A National Evaluation of Homeless and Nonhomeless Veterans' Experiences With Primary Care
A National Evaluation of Homeless and Nonhomeless Veterans' Experiences With Primary Care
复制标题
DOI：
10.1037/ser0000116
复制
发表时间：
2017-05-01
影响因子：
2.3
通讯作者：
Gordon, Adam J.
中科院分区：
文献类型：
--
作者：
Jones, Audrey L.;Hausmann, Leslie R. M.;Gordon, Adam J.
无家可归者，尤其是那些患有精神健康和/或物质使用障碍（MHSUDs）的人，往往无法获得或接受持续的初级医疗服务。此外，初级医疗的负面经历可能导致无家可归者回避并提前终止MHSUD治疗。以患者为中心的医疗之家（PCMH）模式旨在解决医疗服务碎片化问题并改善患者体验。患有MHSUD的无家可归者在PCMH中的医疗体验如何尚不清楚。本研究比较了在退伍军人健康管理局的医疗之家环境（称为患者对齐医疗团队）中接受治疗的患有MHSUD的无家可归和非无家可归退伍军人的初级医疗体验。样本包括对2013年全国PCMH - 患者医疗体验调查（PCMH - SHEP）做出回应且在过去一年中有MHSUD诊断的退伍军人健康管理局门诊患者。通过退伍军人健康管理局的行政记录确定有流浪证据的退伍军人（以下简称“无家可归者”）。PCMH - SHEP调查的受访者包括67666名患有MHSUD的退伍军人（9.2%无家可归）。与非无家可归的同龄人相比，无家可归的退伍军人更年轻，更有可能是非西班牙裔黑人且未婚，受教育程度较低，并且更有可能居住在城市地区。无家可归的退伍军人大多数被评估的MHSUD发病率较高，表明并发情况显著。在控制了这些差异之后，无家可归的退伍军人在沟通方面报告了更多负面体验和更少正面体验；对医疗服务提供者的评价更负面；并且在医疗服务的全面性、医疗协调、药物决策和自我管理支持方面比非无家可归的退伍军人有更多负面体验。患有MHSUD的无家可归者可能需要特定的服务来减轻负面医疗体验并鼓励他们继续接受长期初级医疗服务。
Persons who are homeless, particularly those with mental health and/or substance use disorders (MHSUDs), often do not access or receive continuous primary care services. In addition, negative experiences with primary care might contribute to homeless persons' avoidance and early termination of MHSUD treatment. The patient-centered medical home (PCMH) model aims to address care fragmentation and improve patient experiences. How homeless persons with MHSUDs experience care within PCMHs is unknown. This study compared the primary care experiences of homeless and nonhomeless veterans with MHSUDs receiving care in the Veterans Health Administration's medical home environment, called Patient Aligned Care Teams. The sample included VHA outpatients who responded to the national 2013 PCMH-Survey of Health Care Experiences of Patients (PCMH-SHEP) and had a past-year MSHUD diagnosis. Veterans with evidence of homelessness (henceforth "homeless") were identified through VHA administrative records. PCMH-SHEP survey respondents included 67,666 veterans with MHSUDs (9.2% homeless). Compared with their nonhomeless counterparts, homeless veterans were younger, more likely to be non-Hispanic Black and nonmarried, had less education, and were more likely to live in urban areas. Homeless veterans had elevated rates of most MHSUDs assessed, indicating significant co-occurrence. After controlling for these differences, homeless veterans reported more negative and fewer positive experiences with communication; more negative provider ratings; and more negative experiences with comprehensiveness, care coordination, medication decision-making, and self-management support than nonhomeless veterans. Homeless persons with MHSUDs may need specific services that mitigate negative care experiences and encourage their continuation in longitudinal primary care services.