title: Priorities in the primary care of persons experiencing homelessness: convergence and divergence in the views of patients and provider/experts.
abstract: OBJECTIVE
  Homeless individuals face unique challenges in health care. Several US initiatives seeking to advance patient-centered primary care for homeless persons are more likely to succeed if they incorporate the priorities of the patients they are to serve. However, there has been no prior research to elicit their priorities in primary care. This study sought to identify aspects of primary care important to persons familiar with homelessness based on personal experience or professional commitment, and to highlight where the priorities of patients and professionals dedicated to their care converge or diverge.
  
  
  METHODS
  This qualitative exercise asked 26 homeless patients and ten provider/experts to rank 16 aspects of primary care using a card sort. Patient-level respondents (n=26) were recruited from homeless service organizations across all regions of the USA and from an established board of homeless service users. Provider/expert-level respondents (n=10) were recruited from veteran and non-veteran-focused homeless health care programs with similar geographic diversity.
  
  
  RESULTS
  Both groups gave high priority to accessibility, evidence-based care, coordination, and cooperation. Provider/experts endorsed patient control more strongly than patients. Patients ranked information about their care more highly than provider/experts.
  
  
  CONCLUSIONS
  Accessibility and the perception of care based on medical evidence represent priority concerns for homeless patients and provider/experts. Patient control, a concept endorsed by experts, is not strongly endorsed by homeless patients. Understanding how to assure fluid communication, coordination, and team member cooperation could represent more worthy targets for research and quality improvement in this domain.
authors.affiliation: Department of Health Care Management, Clayton State University, Morrow, GA, USA.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Steward
authors.affiliation: Department of Psychology, University of Maryland, College Park, MD, USA.
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Holt
authors.affiliation: Department of Social Work, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Pollio
authors.affiliation: Birmingham VA Medical Center, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA; Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA.
authors.forename: Erika L
authors.initials: EL
authors.lastname: Austin
authors.affiliation: Birmingham VA Medical Center, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Johnson
authors.affiliation: VA Pittsburgh Health Care System, Pittsburgh, PA, USA; University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Gordon
authors.affiliation: Birmingham VA Medical Center, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA; Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Kertesz
keywords: homeless persons; patient-centered care; primary care; provider perspectives