The Behavioral Model for Vulnerable Populations: application to medical care use and outcomes for homeless people.
OBJECTIVE
(1) To present the Behavioral Model for Vulnerable Populations, a major revision of a leading model of access to care that is particularly applicable to vulnerable populations; and (2) to test the model in a prospective study designed to define and determine predictors of the course of health services utilization and physical health outcomes within one vulnerable population: homeless adults. We paid particular attention to the effects of mental health, substance use, residential history, competing needs, and victimization.


METHODS
A community-based probability sample of 363 homeless individuals was interviewed and examined for four study conditions (high blood pressure, functional vision impairment, skin/leg/foot problems, and tuberculosis skin test positivity). Persons with at least one study condition were followed longitudinally for up to eight months.


RESULTS
Homeless adults had high rates of functional vision impairment (37 percent), skin/leg/foot problems (36 percent), and TB skin test positivity (31 percent), but a rate of high blood pressure similar to that of the general population (14 percent). Utilization was high for high blood pressure (81 percent) and TB skin test positivity (78 percent), but lower for vision impairment (33 percent) and skin/leg/foot problems (44 percent). Health status for high blood pressure, vision impairment, and skin/leg/foot problems improved over time. In general, more severe homeless status, mental health problems, and substance abuse did not deter homeless individuals from obtaining care. Better health outcomes were predicted by a variety of variables, most notably having a community clinic or private physician as a regular source of care. Generally, use of currently available services did not affect health outcomes.


CONCLUSIONS
Homeless persons are willing to obtain care if they believe it is important. Our findings suggest that case identification and referral for physical health care can be successfully accomplished among homeless persons and can occur concurrently with successful efforts to help them find permanent housing, alleviate their mental illness, and abstain from substance abuse.
Gelberg
L
L
UCLA Dept. of Family Medicine, Los Angeles, CA 90095-1683, USA.
Andersen
R M
RM
Leake
B D
BD
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D015438:Health Behavior; D006297:Health Services Accessibility / Q000592:standards*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data* / Q000639:trends; D006302:Health Services Research; D006304:Health Status; D006703:Ill-Housed Persons / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D015233:Models, Statistical; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care / Q000458:organization & administration*; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires