Exploring Quality of Primary Care for Patients Who Experience Homelessness and the Clinicians Who Serve Them: What Are Their Aspirations?

Abstract

To develop and evaluate an effective model of patient-centered, high-quality, homeless-focused primary care, our team explored key domains of primary care that may be important to patients. We anchored our conceptual framework in two reports from the Institute of Medicine (IOM) that defined components of primary care and quality of care. Using questions developed from this framework, we conducted semistructured interviews with 36 homeless-experienced individuals with past-year primary care engagement and 24 health care professionals (clinicians and researchers) who serve homeless-experienced patients in the primary care setting. Template analysis revealed factors important to this population. These included stigma, respect, and perspectives on patient control of medical decision-making in regard to both pain and addiction. For patients experiencing homelessness, the results suggest that quality primary care may have different meanings for patients and professionals, and that services should be tailored to meet homeless-specific needs.

Determinants of Implementation of a Clinical Practice Guideline for Homeless Health

“…Stigma experienced by homeless persons can be propagated through interactions with health care practitioners, thus perpetuating power imbalances, negative stereotypes, and inequalities [36] associated with structural violence [37]. Stigma experienced by people experiencing homelessness in the context of receiving healthcare services could deter willingness to seek healthcare resources and negatively impact the depth of the relationship with healthcare providers [38,39]. Evidence shows that persons experiencing homelessness appreciate a clinical environment that emphasizes mutual trust, respect, and personal safety [10,39].…”

“…Stigma experienced by people experiencing homelessness in the context of receiving healthcare services could deter willingness to seek healthcare resources and negatively impact the depth of the relationship with healthcare providers [38,39]. Evidence shows that persons experiencing homelessness appreciate a clinical environment that emphasizes mutual trust, respect, and personal safety [10,39]. It is, therefore, imperative that any person who has direct contact and interaction with homeless persons in these contexts be trained in stigma or trauma-informed practices [40].…”

“…Health professional trainees could benefit from Community Service Learning programs which provide exposure to the health issues of marginalized populations and opportunities to practice skills such as communication, cultural safety, a community-grounded perspective, and advocacy for health [43]. At the same time, it can be expected that relying on training has its limitations and only certain primary care physicians will be open to serving people with lived experience [39].…”

Perceived care coordination among permanent supportive housing participants: Evidence from a managed care plan in the United States

“…Like prior research (Parsell et al, 2018;Varley et al, 2020), shared decision-making was an issue cited by participants with mental health concerns. In the event that healthcare providers and patients fail to see eye-to-eye on the interventions most appropriate to meet their needs, this generates a risk that patients fail to follow through with the clinical instruction provided.…”

From Theory to Implementation: Adaptations to a Quality Improvement Initiative According to Implementation Context

“…As interest in QI increases in LMICs, there are concerns that many examples of QI initiatives lack a detailed description of how changes were achieved and the role of context during implementation ( Varley et al, 2020 ; Zamboni et al, 2020 ). Consequently, new implementers may not benefit from the knowledge of what worked, what was adapted, and why ( Campbell et al, 2010 ; Siriwardena et al, 2014 ).…”