Quality of Depression Care for Veterans Affairs Primary Care Patients with Experiences of Homelessness.
J Gen Intern Med
; 38(11): 2436-2444, 2023 08.
Article
in En
| MEDLINE
| ID: mdl-36810631
ABSTRACT
BACKGROUND:
Persons who experience homelessness (PEH) have high rates of depression and incur challenges accessing high-quality health care. Some Veterans Affairs (VA) facilities offer homeless-tailored primary care clinics, although such tailoring is not required, within or outside VA. Whether services tailoring enhances care for depression is unstudied.OBJECTIVE:
To determine whether PEH in homeless-tailored primary care settings receive higher quality of depression care, compared to PEH in usual VA primary care.DESIGN:
Retrospective cohort study of depression treatment among a regional cohort of VA primary care patients (2016-2019).PARTICIPANTS:
PEH diagnosed or treated for a depressive disorder. MAINMEASURES:
The quality measures were timely follow-up care (3 + completed visits with a primary care or mental health specialist provider, or 3 + psychotherapy sessions) within 84 days of a positive PHQ-2 screen result, timely follow-up care within 180 days, and minimally appropriate treatment (4 + mental health visits, 3 + psychotherapy visits, 60 + days antidepressant) within 365 days. We applied multivariable mixed-effect logistic regressions to model differences in care quality for PEH in homeless-tailored versus usual primary care settings. KEYRESULTS:
Thirteen percent of PEH with depressive disorders received homeless-tailored primary care (n = 374), compared to usual VA primary care (n = 2469). Tailored clinics served more PEH who were Black, who were non-married, and who had low income, serious mental illness, and substance use disorders. Among all PEH, 48% received timely follow-up care within 84 days of depression screening, 67% within 180 days, and 83% received minimally appropriate treatment. Quality metric attainment was higher for PEH in homeless-tailored clinics, compared to PEH in usual VA primary care follow-up within 84 days (63% versus 46%; adjusted odds ratio [AOR] = 1.61, p = .001), follow-up within 180 days (78% versus 66%; AOR = 1.51, p = .003), and minimally appropriate treatment (89% versus 82%; AOR = 1.58, p = .004).CONCLUSIONS:
Homeless-tailored primary care approaches may improve depression care for PEH.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Veterans
/
Ill-Housed Persons
Type of study:
Observational_studies
/
Risk_factors_studies
Aspects:
Determinantes_sociais_saude
Limits:
Humans
Country/Region as subject:
America do norte
Language:
En
Journal:
J Gen Intern Med
Journal subject:
MEDICINA INTERNA
Year:
2023
Document type:
Article
Affiliation country: