Comparison of Patient Experience Between Primary Care Settings Tailored for Homeless Clientele and Mainstream Care Settings

Kertesz, Stefan G.; DeRussy, Aerin J.; Kim, Young Il; Hoge, April E.; Austin, Erika L.; Gordon, Adam J.; Gelberg, Lillian; Gabrielian, Sonya; Riggs, Kevin R.; Blosnich, John R.; Montgomery, Ann Elizabeth; Holmes, Sally K.; Varley, Allyson L.; Pollio, David E.; Gundlapalli, Adi V.; Jones, Audrey L.

doi:10.1097/mlr.0000000000001548

Cited by 23 publications

(18 citation statements)

References 43 publications

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“…These services have been incorporated successfully using a "one-stop-shop" strategy for different types of health and social care, or through the use of an outreach model of care. This concept was reported as a strength of many healthcare interventions targeted to individuals experiencing homelessness (Kertesz et al, 2021;Luchenski et al, 2018;Magwood et al, 2020). In a program serving veterans who are homeless, comparing regular health services to an integrated program that included primary care, social services, and mental health services demonstrated that patients who attended the integrated service had higher usage of primary care services and reduced usage of emergency services (McGuire et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

Identifying Challenges and Solutions to Providing Diabetes Care for Those Experiencing Homelessness

Mancini

Campbell

Yaphe

et al. 2021

IJOH

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Introduction: Health care providers face a multitude of challenges in providing care to patients with diabetes who are experiencing homelessness. Considering the unique circumstance faced by this population, mainstream services must be adapted and tailored to meet patients’ needs. The objective of this study was to explore both the barriers faced by providers and programs in offering comprehensive diabetes care to these patients, and their suggested areas for improvement. Methods: We conducted semi-structured interviews with providers who care for patients who have diabetes and/or who experience homelessness. Participants included primary care providers, specialist physicians, dietitians, shelter staff, outreach workers, and diabetes educators in five Canadian centres (n=96). Responses were analyzed using qualitative thematic analysis. Results: Barriers most frequently cited by providers were a lack of resources for staff. Other challenges included policy barriers (restrictions on billing codes, care professionals’ scope of practice, and the structure of financial support for this population), duplication of services, and alternative priorities of care. Participants identified several strategies to improve care, which targeted the following spheres: location of service provision and coordination of care, policy changes, and extending funding and resources for staff, such as augmented funding to hire allied health professionals in outpatient settings and increasing outreach capabilities. Conclusion: Programs that strive to address the unique needs of clients experiencing homelessness face numerous challenges. Unique potential solutions to these barriers, such as service provision in a convenient location involving social and health services, incorporating allied health care providers in care to a greater extent, and updating policies to reflect the social complexity of the population can improve diabetes care.

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Section: Discussionmentioning

confidence: 99%

Identifying Challenges and Solutions to Providing Diabetes Care for Those Experiencing Homelessness

Mancini

Campbell

Yaphe

et al. 2021

IJOH

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“…This study utilized data from a national survey of homelessexperienced Veterans completed between April and October of 2018, carried out under contract by a professional survey organization, Strategic Research Group of Columbus, Ohio, to the VA as part of a broader funded research study. [17][18][19] The primary aim of the survey was to compare care experience between primary care delivered in clinics that were tailored for clientele with recent homeless experience to care in nontailored clinics. As described in greater detail elsewhere, 17 survey eligibility was based on VA records indicating receipt of services or diagnostic codes that indicated a history of homelessness, and 2 or more visits to a primary care clinic in the prior 2 years.…”

Section: Methodsmentioning

confidence: 99%

“…This study utilized data from a national survey of homeless‐experienced Veterans completed between April and October of 2018, carried out under contract by a professional survey organization, Strategic Research Group of Columbus, Ohio, to the VA as part of a broader funded research study 17–19 . The primary aim of the survey was to compare care experience between primary care delivered in clinics that were tailored for clientele with recent homeless experience to care in nontailored clinics.…”

