Understanding the primary health care experiences of individuals who are homeless in non-traditional clinic settings

Jahanett Ramirez, The Steve Hicks School of Social Work at the University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA. Jahanett.Ramirez@austin.utexas.edu.
Liana J. Petruzzi, Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
Timothy Mercer, Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
Lauren E. Gulbas, The Steve Hicks School of Social Work at the University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA.
Katherine R. Sebastian, Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.

Abstract

BACKGROUND: Despite the widespread implementation of Health Care for the Homeless programs that focus on comprehensive, integrated delivery systems of health care for people experiencing homelessness, engaging and retaining people experiencing homelessness in primary care remains a challenge. Few studies have looked at the primary care delivery model in non-traditional health care settings to understand the facilitators and barriers to engagement in care. The objective of our study was to explore the clinic encounters of individuals experiencing homelessness receiving care at two different sites served under a single Health Care for the Homeless program. METHODS: Semi-structured interviews were conducted with people experiencing homelessness for an explorative qualitative study. We used convenience sampling to recruit participants who were engaged in primary care at one of two sites: a shelter clinic, n = 16, and a mobile clinic located in a church, n = 15. We then used an iterative, thematic approach to identify emergent themes and further mapped these onto the Capability-Opportunity-Motivation model. RESULTS: Care accessibility, quality and integration were themes that were often identified by participants as being important facilitators to care. Psychological capability and capacity became important barriers to care in instances when patients had issues with memory or difficulty with perceiving psychological safety in healthcare settings. Motivation for engaging and continuing in care often came from a team of health care providers using shared decision-making with the patient to facilitate change. CONCLUSION: To optimize health care for people experiencing homelessness, clinical interventions should: (1) utilize shared-decision making during the visit, (2) foster a sense of trust, compassion, and acceptance, (3) emphasize continuity of care, including consistent providers and staff, and (4) integrate social services into Health Care for the Homeless sites.