Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VA Healthcare System, Bedford, Massachusetts, USA.
Robert and Donna Manning College Nursing & Health Sciences, University of Massachusetts, Boston, Massachusetts, USA.
Health Soc Care Community. 2022 Nov;30(6):e5755-e5764. doi: 10.1111/hsc.14007. Epub 2022 Sep 12.
People experiencing homelessness (PEH) have stated that impersonal care and feelings of discrimination are barriers to accessing healthcare which is associated with poor health outcomes amongst PEH. This study examined whether patient-centred care (PCC) mediates the relationship between access to care and subjective health outcomes. Using the 2014-15 Healthcare Center Patient Survey, we identified 1873 homeless and vulnerably housed adults. Items related to the delay or inability to receive primary or mental healthcare, PCC provided by healthcare providers, general health status, and the Kessler-6 psychological distress scale were selected. Ordinary least squares analyses were used to perform mediation analysis. We found that both access to primary care and access to mental healthcare were positively associated with physical health status (β = 0.492, p < 0.001; β = 0.311, p < 0.001) and negatively associated with psychological distress (β = -2.53, p < 0.001; β = -1.85, p < 0.001). PCC partially mediated all associations, but the mediation was stronger in the relationships between access to primary care and health outcomes (ab = 0.25, 95% CI [0.002, 0.052]; ab = -0.21, 95% CI [-0.37, -0.07]) compared to mental healthcare (ab = 0.02, 95% CI [0.01, 0.04]; ab = -0.14, 95% CI [-0.25, -0.06]). The results of this study indicated access to primary and mental healthcare is important in the patient-centred health outcomes of PEH. Additionally, the partial mediation of PCC in these relationships indicated that participants' perception of collaborative, trustworthy, respectful care from healthcare providers impacted the relationship between access to healthcare and health outcomes.
无家可归者（PEH）表示，非个人化的护理和歧视感是他们获得医疗保健的障碍，这与 PEH 的健康状况不佳有关。本研究检验了以患者为中心的护理（PCC）是否在获得医疗保健和主观健康结果之间起中介作用。我们使用了 2014-15 年医疗中心患者调查，确定了 1873 名无家可归和脆弱住房的成年人。选择了与延迟或无法获得初级或精神保健、医疗保健提供者提供的 PCC、一般健康状况以及 Kessler-6 心理困扰量表相关的项目。使用普通最小二乘法进行中介分析。我们发现，获得初级保健和获得精神保健都与身体健康状况呈正相关（β=0.492，p<0.001；β=0.311，p<0.001），与心理困扰呈负相关（β=-2.53，p<0.001；β=-1.85，p<0.001）。PCC 部分中介了所有关联，但在获得初级保健和健康结果之间的关联中，中介作用更强（ab=0.25，95%置信区间[0.002，0.052]；ab=-0.21，95%置信区间[-0.37，-0.07]），而与精神保健相比（ab=0.02，95%置信区间[0.01，0.04]；ab=-0.14，95%置信区间[-0.25，-0.06]）。本研究结果表明，获得初级和精神保健对 PEH 的以患者为中心的健康结果很重要。此外，PCC 在这些关系中的部分中介作用表明，参与者对医疗保健提供者协作、值得信赖、尊重的护理的感知影响了获得医疗保健和健康结果之间的关系。