Section: Methodsmentioning

confidence: 99%

Sensitivity of health records for self‐reported nonfatal drug and alcohol overdose

et al. 2022

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Background and Objectives Public health surveillance for overdose sometimes depends on nonfatal drug overdoses recorded in health records. However, the proportion of total overdoses identified through health record systems is unclear. Comparison of overdoses from health records to those that are self‐reported may provide insight on the proportion of nonfatal overdoses that are not identified. Methods We conducted a cohort study linking survey data on overdose from a national survey of Veterans to United States Department of Veterans Affairs (VA) health records, including community care paid for by VA. Self‐reported overdose in the prior 3 years was compared to diagnostic codes for overdoses and substance use disorders in the same time period. Results The sensitivity of diagnostic codes for overdose, compared to self‐report as a reference standard for this analysis, varied by substance: 28.1% for alcohol, 23.1% for sedatives, 12.0% for opioids, and 5.5% for cocaine. There was a notable concordance between substance use disorder diagnoses and self‐reported overdose (sensitivity range 17.9%–90.6%). Discussion and Conclusions Diagnostic codes in health records may not identify a substantial proportion of drug overdoses. A health record diagnosis of substance use disorder may offer a stronger inference regarding the size of the population at risk. Alternatively, screening for self‐reported overdose in routine clinical care could enhance overdose surveillance and targeted intervention. Scientific Significance This study suggests that diagnostic codes for overdose are insensitive. These findings support consideration of alternative approaches to overdose surveillance in public health.

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“…Recent research focuses on whether tailoring services for the homeless experience can engage and improve care for this population (Gabrielian et al, 2017; O'Toole et al, 2016). Such efforts to tailor care include a Veterans Health Administration (VHA) clinic paradigm, called Homeless Patient Aligned Care Teams (H‐PACTs), which may improve patient experience and satisfaction (Kertesz et al, 2021). The VHA is the largest integrated healthcare system in the U.S., providing health and social services for 9 million Veteran enrollees across 179 medical centres and 1245 outpatient clinics.…”

Section: Introductionmentioning

confidence: 99%

What do Veterans with homeless experience want us to know that we are not asking? A qualitative content analysis of comments from a national survey of healthcare experience

Varley

Hoge

Riggs

et al. 2022

Health Social Care Comm

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Surveys of people who experience homelessness can portray their life and healthcare experiences with a level of statistical precision; however, few have explored how the very same surveys can deliver qualitative insights as well. In responding to surveys, people experiencing homelessness can use the margins to highlight health and social concerns that investigators failed to anticipate that standard question batteries miss. This study describes the unprompted comments of a large national survey of Veterans with homeless experiences. The Primary Care Quality‐Homeless Services Tailoring (PCQ‐HOST) survey presented 85 close‐ended items to solicit social and psychological experiences, health conditions, and patient ratings of primary care. Amongst 5377 Veterans responding to the paper survey, 657 (12%) offered 1933 unprompted comments across nearly all domains queried. Using a team‐based content analysis approach, we coded and organised survey comments by survey domain, and identified emergent themes. Respondents used comments for many purposes. They noted when questions called for more nuanced responses than those allowed, especially ‘sometimes’ or ‘not applicable’ on sensitive questions, such as substance use, where recovery status was not queried. On such matters, the options of ‘no’ and ‘yes’ failed to capture important contextual and historical information that mattered to respondents, such as being in recovery. Respondents also elaborated on negative and positive care experiences, often naming specific clinics or clinicians. This study highlights the degree to which members of vulnerable populations, who participate in survey research, want researchers to know the reasons behind their responses and topics (like chronic pain and substance use disorders) that could benefit from open‐ended response options. Understanding patient perspectives can help improve care. Quantitative data from surveys can provide statistical precision but may miss key patient perspectives. The content that patients write into survey margins can highlight shortfalls of a survey and point towards future areas of inquiry. Veterans with homeless experience want to provide additional detail about their lives and care experiences in ways that transcend the boundaries of close‐ended survey questions. Questions on substance use proved especially likely to draw comments that went beyond the permitted response options, often to declare that the respondent was in recovery. Respondents frequently clarified aspects of their care experiences related to pain, pain care, transportation and experiences of homelessness.

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Comparison of Patient Experience Between Primary Care Settings Tailored for Homeless Clientele and Mainstream Care Settings

Cited by 23 publications

References 43 publications

Identifying Challenges and Solutions to Providing Diabetes Care for Those Experiencing Homelessness

Identifying Challenges and Solutions to Providing Diabetes Care for Those Experiencing Homelessness

Sensitivity of health records for self‐reported nonfatal drug and alcohol overdose

What do Veterans with homeless experience want us to know that we are not asking? A qualitative content analysis of comments from a national survey of healthcare experience

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