Douglas Mental Health University Institute, Montréal, QC, Canada.
Department of Psychiatry, McGill University, Montreal, QC, Canada.
Health Soc Care Community. 2020 Jan;28(1):22-33. doi: 10.1111/hsc.12834. Epub 2019 Aug 26.
User satisfaction is a crucial quality indicator in health service provision. Few studies have measured user satisfaction among homeless and formerly homeless individuals, despite the high prevalence of mental health disorders (MHD) in this population. The purpose of this study was to assess overall satisfaction among 455 homeless and formerly homeless individuals who were receiving health and community services, and to identify factors associated with user satisfaction. Data collection occurred between January and September 2017. Study participants were 18 years old or over, with experience of homelessness in the current or recent past. They completed a questionnaire eliciting socio-demographic information, and data on residential history, service use and satisfaction and health profiles. Multivariate linear analysis was performed on overall satisfaction with health and community services in the previous 12 months. Independent variables were organised as predisposing, enabling and needs factors based on the Gelberg-Andersen Behavioral Model. The mean satisfaction score was 4.11 (minimum: 1; maximum: 5). Variables associated with greater user satisfaction included: older age, residence in permanent housing, common MHD (e.g., depression, anxiety), having a family physician, having a case manager, strong social network, good quality of life and, marginally, male sex and having substance use disorders (SUD). By contrast, frequent users of public ambulatory health services were the most dissatisfied. User satisfaction was more strongly associated with enabling factors. Strategies for improving satisfaction include: promoting more tailored primary care programmes (including family physician) adapted to the needs of this population, better integrating primary care with specialised services including SUD integrated treatment and enhancing continuity of care through the reinforcement of case management services. Further efforts aimed at increasing access to permanent housing with supports, and eliciting more active involvement by relatives and friends may also improve user satisfaction with services, and reduce unnecessary service use.
用户满意度是医疗服务提供的一个关键质量指标。尽管该人群中心理健康障碍（MHD）的患病率很高，但很少有研究衡量无家可归者和以前无家可归者的用户满意度。本研究的目的是评估正在接受健康和社区服务的 455 名无家可归者和以前无家可归者的总体满意度，并确定与用户满意度相关的因素。数据收集于 2017 年 1 月至 9 月进行。研究参与者年龄在 18 岁或以上，目前或近期有过无家可归经历。他们完成了一份调查问卷，内容包括社会人口统计学信息、居住史、服务使用和满意度以及健康状况。对过去 12 个月内对健康和社区服务的总体满意度进行了多变量线性分析。根据 Gelberg-Andersen 行为模型，将自变量组织为倾向因素、促成因素和需求因素。满意度平均得分为 4.11（最低：1；最高：5）。与更高的用户满意度相关的变量包括：年龄较大、居住在永久性住房中、常见的 MHD（例如抑郁、焦虑）、有家庭医生、有个案经理、强大的社会网络、良好的生活质量以及边缘上的男性和物质使用障碍（SUD）。相比之下，经常使用公共门诊卫生服务的人最不满意。用户满意度与促成因素的相关性更强。提高满意度的策略包括：促进更适合该人群需求的量身定制的初级保健计划（包括家庭医生），更好地将初级保健与包括 SUD 综合治疗在内的专业服务相结合，并通过加强个案管理服务来增强护理的连续性。进一步努力增加有支持的永久性住房的获得机会，并促使亲属和朋友更积极地参与，也可能提高服务的用户满意度，并减少不必要的服务使用。
