties engaging with professionals (Mills, Burton, & Matheson, 2015), represent barriers that prevent them from using health services, particularly primary care and mental health services (Chrystal et al, 2015).…”

O cuidado a pessoas em situação de rua: a experiência da Rede de Atenção Psicossocial da Sé

“…Estudos internacionais afirmam que, em sua maioria, essa população é altamente vulnerável (CHRYSTAL et al, 2015), marginalizada e não tem acesso a fontes de renda e direitos humanos fundamentais e/ou direitos sociais básicos (SARRADON-ECK et al, 2014). Esse grupo frequentemente é discriminado e tende a se distanciar de amigos e familiares (ZERGER et al, 2014).…”

“…Esse grupo frequentemente é discriminado e tende a se distanciar de amigos e familiares (ZERGER et al, 2014). A discriminação também dificulta seu acesso a oportunidades de emprego (ZERGER et al, 2014) e a serviços de saúde (SKOSIREVA et al, 2014;CHRYSTAL et al, 2015;SARRADON-ECK et al, 2014).…”

“…Por apresentar dificuldades em acessar serviços de atenção básica e especializada, utiliza hospitais e prontos-socorros com mais frequência (CHRYSTAL et al, 2015). Muitos serviços não identificam suas necessidades (SKOSIREVA et al, 2014;CHRYSTAL et al, 2015) e frequentemente a discrimina (SKOSIREVA et al, 2014;CHRYSTAL et al, 2015;SARRADON-ECK et al, 2014), o que provoca impacto negativo na busca por ajuda e acesso a cuidado (SKOSIREVA et al, 2014).…”

“…Alguns estudos destacam as limitações nas Políticas Públicas voltadas para esse grupo (BORYSOW e FURTADO, 2013;2014;CHRYSTAL et al, 2015;SKOSIREVA et al, 2014 …”