2011 HSR&D National Meeting Abstract
1061 — Accessing Homeless-Oriented Primary Care and Making the Transition to Stable Sheltering
O'Toole TP (Providence VAMC (PVAMC) REAP), Bourgault C
(PVAMC), Johnson E
(PVAMC REAP), Redihan S
We sought to study the relationship between accessing a homeless oriented primary care model and transitioning out of homelessness.
Prospective cohort study of homeless veterans newly enrolled in a homeless-oriented primary care model. Primary outcome measures were stabilization of sheltering, referral to and receipt of additional services, and health services utilization.
Overall, 65 study subjects were followed for 6 months following their initial visit to primary care. The average age was 51.4 years, 70% were white and 93.7% were male. At enrollment, 12.5% were unsheltered, 34.4% were in an emergency shelter, 18.8% were doubled-up, and 32.8% were in transitional housing. 23.8% had a mental health diagnosis and 93.8% had at least one chronic medical condition (average 2.3/person). At the initial visit, all patients received assistance with housing and benefits eligibility and 21.8% received a referral for mental health care, 18.8% for substance abuse treatment, 45.3% for specialty care, and 40.6% for vocational services. Over the following 6 months, 73.8% of respondents either moved to more stable sheltering (from unsheltered, emergency sheltered or doubled-up to transitional or permanent supportive housing) or remained in stable sheltering if they presented in that arrangement. Only 4 patients moved to less stable housing. While there was no difference in the proportion receiving mental health or substance abuse services or in the average number of primary care visits (6.2), those persons moving to more stable housing had more primary care contacts in the time immediately preceding their sheltering change than those without a shelter change. There were a total of 65 ED visits by the group (ave 1.0/person), with most visits occurring in the first month (0.31/person/month) when more individuals had unstable sheltering than in months 2 and 3 (0.17 visits/pt/mo) and months 4, 5, and 6 (0.12 visits/person/month).
The majority of homeless veterans attending an open access, integrated services primary care model moved to stable housing or stayed in stable housing at rates higher than previously noted in the literature.
Modifying the PACT model of care for high-risk patients has both societal and health systems benefits.