title: 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.
authors: Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, United States of America.
authors: Joya G
authors: JG
authors: Chrystal
authors: Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, United States of America.
authors: Dawn L
authors: DL
authors: Glover
authors: Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, United States of America; University of California Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, California, United States of America.
authors: Alexander S
authors: AS
authors: Young
authors: University of California Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, California, United States of America.
authors: Fiona
authors: F
authors: Whelan
authors: Center for Surgical, Medical Acute Care Research and Transitions (C-SMART), Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, United States of America.
authors: Erika L
authors: EL
authors: Austin
authors: Center for Surgical, Medical Acute Care Research and Transitions (C-SMART), Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, United States of America.
authors: Nancy K
authors: NK
authors: Johnson
authors: University of Alabama, School of Social Work, Tuscaloosa, Alabama, United States of America.
authors: David E
authors: DE
authors: Pollio
authors: University of Maryland, Department of Behavioral and Community Health, College Park, Maryland, United States of America.
authors: Cheryl L
authors: CL
authors: Holt
authors: Boston Health Care for the Homeless Program, Boston, Massachusetts, United States of America.
authors: Erin
authors: E
authors: Stringfellow
authors: Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States of America; University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, United States of America.
authors: Adam J
authors: AJ
authors: Gordon
authors: Boston Medical Center, Boston, Massachusetts, United States of America; Boston University, School of Medicine, Boston, Massachusetts, United States of America.
authors: Theresa A
authors: TA
authors: Kim
authors: Center for Surgical, Medical Acute Care Research and Transitions (C-SMART), Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, United States of America.
authors: Shanette G
authors: SG
authors: Daigle
authors: Center for Surgical, Medical Acute Care Research and Transitions (C-SMART), Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, United States of America.
authors: Jocelyn L
authors: JL
authors: Steward
authors: Center for Surgical, Medical Acute Care Research and Transitions (C-SMART), Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, United States of America; University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama, United States of America.
authors: Stefan G
authors: SG
authors: Kertesz
mesh_terms: D003695:Delivery of Health Care; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D008016:Life Change Events; D008297:Male; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy; D008875:Middle Aged; D011320:Primary Health Care; D012189:Retrospective Studies