TY - JOUR
T1 - Tailoring Outreach Efforts to Increase Primary Care Use Among Homeless Veterans
T2 - Results of a Randomized Controlled Trial
AU - O’Toole, Thomas P.
AU - Johnson, Erin E.
AU - Borgia, Matthew L.
AU - Rose, Jennifer
PY - 2015/2/12
Y1 - 2015/2/12
N2 - BACKGROUND: Homeless individuals often have significant unmet health care needs that are critical to helping them leave homelessness. However, engaging them in primary and mental health care services is often elusive and difficult to achieve. OBJECTIVE: We aimed to increase health-seeking behavior and receipt of health care among homeless Veterans. DESIGN: This was a multi-center, prospective, community-based, two-by-two randomized controlled trial of homeless Veterans. PARTICIPANTS: Homeless Veterans not receiving primary care participated in the study. INTERVENTIONS: An outreach intervention that included a personal health assessment and brief intervention (PHA/BI), and/or a clinic orientation (CO) was implemented. MAIN MEASURE: We measured receipt of primary care within 4 weeks of study enrollment. KEY RESULTS: Overall, 185 homeless Veterans were enrolled: the average age was 48.6 years (SD 10.8), 94.6 % were male, 43.0 % were from a minority population, 12.0 % were unsheltered, 25.5 % were staying in a dusk-to-dawn emergency shelter, 26.1 % were in transitional housing, while 27.7 % were in an unstable, doubled-up arrangement. At one month, 77.3 % of the PHA/BI plus CO group accessed primary care and by 6 months, 88.7 % had been seen in primary care. This was followed by the CO-only group, 50.0 % of whom accessed care in the first 4 weeks, the PHI/BI-only arm at 41.0 % and the Usual Care arm at 30.6 %. Chi-squared tests by group were significant (p <0.001) at both 4 weeks and 6 months. There was no difference in attitudes about care at baseline and 6 months or in use patterns once enrolled in care. CONCLUSIONS: Our findings suggest that treatment-resistant/avoidant homeless Veterans can be effectively engaged in primary and other clinical care services through a relatively low intensity, targeted and tailored outreach effort.
AB - BACKGROUND: Homeless individuals often have significant unmet health care needs that are critical to helping them leave homelessness. However, engaging them in primary and mental health care services is often elusive and difficult to achieve. OBJECTIVE: We aimed to increase health-seeking behavior and receipt of health care among homeless Veterans. DESIGN: This was a multi-center, prospective, community-based, two-by-two randomized controlled trial of homeless Veterans. PARTICIPANTS: Homeless Veterans not receiving primary care participated in the study. INTERVENTIONS: An outreach intervention that included a personal health assessment and brief intervention (PHA/BI), and/or a clinic orientation (CO) was implemented. MAIN MEASURE: We measured receipt of primary care within 4 weeks of study enrollment. KEY RESULTS: Overall, 185 homeless Veterans were enrolled: the average age was 48.6 years (SD 10.8), 94.6 % were male, 43.0 % were from a minority population, 12.0 % were unsheltered, 25.5 % were staying in a dusk-to-dawn emergency shelter, 26.1 % were in transitional housing, while 27.7 % were in an unstable, doubled-up arrangement. At one month, 77.3 % of the PHA/BI plus CO group accessed primary care and by 6 months, 88.7 % had been seen in primary care. This was followed by the CO-only group, 50.0 % of whom accessed care in the first 4 weeks, the PHI/BI-only arm at 41.0 % and the Usual Care arm at 30.6 %. Chi-squared tests by group were significant (p <0.001) at both 4 weeks and 6 months. There was no difference in attitudes about care at baseline and 6 months or in use patterns once enrolled in care. CONCLUSIONS: Our findings suggest that treatment-resistant/avoidant homeless Veterans can be effectively engaged in primary and other clinical care services through a relatively low intensity, targeted and tailored outreach effort.
KW - community outreach
KW - homeless persons
KW - patient engagement
KW - Veterans
UR - http://www.scopus.com/inward/record.url?scp=84931567389&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84931567389&partnerID=8YFLogxK
U2 - 10.1007/s11606-015-3193-x
DO - 10.1007/s11606-015-3193-x
M3 - Article
C2 - 25673574
AN - SCOPUS:84931567389
SN - 0884-8734
VL - 30
SP - 886
EP - 898
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
IS - 7
ER -