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Publication Briefs

Homeless Veterans Report More Positive Experiences in Facilities with Homeless-Tailored Primary Care Teams


BACKGROUND:
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.

FINDINGS:

  • 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.

IMPLICATIONS:

  • 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.

LIMITATIONS:

  • 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.

AUTHOR/FUNDING INFORMATION:
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.


PubMed Logo 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.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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