Effects of Homeless Veterans' Use of Peer Mentors
Homeless Veterans with multiple medical and psychiatric comorbidities pose challenges for ambulatory care practices since they have complex clinical and psychosocial demands for care. Some chronically ill patients have benefitted from peer support programs since peers can relate more closely to the concerns of other patients, support self-management techniques, and act as role models. This two-arm randomized trial tested the use of peer mentors among homeless Veterans at VA primary care clinics. Between January 2012 and September 2013, homeless patients at four VA clinics were randomly assigned to a peer mentor (n=195) or usual care (n=180). Two VA sites had existing patient-centered medical home models tailored for homeless patients, called Homeless Patient Aligned Care Teams (H-PACT), while the other two sites were regular PACT sites. Investigators combined administrative data on utilization and costs with peer mentors' reports of patient contacts to assess patient demographics, contacts with peer mentors, topics of discussion between Veterans and peers, as well as VA healthcare use and cost. Healthcare utilization was measured for six months prior to and six months following study enrollment.
- While significant impacts of peer mentors on healthcare patterns or costs were not detected, some patients engaged in frequent contact with peer mentors. Most (87%) of the peer mentor group had at least one peer contact – and spent the most time discussing housing and health issues. Patients also spent time discussing basic needs (i.e., food and clothing), VA benefits, work experience, and social issues.
- Peer mentor patients had more outpatient encounters, although differences were not significant.. There were no other differences in utilization or costs between groups. Costs of the peer mentor intervention were estimated to be $737 per patient.
- Peer mentors may serve a key role in building trust between patients and providers to foster engagement with the healthcare system. However, further investigations are needed with larger sample sizes and longer follow-up periods to determine whether peer mentors can increase outpatient utilization and reduce acute care to improve care overall.
- Because Veterans in this study already had accessible primary care and exhibited high levels of acute care utilization at baseline, it may be difficult for ambulatory care interventions to affect acute care for these types of patients.
- Investigators did not measure outcomes on quality of life or social support, so future work should examine whether peer mentors can affect these outcomes.
This study was funded by HSR&D (SDR 11-230). Dr. Yoon is part of HSR&D's Health Economics Resource Center (HERC), and Dr. O'Toole is part of HSR&D's Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans.
Yoon J, Lo J, Gehlert E, Johnson, E, and O’Toole T. Homeless Veterans’ Use of Peer Mentors and Effects on Costs and Utilization in VA Clinics. Psychiatric Services. February 1, 2017; Epub ahead of print.