The impact of patient-centred care on the relationship between access to care and subjective health outcomes amongst people experiencing homelessness: A mediation analysis.
adult mental healthcare
health status
homelessness
patient centered care
primary care
Journal
Health & social care in the community
ISSN: 1365-2524
Titre abrégé: Health Soc Care Community
Pays: England
ID NLM: 9306359
Informations de publication
Date de publication:
11 2022
11 2022
Historique:
revised:
10
08
2022
received:
28
02
2022
accepted:
20
08
2022
pubmed:
13
9
2022
medline:
20
12
2022
entrez:
12
9
2022
Statut:
ppublish
Résumé
People experiencing homelessness (PEH) have stated that impersonal care and feelings of discrimination are barriers to accessing healthcare which is associated with poor health outcomes amongst PEH. This study examined whether patient-centred care (PCC) mediates the relationship between access to care and subjective health outcomes. Using the 2014-15 Healthcare Center Patient Survey, we identified 1873 homeless and vulnerably housed adults. Items related to the delay or inability to receive primary or mental healthcare, PCC provided by healthcare providers, general health status, and the Kessler-6 psychological distress scale were selected. Ordinary least squares analyses were used to perform mediation analysis. We found that both access to primary care and access to mental healthcare were positively associated with physical health status (β = 0.492, p < 0.001; β = 0.311, p < 0.001) and negatively associated with psychological distress (β = -2.53, p < 0.001; β = -1.85, p < 0.001). PCC partially mediated all associations, but the mediation was stronger in the relationships between access to primary care and health outcomes (ab = 0.25, 95% CI [0.002, 0.052]; ab = -0.21, 95% CI [-0.37, -0.07]) compared to mental healthcare (ab = 0.02, 95% CI [0.01, 0.04]; ab = -0.14, 95% CI [-0.25, -0.06]). The results of this study indicated access to primary and mental healthcare is important in the patient-centred health outcomes of PEH. Additionally, the partial mediation of PCC in these relationships indicated that participants' perception of collaborative, trustworthy, respectful care from healthcare providers impacted the relationship between access to healthcare and health outcomes.
Types de publication
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
e5755-e5764Informations de copyright
© 2022 John Wiley & Sons Ltd.
Références
Aldridge, R. W., Story, A., Hwang, S. W., Nordentoft, M., Luchenski, S. A., Hartwell, G., Tweed, E. J., Lewer, D., Vittal Katikireddi, S., & Hayward, A. C. (2018). Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: A systematic review and meta-analysis. The Lancet, 391(10117), 241-250. https://doi.org/10.1016/s0140-6736(17)31869-x
Andersson, V., Sawatzky, R., & Öhlén, J. (2022). Relating person-centredness to quality-of-life assessments and patient-reported outcomes in healthcare: A critical theoretical discussion. Nursing Philosophy, 23(3), 1-10. https://doi.org/10.1111/nup.12391
Apers, S., Dancet, E., Aarts, J., Kluivers, K. B., D'Hooghe, T. M., & Nelen, W. (2018). The association between experiences with patient-centred care and health-related quality of life in women with endometriosis. Reproductive Biomedicine Online, 36(2), 197-205. https://doi.org/10.1016/j.rbmo.2017.10.106
