Primary Care for Homeless Veterans: A Systematic Review of the Homeless Patient Aligned Care Team (HPACT)

Abstract

BackgroundIn 2011, the Veterans Health Administration (VHA) implemented homeless-tailored primary care medical home models, called the Homeless Patient Aligned Care Teams (HPACT) to improve care for homeless Veterans. The aim of this study was to describe the existing peer-reviewed literature on HPACTs by systematically reviewing studies published since 2011 to date.MethodsWe conducted a systematic review of peer-reviewed studies published from 2011 to June 2019 to evaluate the literature since the inception of the VHA’s Homeless PACT program implementation. We included original research articles evaluating the Homeless PACT and excluded those that did not contain original data.ResultsOf 379 studies screened, 20 studies met our inclusion criteria and were included for analysis. Given wide variability in research designs and outcome measures, a narrative review was conducted. The 20 included studies were categorized into 3 groups: Early HPACT pilot implementations; Association of HPACT clinics with quality and utilization; and Specialized programs within HPACTs. Observational findings suggest reductions in emergency department utilization, improvements in primary care treatment utilization, engagement, and patient experience; but limited rigorous studies exist beyond single site pilots and a few large observational cohort studies.DiscussionThe HPACT model has been successfully implemented in VHA medical centers throughout the country with multiple studies showing increased primary care engagement and improved patient experience; however, further studies are needed about quality, utilization and whether the model can be implemented outside the VHA system.Registration Number/Funding sourcenone

Factors associated with a lack of health care utilization among Veterans after a positive suicide screen in the emergency department

“…Given the high prevalence of MH diagnoses among Veterans who experience homelessness and the unique barriers they face, 28–30 VHA has implemented the Homeless Primary Care Treatment (HPACT) program. HPACT has been shown to improve patient satisfaction and the use of primary care and MH treatment and reduce ED utilization 31,32 . Similarly, the relatively low rate of VHA MH care disengagement observed among all Veterans in this study is consistent with the literature suggesting that VHA's implementation of programs such as Risk ID, Safety Planning in the Emergency Department (SPED), and Recovery Engagement and Coordination for Health–Veterans Enhanced Treatment (REACH VET) have been successful at engaging Veterans at risk for suicide in the recommended follow‐up care 12,33–35 .…”

Increasing Use of Video Telehealth Among Veterans Experiencing Homelessness with Substance Use Disorder: Design of A Peer-Led Intervention

“…Homeless veterans are a VA priority population who face elevated rates of mental illness (Ding et al, 2018), suicide (Holliday et al, 2021), substance use disorder (SUD) (Finlay et al, 2021) and have twice the rate of fatal overdose as the general population. Homeless veterans are less likely than other veterans to receive healthcare and treatment (Rosenthal et al, 2021). The COVID-19 pandemic limited social interaction and access to care (Marini et al, 2020;Tsai & Wilson, 2020), likely contributing to the increases in US drug-related deaths in 2020 and 2021 (Centers for Disease Control and Prevention, 2022).…”