title: Tailoring Outreach Efforts to Increase Primary Care Use Among Homeless Veterans: Results of a Randomized Controlled Trial.
abstract: BACKGROUND
  Homeless individuals often have significant unmet health care needs that are critical to helping them leave homelessness. However, engaging them in primary and mental health care services is often elusive and difficult to achieve.
  
  
  OBJECTIVE
  We aimed to increase health-seeking behavior and receipt of health care among homeless Veterans.
  
  
  METHODS
  This was a multi-center, prospective, community-based, two-by-two randomized controlled trial of homeless Veterans.
  
  
  METHODS
  Homeless Veterans not receiving primary care participated in the study.
  
  
  METHODS
  An outreach intervention that included a personal health assessment and brief intervention (PHA/BI), and/or a clinic orientation (CO) was implemented.
  
  
  METHODS
  We measured receipt of primary care within 4 weeks of study enrollment.
  
  
  RESULTS
  Overall, 185 homeless Veterans were enrolled: the average age was 48.6 years (SD 10.8), 94.6% were male, 43.0% were from a minority population, 12.0% were unsheltered, 25.5% were staying in a dusk-to-dawn emergency shelter, 26.1% were in transitional housing, while 27.7% were in an unstable, doubled-up arrangement. At one month, 77.3% of the PHA/BI plus CO group accessed primary care and by 6 months, 88.7% had been seen in primary care. This was followed by the CO-only group, 50.0% of whom accessed care in the first 4 weeks, the PHI/BI-only arm at 41.0% and the Usual Care arm at 30.6%. Chi-squared tests by group were significant (p < 0.001) at both 4 weeks and 6 months. There was no difference in attitudes about care at baseline and 6 months or in use patterns once enrolled in care.
  
  
  CONCLUSIONS
  Our findings suggest that treatment-resistant/avoidant homeless Veterans can be effectively engaged in primary and other clinical care services through a relatively low intensity, targeted and tailored outreach effort.
authors: Providence VA Medical Center, 830 Chalkstone Ave, Providence, RI, 02908, USA, thomas.otoole@va.gov.
authors: Thomas P
authors: TP
authors: O'Toole
authors: Erin E
authors: EE
authors: Johnson
authors: Matthew L
authors: ML
authors: Borgia
authors: Jennifer
authors: J
authors: Rose
mesh_terms: D000328:Adult; D001294:Attitude to Health; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D009042:Motivation; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration*; D012237:Rhode Island; D012959:Socioeconomic Factors; D014728:Veterans / Q000523:psychology*