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Experience of primary care among homeless individuals with mental health conditions.

Chrystal JG, Glover DL, Young AS, Whelan F, Austin EL, Johnson NK, Pollio DE, Holt CL, Stringfellow E, Gordon AJ, Kim TA, Daigle SG, Steward JL, Kertesz SG - PLoS ONE (2015)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, United States of America.

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.

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Adapted conceptual framework for predictors of patient care experiences among individual experiencing homelessness.This framework was adapted from Shosanna Sofaer and Kirsten Firminger model of patient perceptions. For the purpose of our analysis, we retained some original variables as well as the general relationship expressed in this model, although the variables are specific to our sample population.
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pone.0117395.g001: Adapted conceptual framework for predictors of patient care experiences among individual experiencing homelessness.This framework was adapted from Shosanna Sofaer and Kirsten Firminger model of patient perceptions. For the purpose of our analysis, we retained some original variables as well as the general relationship expressed in this model, although the variables are specific to our sample population.

Mentions: Sofaer and Firminger’s patient perceptions model guided choice of predictors related to primary care experience [29]. As shown in Fig. 1, nodes within the model include the following measured variables: characteristics of patient (demographics, health, depression/anxiety, severe psychiatric symptoms, drug and alcohol severity, and housing status), social support, perceived extent of choice among providers, primary care service tailoring for homeless persons, and patient experience seeking and using services. Within this model, the nodes highlight the predictive relationship between the nodes and outcome variable, patient perceptions of the primary care experience. In modifying Sofaer and Firminger’s model, we added two particular nodes of interest: social support and primary care service tailoring for homeless persons (based on receiving care at either of two tailored primary care programs, compared to three mainstream programs). Recent studies have highlighted the importance of both variables in similarly vulnerable populations [30–31]. Our adaptation of the model is intended to be conceptually broad and generalizable to other vulnerable populations. However dimensions within the adapted model highlight important characteristics in populations with mental health conditions.


Experience of primary care among homeless individuals with mental health conditions.

Chrystal JG, Glover DL, Young AS, Whelan F, Austin EL, Johnson NK, Pollio DE, Holt CL, Stringfellow E, Gordon AJ, Kim TA, Daigle SG, Steward JL, Kertesz SG - PLoS ONE (2015)

Adapted conceptual framework for predictors of patient care experiences among individual experiencing homelessness.This framework was adapted from Shosanna Sofaer and Kirsten Firminger model of patient perceptions. For the purpose of our analysis, we retained some original variables as well as the general relationship expressed in this model, although the variables are specific to our sample population.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4319724&req=5

pone.0117395.g001: Adapted conceptual framework for predictors of patient care experiences among individual experiencing homelessness.This framework was adapted from Shosanna Sofaer and Kirsten Firminger model of patient perceptions. For the purpose of our analysis, we retained some original variables as well as the general relationship expressed in this model, although the variables are specific to our sample population.
Mentions: Sofaer and Firminger’s patient perceptions model guided choice of predictors related to primary care experience [29]. As shown in Fig. 1, nodes within the model include the following measured variables: characteristics of patient (demographics, health, depression/anxiety, severe psychiatric symptoms, drug and alcohol severity, and housing status), social support, perceived extent of choice among providers, primary care service tailoring for homeless persons, and patient experience seeking and using services. Within this model, the nodes highlight the predictive relationship between the nodes and outcome variable, patient perceptions of the primary care experience. In modifying Sofaer and Firminger’s model, we added two particular nodes of interest: social support and primary care service tailoring for homeless persons (based on receiving care at either of two tailored primary care programs, compared to three mainstream programs). Recent studies have highlighted the importance of both variables in similarly vulnerable populations [30–31]. Our adaptation of the model is intended to be conceptually broad and generalizable to other vulnerable populations. However dimensions within the adapted model highlight important characteristics in populations with mental health conditions.

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, United States of America.

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.

Show MeSH
Related in: MedlinePlus