Department of Sociology, University of Massachusetts Boston.
Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Harvard Medical Center, Boston.
Med Care. 2021 Apr 1;59(Suppl 2):S117-S123. doi: 10.1097/MLR.0000000000001498.
The behavioral model of health service use identified health needs, service preferences (predispositions), and service availability (enabling factors) as important predictors, but research has not conceptualized consistently each type of influence nor identified their separate effects on use of substance abuse and mental health services or their value in predicting service outcomes.
To test hypotheses predicting use of substance abuse and mental health services and residential stability and evaluate peer specialists' impact.
Randomized trial of peer support added to standard case management in VA-supported housing program (Housing and Urban Development-VA Supportive Housing program).
One hundred sixty-six dually diagnosed Veterans in Housing and Urban Development-VA Supportive Housing program in 2 cities.
Average VA service episodes for substance abuse and mental illness; residential instability; preferences for alcohol, drug, and psychological services; extent of alcohol, drug, and psychological problems; availability of a peer specialist.
Self-assessed health needs, mediated by service preferences, and assignment to a peer specialist predicted use of VA behavioral health services and residential stability, as did chronic medical problems, sex, and race.
The behavioral model identifies major predictors of health service use and residential stability, but must recognize the mediating role of service preferences, the differing effects of alcohol and drug use, the unique influences of social background, and the importance of clinical judgment in needs assessment. Service availability and residential stability can be increased by proactive efforts involving peer specialists even in a health care system that provides services without a financial barrier.
健康服务利用行为模型将健康需求、服务偏好（倾向）和服务可及性（促成因素）确定为重要的预测因素，但研究尚未一致地概念化每种类型的影响，也未确定它们对药物滥用和心理健康服务使用的单独影响，或它们在预测服务结果方面的价值。
检验预测药物滥用和心理健康服务以及居住稳定性使用的假设，并评估同伴专家的影响。
在退伍军人事务部支持的住房计划（住房和城市发展-退伍军人事务部支持住房计划）中，对同伴支持添加到标准个案管理的随机试验。
来自住房和城市发展-退伍军人事务部支持住房计划的 2 个城市的 166 名双重诊断退伍军人。
退伍军人事务部用于药物滥用和精神疾病的平均服务事件；居住不稳定；对酒精、药物和心理服务的偏好；酒精、药物和心理问题的严重程度；同伴专家的可用性。
自我评估的健康需求通过服务偏好进行中介，以及分配给同伴专家，预测了退伍军人事务部行为健康服务和居住稳定性的使用，慢性医疗问题、性别和种族也是如此。
行为模型确定了健康服务使用和居住稳定性的主要预测因素，但必须认识到服务偏好的中介作用、酒精和药物使用的不同影响、社会背景的独特影响以及临床判断在需求评估中的重要性。通过涉及同伴专家的积极努力，即使在提供服务没有财务障碍的医疗保健系统中，也可以增加服务可用性和居住稳定性。
