Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use

Jones, Audrey L.; Cochran, Susan D.; Leibowitz, Arleen; Wells, Melissa; Kominski, Gerald F.; Mays, MaryAnn

doi:10.1007/s11606-015-3417-0

Cited by 39 publications

(32 citation statements)

References 55 publications

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“…Consistent with prior studies of healthcare experiences, the composite distributions were negatively skewed, with most Veterans with MHSUDs reporting positive experiences (Burnett-Zeigler et al, 2011; Jones et al, 2015). We therefore sought to categorize each domain as negative, moderate, or positive (Hausmann, Gao, Mor, Schaefer, & Fine, 2013, 2014).…”

Section: Methodssupporting

confidence: 78%

A national evaluation of homeless and nonhomeless veterans’ experiences with primary care.

Jones¹,

Hausmann²,

Haas³

et al. 2017

Psychological Services

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Persons who are homeless, particularly those with mental health and/or substance use disorders (MHSUDs), often do not receive continuous primary care services. In addition, negative experiences with primary care might contribute to homeless persons’ avoidance and early termination of MHSUD treatment. The patient-centered medical home (PCMH) model aims to address care fragmentation and improve patient experiences. How homeless persons with MHSUDs experience care within PCMHs is unknown. This study compared the primary care experiences of homeless and non-homeless Veterans with MHSUDs receiving care in the Veterans Health Administration’s medical home environment, called Patient Aligned Care Teams. The sample included VHA outpatients who responded to the national 2013 PCMH-Survey of Healthcare Experiences of Patients (PCMH-SHEP) and had a past-year MSHUD diagnosis. Veterans with evidence of homelessness (henceforth “homeless”) were identified through VHA administrative records. PCMH-SHEP survey respondents included 67,666 Veterans with MHSUDs (9.2% homeless). Compared to their non-homeless counterparts, homeless Veterans were younger, more likely to be non-Hispanic Black and non-married; had less education; and were more likely to live in urban areas. Homeless Veterans had elevated rates of most MHSUDs assessed, indicating significant co-occurrence. After controlling for these differences, homeless Veterans reported more negative and fewer positive experiences with communication; more negative provider ratings; and more negative experiences with comprehensiveness, care coordination, medication decision-making, and self-management support than non-homeless Veterans. Homeless persons with MHSUDs may need specific services that mitigate negative care experiences and encourage their continuation in longitudinal primary care services.

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Section: Methodssupporting

confidence: 78%

A national evaluation of homeless and nonhomeless veterans’ experiences with primary care.

Jones¹,

Hausmann²,

Haas³

et al. 2017

Psychological Services

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“…The social factors sought to examine the impact on PLCDs who: (1) were the head of household (yes, no); (2) resided in a rural or urban setting; (3) had social support (i.e., someone to accompany him/her to clinical visits); (4) Also, we accounted for the number of household members residing with PLCD who also have chronic diseases that are grades 1, 2, or above; (5) to determine usual source of care, we asked participants about the types of hospitals they usually chose to visit when they are sick or in need of medical advice [31]. Responses were coded according to the three levels of hospitals, i.e., village or community clinics belonged to first level, township or community hospitals belonged to second level, and county hospitals/municipal level-or-above hospitals are belonged to the third level; (6) Contribution to household income was coded in three ways: primary source (50% or above), secondary source (less than 50%), and no financial contribution [32].…”

Section: Methodsmentioning

confidence: 99%

What Contributes to the Regularity of Patients with Hypertension or Diabetes Seeking Health Services? A Pilot Follow-Up, Observational Study in Two Sites in Hubei Province, China

Feng

Serrano

et al. 2016

IJERPH

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Regular maintenance of non-communicable chronic diseases can constrain disease progression in diabetic and hypertensive patients. To identify the individual and social factors that are associated with positive health-seeking behaviors and regular maintenance of chronic diseases, we have conducted a follow up study in 2015 on diabetic and hypertensive patients in Hubei Province. We used binary logistic regression models to determine specific factors associated with diabetic and hypertensive patients that sought healthcare services for their conditions in accordance with current Chinese Centers for Disease Prevention and Control (CDC) guidelines. Our findings show that 42.16% of 510 people living with chronic conditions (PLCDs) sought health services in line with existing guidelines. Findings also show a higher probability (8.418 times) for PLCDs seeking healthcare services at higher-tiered hospitals (secondary and tertiary hospitals) than for PLCDs seeking care at primary hospitals (odds ratio (OR) = 8.418, 95% confidence interval (CI) = 4.82, 14.27, p < 0.001). These analyses underscore the importance of having patient advocates who can provide support, where necessary, and encourage positive health-seeking behavior. The study also shows a negative impact on regular maintenance for PLCDs in households with high financial constraints. In contrast, the study shows positive impacts for increased household income, age, and residency in rural locations. In sum, this study underscores the importance of primary hospitals as key points of care and critical players in care coordination for PLCDs. The study provides more evidence for Chinese policymakers seeking to contain costs and improve population health. The findings also underscore the need for community-based interventions, specifically interventions that link local primary hospitals, friends/family members, and PLCDs.

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“…8 For example, the PCMH model has been associated with increased visits to mental health specialists, improved adherence to psychiatric medications, and greater mental health recovery for patients with MHSUDs. [9][10][11][12][13] Despite evidence suggesting that the PCMH model can benefit patients with MHSUDs, a paucity of data exists regarding patient experiences with care in the PCMH. In general, the positive experiences with care reported by outpatient populations have been associated with increased health service utilization, adherence to treatment recommendations, and better health outcomes.…”

Section: Introductionmentioning

confidence: 99%

Racial/Ethnic Differences in Primary Care Experiences in Patient-Centered Medical Homes among Veterans with Mental Health and Substance Use Disorders

et al. 2016

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BACKGROUND: Patient-Centered Medical Homes (PCMH) may be effective in managing care for racial/ ethnic minorities with mental health and/or substance use disorders (MHSUDs). How such patients experience care in PCMH settings is relatively unknown. OBJECTIVE: We aimed to examine racial/ethnic differences in experiences with primary care in PCMH settings among Veterans with MHSUDs. DESIGN: We used multinomial regression methods to estimate racial/ethnic differences in PCMH experiences reported on a 2013 national survey of Veterans Affairs patients. Both Blacks and Hispanics reported more positive (RDs = 2.3; 4.2) and fewer negative (RDs = −1.8; -1.9) provider ratings, and more positive experiences with decision making (RDs = 2.4; 3.0). Blacks reported more positive (RD = 3.9) and fewer negative (RD = −5.1) experiences with selfmanagement support. CONCLUSIONS: In a national sample of Veterans with MHSUDs, potential deficiencies were observed in access, self-management support, and comprehensiveness. Racial/ethnic minorities reported worse experiences than Whites with access, comprehensiveness, communication, and office staff helpfulness/courtesy.KEY WORDS: patient-centered medical home; health care experience; race and ethnicity; mental health services.

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Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use

Cited by 39 publications

References 55 publications

A national evaluation of homeless and nonhomeless veterans’ experiences with primary care.

A national evaluation of homeless and nonhomeless veterans’ experiences with primary care.

What Contributes to the Regularity of Patients with Hypertension or Diabetes Seeking Health Services? A Pilot Follow-Up, Observational Study in Two Sites in Hubei Province, China

Racial/Ethnic Differences in Primary Care Experiences in Patient-Centered Medical Homes among Veterans with Mental Health and Substance Use Disorders

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