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Experience of Primary Care among Homeless Individuals with Mental Health Conditions

Author

Listed:
  • Joya G Chrystal
  • Dawn L Glover
  • Alexander S Young
  • Fiona Whelan
  • Erika L Austin
  • Nancy K Johnson
  • David E Pollio
  • Cheryl L Holt
  • Erin Stringfellow
  • Adam J Gordon
  • Theresa A Kim
  • Shanette G Daigle
  • Jocelyn L Steward
  • Stefan G Kertesz

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.

Suggested Citation

  • Joya G Chrystal & Dawn L Glover & Alexander S Young & Fiona Whelan & Erika L Austin & Nancy K Johnson & David E Pollio & Cheryl L Holt & Erin Stringfellow & Adam J Gordon & Theresa A Kim & Shanette G , 2015. "Experience of Primary Care among Homeless Individuals with Mental Health Conditions," PLOS ONE, Public Library of Science, vol. 10(2), pages 1-14, February.
    • Handle: RePEc:plo:pone00:0117395
    DOI: 10.1371/journal.pone.0117395
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    References listed on IDEAS

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    1. Seena Fazel & Vivek Khosla & Helen Doll & John Geddes, 2008. "The Prevalence of Mental Disorders among the Homeless in Western Countries: Systematic Review and Meta-Regression Analysis," PLOS Medicine, Public Library of Science, vol. 5(12), pages 1-1, December.
    2. Gelberg, L. & Gallagher, T.C. & Andersen, R.M. & Koegel, P., 1997. "Competing priorities as a barrier to medical care among homeless adults in Los Angeles," American Journal of Public Health, American Public Health Association, vol. 87(2), pages 217-220.
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