Argintaru, N., Chambers, C., Gogosis, E., Farrell, S., Palepu, A., Klodawsky, F., & Hwang, S. (2013). A cross-sectional observational study of unmet health needs among homeless and vulnerably housed adults in three Canadian cities. BMC Public Health, 13(577), 1-9. https://doi.org/10.1186/1471-2458-13-577
Asgary, R. (2018). Cancer screening in the homeless population. The Lancet Oncology, 19(7), e344-e350. https://doi.org/10.1016/S1470-2045(18)30200-6
Baggett, T. P., Berkowitz, S. A., Fung, V., & Gaeta, J. M. (2018). Prevalence of housing problems among community health center patients. JAMA, 319(7), 717-719. https://doi.org/10.1001/jama.2017.19869
Baggett, T. P., Liauw, S. S., & Hwang, S. W. (2018). Cardiovascular disease and homelessness. Journal of the American College of Cardiology, 71(22), 2585-2597. https://doi.org/10.1016/j.jacc.2018.02.077
Behl-Chadha, B., Savageau, J. A., Bharel, M., Gagnon, M., Lei, P., & Hillerns, C. (2017). Comparison of patient experience between a practice for homeless patients and other practices engaged in a patient-centered medical home initiative. Journal of Health Care for the Poor and Underserved, 28(3), 1151-1164. https://doi.org/10.1353/hpu.2017.0103
Bell, L., Whelan, M. E., Fernandez, E., & Lycett, D. (2022). Nurse-led mental and physical healthcare for the homeless community: A qualitative evaluation. Health & Social Care in the Community. Advance online publication. https://doi.org/10.1111/hsc.13778
Bowling, A. (2005). Just one question: If one question works, why ask several? Journal of Epidemiology & Community Health, 59, 342-345. https://doi.org/10.1136/jech.2004.021204
Centers for Disease Control. (2021). Patient-centered medical home (PCMH) model. https://www.cdc.gov/dhdsp/policy_resources/pcmh.htm?msclkid=8f49bcefcd6511ecb6456dbba6b10dd0
DeSalvo, K. B., Fisher, W., Tran, K., Bloser, N., Merrill, W., & Peabody, J. (2006). Assessing measurement properties of two single-item general health measures. Quality of Life Research, 15(2), 191-201. https://doi.org/10.1007/s11136-005-0887-2
Epstein, R. M., & Street, R. L., Jr. (2011). The values and value of patient-centered care. Annals of Family Medicine, 9(2), 100-103. https://doi.org/10.1370/afm.1239
Fazel, S., Geddes, J., & Kushel, M. (2014). The health of homeless people in high-income countries: Descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet, 384, 1529-1540. https://doi.org/10.1016/S0140-6736(14)61132-6
Flike, K., & Aronowitz, T. (2021). Factors which influence quality of life in people experiencing homelessness: A systematic mixed studies review. Journal of the American Psychiatric Nurses Association, 28(2), 128-153. https://doi.org/10.1177/1078390320985286
Flike, K., Foust, J. B., Hayman, L. L., & Aronowitz, T. (2022). Homelessness and vulnerably-housed defined: A synthesis of the literature. Nursing Science Quarterly, 35(3), 350-367. https://doi.org/10.1177/08943184221092445
Garey, L., Reitzel, L. R., Kendzor, D. E., & Businelle, M. S. (2016). The potential explanatory role of perceived stress in associations between subjective social status and health-related quality of life among homeless smokers. Behavior Modification, 40(1-2), 303-324. https://doi.org/10.1177/0145445515612396
Harvard Joint Center for Housing Studies. (2020). America's rental housing 2020. https://www.jchs.harvard.edu/sites/default/files/Harvard_JCHS_Americas_Rental_Housing_2020.pdf
Hayes, A. (2018). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. The Guilford Press.
