Preferences for sites of care among urban homeless and housed poor adults

OBJECTIVE: To describe sources of health care used by homeless and housed poor adults. DESIGN: In a cross-sectional survey, face-to-face interviews were conducted to assess source of usual care, preferred site of care for specific problems, perceived need for health insurance at different sites of care, and satisfaction with care received. Polychotomous logistic regression analysis was used to identify the factors associated with selecting non-ambulatory-care sites for usual care. SETTING: Twenty-four community-based sites (i.e., soup kitchens, drop-in centers, and emergency shelters) frequented by the homeless and housed poor in Allegheny County, Pa. PARTICIPANTS: Of the 388 survey respondents, 85.6% were male, 78.1% African American, 76.9% between 30 and 49 years of age, 59.3% were homeless less than I year, and 70.6% had health insurance. MAIN RESULTS: Overall, 350 (90.2%) of the respondents were able to identify a source of usual medical care. Of those, 51.3% identified traditional ambulatory care sites (i.e., hospital- based clinics, community and VA clinics, and private physicians offices); 28.9% chose emergency departments; 8.0%, clinics based in shelters or drop-in centers; and 2.1%, other sites. Factors associated with identifying nonambulatory sites for usual care included lack of health insurance (relative risk range for all sites [RR] = 3.1-4.0), homelessness for more than 2 years (RR = 1.4-3.0), receiving no medical care in the previous 6 months (RR = 1.6-7.5), nonveteran status (RR = 1.0-2.5), being unmarried (RR = 1.2-3.1), and white race (RR = 1.0-3.3). CONCLUSIONS: Having no health insurance or need for care in the past 6 months increased the use of a non- ambulatory-care site as a place for usual care. Programs designed to decrease emergency department use may need to be directed at those not currently accessing any care.