Experience of primary care among homeless individuals with mental health conditions

Chrystal, JG and Glover, DL and Young, AS and Whelan, F and Austin, EL and Johnson, NK and Pollio, DE and Holt, CL and Stringfellow, E and Gordon, AJ and Kim, TA and Daigle, SG and Steward, JL and Kertesz, SG (2015) Experience of primary care among homeless individuals with mental health conditions. PLoS ONE, 10 (2).

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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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Details

Item Type:	Article
Status:	Published
Creators/Authors:	Creators Email Pitt Username ORCID Chrystal, JG Glover, DL Young, AS Whelan, F Austin, EL Johnson, NK Pollio, DE Holt, CL Stringfellow, E Gordon, AJ ajg7@pitt.edu AJG7 Kim, TA Daigle, SG Steward, JL Kertesz, SG
Contributors:	Contribution Contributors Name Email Pitt Username ORCID Editor Macleod, Una UNSPECIFIED UNSPECIFIED UNSPECIFIED
Date:	6 February 2015
Date Type:	Publication
Journal or Publication Title:	PLoS ONE
Volume:	10
Number:	2
DOI or Unique Handle:	10.1371/journal.pone.0117395
Schools and Programs:	School of Medicine > Medicine
Refereed:	Yes
Other ID:	NLM PMC4319724
PubMed Central ID:	PMC4319724
PubMed ID:	25659142
Date Deposited:	12 May 2015 18:21
Last Modified:	30 Mar 2021 13:55
URI:	http://d-scholarship.pitt.edu/id/eprint/24090

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