Suchergebnisse

AbstractEfforts to end long‐term homelessness have embraced a Housing First approach. Housing First emphasises rapid placement of clients into independent, permanent accommodation and eschews traditionally favoured requirements that clients demonstrate sobriety or success in treatment programs prior to being offered housing. Although housing retention rates are superior to those obtained from traditional programs, some claims made on behalf of the Housing First approach remain controversial. The present article reviews results from Housing First research to date, as well as challenges and concerns that remain in regard to clinical outcomes, fidelity of implementation and application in the Australian context.

BACKGROUND: In 2012, select Veterans Health Administration (VHA) facilities implemented a homeless-tailored medical home model (called H-PACT) to improve care processes and outcomes for homeless Veterans. OBJECTIVE. To determine whether H-PACT offers a better patient experience than standard VHA primary care. RESEARCH DESIGN: We used multivariable logistic regressions to estimate differences in the probability of reporting positive primary care experiences on a national survey. SUBJECTS: Homeless-experienced survey respondents enrolled in H-PACT (n=251) or standard primary care in facilities with HPACT available (n=1,527) and facilities without H-PACT (n=10,079). MEASURES: Patient experiences in eight domains from the Consumer Assessment of Healthcare Provider and Systems surveys. Domain scores were categorized as positive versus non-positive. RESULTS: H-PACT patients were less likely than standard primary care patients to be female, have four-year college degrees, or to have served in recent military conflicts; they received more primary care visits and social services. H-PACT patients were more likely than standard primary care patients in the same facilities to report positive experiences with access (adjusted risk difference[RD]=17.4), communication (RD=13.9), office staff (RD=13.1), provider ratings (RD=11.0), and comprehensiveness (RD=9.3). Standard primary care patients in facilities with H-PACT available were more likely than those from facilities without H-PACT to report positive experiences with communication (RD=4.7) and self-management support (RD=4.6). CONCLUSIONS: Patient-centered medical homes designed to address the social determinants of health offer a better care experience for homeless patients, compared to standard primary care approaches. The lessons learned from H-PACT can be applied throughout VHA and to other healthcare settings.