Jones Audrey L, Hausmann Leslie R M, Haas Gretchen L, Mor Maria K, Cashy John P, Schaefer James H, Gordon Adam J
VA Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System.
VISN 4 Mental Illness Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System.
Psychol Serv. 2017 May;14(2):174-183. doi: 10.1037/ser0000116.
Persons who are homeless, particularly those with mental health and/or substance use disorders (MHSUDs), often do not access or 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 nonhomeless 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 Health Care 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 with their nonhomeless counterparts, homeless veterans were younger, more likely to be non-Hispanic Black and nonmarried, 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 nonhomeless veterans. Homeless persons with MHSUDs may need specific services that mitigate negative care experiences and encourage their continuation in longitudinal primary care services. (PsycINFO Database Record
无家可归者，尤其是那些患有精神健康和/或物质使用障碍（MHSUDs）的人，往往无法获得或接受持续的初级保健服务。此外，在初级保健中产生的负面经历可能会导致无家可归者回避和提前终止MHSUD治疗。以患者为中心的医疗之家（PCMH）模式旨在解决医疗服务碎片化问题并改善患者体验。患有MHSUDs的无家可归者在PCMHs中的就医体验尚不清楚。本研究比较了在退伍军人健康管理局的医疗之家环境（称为患者协作医疗团队）中接受治疗的患有MHSUDs的无家可归退伍军人和非无家可归退伍军人的初级保健体验。样本包括对2013年全国PCMH患者医疗保健体验调查（PCMH-SHEP）做出回应且在过去一年被诊断患有MSHUD的退伍军人健康管理局门诊患者。通过退伍军人健康管理局的行政记录确定有无家可归迹象的退伍军人（以下简称“无家可归者”）。PCMH-SHEP调查的受访者包括67666名患有MHSUDs的退伍军人（9.2%为无家可归者）。与非无家可归的同行相比，无家可归的退伍军人更年轻，更有可能是非西班牙裔黑人且未婚，受教育程度较低，并且更有可能居住在城市地区。在评估的大多数MHSUDs中，无家可归退伍军人的发病率更高，表明共病情况严重。在控制了这些差异之后，与非无家可归退伍军人相比，无家可归退伍军人报告的沟通负面经历更多、正面经历更少；对医疗服务提供者的评价更低；在全面性、护理协调、药物决策和自我管理支持方面的负面经历更多。患有MHSUDs的无家可归者可能需要特定服务，以减轻负面的就医体验并鼓励他们继续接受纵向初级保健服务。（PsycINFO数据库记录）