Health Resources & Services Administration. (2016). 2014 health center patient survey data file user's manual. https://bphc.hrsa.gov/datareporting/research/hcpsurvey/2014usermanual.pdf
Health Resources & Services Administration. (2021). Health center program: Impact and growth. https://bphc.hrsa.gov/about/healthcenterprogram/index.html
Henry, M., De Sousa, T., Roddey, C., Gayan, S., Bednar, T., & Abt Associates. (2021). The 2020 annual homeless assessment report to congress. The Department of Housing and Urban Development. https://www.huduser.gov/portal/sites/default/files/pdf/2020-AHAR-Part-1.pdf
Homeless Emergency Assistance and Rapid Transition to Housing Act of 2009. (2009). Definition of homelessness. PL 111-22, Sec 1003. 111th Congress ed: US Congress. https://www.hudexchange.info/resources/documents/S896_HEARTHAct.pdf
Hong, Y. R., Samuels, S. K., Huo, J. H., Lee, N., Mansoor, H., & Duncan, R. P. (2019). Patient-centered care factors and access to care: A path analysis using the Andersen behavior model. Public Health, 171, 41-49. https://doi.org/10.1016/j.puhe.2019.03.020
Hwang, S. W., Ueng, J. J., Chiu, S., Kiss, A., Tolomiczenko, G., Cowan, L., Levinson, W., & Redelmeier, D. A. (2010). Universal health insurance and health care access for homeless persons. American Journal of Public Health, 100(8), 1454-1461. https://doi.org/10.2105/AJPH.2009.182022
Hwang, S. W., Wilkins, R., Tjepkema, M., O'Campo, P. J., & Dunn, J. R. (2009). Mortality among residents of shelters, rooming houses, and hotels in Canada: 11 year follow-up study. BMJ Clinical Research, 339, 1-9. https://doi.org/10.1136/bmj.b4036
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. The National Academies Press. https://doi.org/10.17226/10027
Institute of Medicine. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. The National Academies Press. https://doi.org/10.17226/10260
Jones, A. L., Hausmann, L., Kertesz, S. G., Suo, Y., Cashy, J. P., Mor, M. K., Pettey, W., Schaefer, J. H., Jr., Gordon, A. J., & Gundlapalli, A. V. (2019). Providing positive primary care experiences for homeless veterans through tailored medical homes: The veterans health Administration's homeless patient aligned care teams. Medical Care, 57(4), 270-278. https://doi.org/10.1097/MLR.0000000000001070
Jones, A. L., Hausmann, L. R. M., Haas, G. L., Mor, M. K., Cashy, J. P., Schaefer, J. H., & Gordon, A. J. (2017). A national evaluation of homeless and nonhomeless veterans' experiences with primary care. Psychological Services, 14(2), 174-183. https://doi.org/10.1037/ser0000116
Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S. L., Walters, E. E., & Zaslavsky, A. M. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(6), 959-976. https://doi.org/10.1017/s0033291702006074
Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E., Howes, M. J., Normand, S. T., Mandersheid, R. W., Walters, E. E., & Zaslavsky, A. M. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60(2), 184-189. https://doi.org/10.1001/archpsyc.60.2.184
Kushel, M. B., Vittinghoff, E., & Haas, J. S. (2001). Factors associated with the health care utilization of homeless persons. JAMA, 285(2), 200-206. https://doi.org/10.1001/jama.285.2.200
Lebrun-Harris, L. A., Baggett, T. P., Jenkins, D. M., Sripipatana, A., Sharma, R., Hayashi, A. S., Daly, C. A., & Ngo-Metzger, Q. (2013). Health status and health care experiences among homeless patients in federally supported health centers: Findings from the 2009 patient survey. Health Services Research, 48(3), 992-1017. https://doi.org/10.1111/1475-6773.12009
Lewer, D., Aldridge, R. W., Menezes, D., Sawyer, C., Zaninotto, P., Dedicoat, M., Ahmed, I., Luchenski, S., Hayward, A., & Story, A. (2019). Health-related quality of life and prevalence of six chronic diseases in homeless and housed people: A cross-sectional study in London and Birmingham, England. BMJ Open, 9(4), 1-8. https://doi.org/10.1136/bmjopen-2018-025192
Mcenroe-Petitte, D. M. (2020). Caring for patients who are homeless. Nursing, 50(3), 24-30. https://doi.org/10.1097/01.NURSE.0000654600.98061.61
National Center for Farmworker Health. (2020). Facts about agricultural workers. http://www.ncfh.org/facts-about-agricultural-workers.html
Nunnally, J., & Bernstein, I. (1994). Psychometric theory (3rd ed.). McGraw-Hill.
