Homeless Veterans Report More Positive Experiences in Facilities with Homeless-Tailored Primary Care Teams
Homeless patients describe poor experiences with primary care. In 2012, VA implemented homeless-tailored primary care teams (HPACTs) that could improve the primary care experience for these patients. This retrospective cohort study compared the primary care experiences of homeless and non-homeless Veterans from 25 VA facilities that had HPACTs available in 2012 and 485 facilities lacking HPACTs. Data were obtained from the 2014-2015 Survey of Healthcare Experiences of Patients (SHEP). The survey included information on 2,022 homeless and 20,941 non-homeless patients from facilities with HPACTs available, and 10,148 homeless and 309,779 non-homeless patients from facilities lacking HPACTs. Positive and negative experiences were assessed in 8 primary care domains: access, communication, office staff helpfulness, provider rating, comprehensiveness (provider attention to mental health/substance abuse), coordination, medication shared decision-making, and self-management support.
- In facilities lacking HPACT programs, homeless Veterans reported more negative experiences with communication and fewer positive experiences with comprehensiveness, compared to non-homeless Veterans in the same facilities.
- In facilities with HPACTs, homeless Veterans reported more positive and/or fewer negative experiences with office staff, provider ratings, comprehensiveness, and self-management support, compared to non-homeless Veterans in the same facilities.
- Many of the domains in which homeless Veterans reported more positive experiences than non-homeless Veterans are key targets of the HPACT program.
- Facilities with HPACT programs offer a better primary care experience for homeless Veterans, reversing the pattern of relatively poor primary care experiences that is often associated with homelessness.
- Modest survey response rates among homeless Veterans may underestimate the prevalence of negative healthcare experiences.
- The study definition of homelessness was based on administrative records, and could include individuals with housing at the time of the survey.
- Investigators were unable to identify actual visits to HPACT, preventing a determination of whether positive experiences in facilities with HPACT programs were a direct result of HPACT engagement.
Dr. Jones is part of HSR&D's Informatics, Decision-Enhancement and Analytic Sciences (IDEAS 2.0) Center of Innovation in Salt Lake City. Dr. Hausmann is part of HSR&D's Center for Health Equity Research & Promotion (CHERP) in Pittsburgh. Dr. Kertesz is an HSR&D investigator at the VA Birmingham Medical Center.
Jones A, Hausmann L, Kertesz S, et al. Differences in Experiences with Care between Homeless and Non-Homeless Patients in Veterans Affairs Facilities with Tailored and Non-Tailored Primary Care Teams. Medical Care. July 2018;56(7):610-18.