Office of Disease Prevention and Health Promotion (ODPHP). (2021, September 14). Access to health services. Healthy People 2030. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/access-to-health#2
Omerov, P., Craftman, Å. G., Mattsson, E., & Klarare, A. (2020). Homeless persons' experiences of health- and social care: A systematic integrative review. Health & Social Care in the Community, 28(1), 1-11. https://doi.org/10.1111/hsc.12857
Palepu, A., Hubley, A. M., Russell, L. B., Gadermann, A. M., & Chinni, M. (2012). Quality of life themes in Canadian adults and street youth who are homeless or hard-to-house: A multi-site focus group study. Health and Quality of Life Outcomes, 10(1), 93. https://doi.org/10.1186/1477-7525-10-93
Purkey, E., & MacKenzie, M. (2019). Experience of healthcare among the homeless and vulnerably housed a qualitative study: Opportunities for equity-oriented health care. International Journal for Equity in Health, 18(1), 101. https://doi.org/10.1186/s12939-019-1004-4
Rathert, C., Wyrwich, M. D., & Boren, S. A. (2013). Patient-centered care and outcomes. Medical Care Research and Review, 70(4), 351-379. https://doi.org/10.1177/1077558712465774
Roncarati, J., Baggett, T., O'Connell, J., Hwang, S., Cook, F., Krieger, N., & Sorensen, G. (2018). Mortality among unsheltered homeless adults in Boston, Massachusetts, 2000-2009. JAMA Internal Medicine, 178(9), 1242-1248. https://doi.org/10.1001/jamainternmed.2018.2924
Tikkanen, R., Fields, K., Williams, R. D., & Abrams, A. K. (2020, May 21). Mental health conditions and substance use: Comparing US needs and treatment capacity with those in other high-income countries. Commonwealth Fund. https://doi.org/10.26099/09ht-rj07
Tsai, J., Lapidos, A., Rosenheck, R. A., & Harpaz-Rotem, I. (2013). Longitudinal association of therapeutic alliance and clinical outcomes in supported housing for chronically homeless adults. Community Mental Health Journal, 49(4), 438-443. https://doi.org/10.1007/s10597-012-9518-x
US Department of Housing and Urban Development (HUD). (n.d.). At risk of homelessness. https://files.hudexchange.info/resources/documents/AtRiskofHomelessnessDefinition_Criteria.pdf
Varley, A. L., Montgomery, A. E., Steward, J., Stringfellow, E., Austin, E. L., Gordon, A. J., Pollio, D., de Russy, A., Hoge, A., Gelberg, L., Riggs, K., Kim, T. W., Rubens, S. L., & Kertesz, S. G. (2020). Exploring quality of primary care for patients who experience homelessness and the clinicians who serve them: What are their aspirations? Qualitative Health Research, 30(6), 865-879. https://doi.org/10.1177/1049732319895252
Warfield, M., DiPietro, B., & Artiga, S. (2016). How has the ACA Medicaid expansion affected providers serving the homeless population: Analysis of coverage, revenues, and costs. Kaiser Family Foundation. Retrieved from http://files.kff.org/attachment/issue-brief-how-has-the-aca-medicaid-expansion-affected-providers-serving-the-homeless-population
White, B. M., & Newman, S. D. (2015). Access to primary care services among the homeless: A synthesis of the literature using the equity of access to medical care framework. Journal of Primary Care & Community Health, 6(2), 77-87. https://doi.org/10.1177/2150131914556122
Wuorela, M., Lavonius, S., Salminen, M., Vahlberg, M., Viitanen, M., & Viikari, L. (2020). Self-rated health and objective health status as predictors of all-cause mortality among older people: A prospective study with a 5-, 10-, and 27- year follow up. BMC Geriatrics, 20(120), 2-7. https://doi.org/10.1186/s12877-020-01516-9