Longitudinal experience of primary care in a cohort of multiply diagnosed persons with HIV experiencing homelessness

ABSTRACT

Increasing evidence shows benefit of patient-tailored medical care on patients’ experiences of care and, consequently, retention in care and clinical outcomes. Many studies of patient experience use cross-sectional data sampled from broad patient populations. In this study, we assessed longitudinal patient experience of tailored care in a cohort of homeless persons diagnosed with HIV and substance use/mental health disorders. This population faces compounding challenges and, accordingly, has greater need for personalized care to meet clinical needs. At nine tailored medical sites, respondents were surveyed at 3- and 12-months using the Primary Care Quality–Homeless Survey (PCQ-H). The PCQ-H yields an average score of simple statements rated on a 4-point Likert scale about four components of patient experience: access/coordination, patient-clinician relationship, cooperation, and homeless-specific needs. Scores were assessed as continuous and dichotomous (favorable/unfavorable experience). Generalized linear models were run to assess longitudinal trends in patient experience overall and among subgroups. Among 383 respondents, patient experience was broadly favorable and remained stable over time: mean (standard deviation) PCQ-H score at both months 3 and 12 was 3.1 (0.4) (p = 0.38). Differential changes were observed among various subgroups of HIV populations. These findings can inform providers on where to focus advancements in HIV care.

KEYWORDS:

• HIV
• medical home
• patient experience
• homelessness

Acknowledgements

The authors are grateful to the patients in this study. The contents of this document are those of the authors and do not necessarily represent the official views of nor an endorsement, by HRSA, HHS or the U.S. government.

Disclosure statement

Adrienne O’Donnell, Howard J. Cabral, and Serena Rajabiun report no conflicts of interest to declare that are relevant to the content of this article. Stefan G. Kertesz receives royalty payment from UpToDate, Inc. He attests to ownership in stock from Thermo Fisher Scientific & Zimmer Biomet. He attests to past ownership of stock in CVS Caremark, sold in 2020. His spouse privately owns stock in Abbott, Merck, Johnson & Johnson, and Thermo Fisher, purchased with her own funds, held in her own account.

Data availability statement

De-identified data and programming code may be available upon request with approval from the dissemination and publications committee for the project.

Additional information

Funding

This work was supported by the United States Department of Health and Human Services (HHS) [grant number U90HA24974].

Notes on contributors

Adrienne O’Donnell

Adrienne O’Donnell is a PhD candidate in the Department of Biostatistics at the Boston University School of Public Health with experience working with various sources of longitudinal data. She works at the Framingham Heart Study Neurology Group investigating risk factors for dementia and stroke. Her dissertation is focused on improving methods to draw causal inference using longitudinal data from electronic health records in settings with time-varying confounding.

Howard J. Cabral

Howard J. Cabral is Professor of Biostatistics at the Boston University School of Public Health, where he has been on the faculty in the Department of Biostatistics since 1998. He is the founding Director of the Biostatistics and Research Design Program of the Boston University Clinical and Translational Sciences Institute. He has over 30 years of teaching, consulting, collaborating, and statistical research experience in a variety of biomedical fields. These include public health, epidemiology, behavioral sciences, health services, and basic physical sciences research and practice. Dr. Cabral’s research spans both observational studies and randomized clinical trials, including well known studies in cardiovascular health and studies of the effects of substance use on human health across the life span, with currently over 350 peer-reviewed publications. He has extensive experience in the analysis of longitudinal health data, especially those collected in urban areas with ethnic and socioeconomic diversity

Stefan G. Kertesz

Stefan G. Kertesz, certified in internal medicine and addiction medicine, has a 22-year history of delivering primary care for vulnerable populations such as the homeless, and an 18-year history of research funded by the National Institute on Drug Abuse and Veterans Administration on care and services for problems of addiction and drug use. An addiction scholar, Dr. Kertesz serves on multiple task forces and teams related to opioid safety. He also led a national petition that resulted in major changes to a planned policy set up by the Centers for Medicare and Medicaid Services.

Serena Rajabiun

Serena Rajabiun, is an Assistant Professor with over twenty years of international and domestic public health experience. Her research focuses on community based strategies and interventions to increase access to and the quality of health care services and reduce health disparities. She works with individuals across the life course, including immigrant children and their families, children and youth in the foster care system, and youth and adults living with HIV who experience homelessness. She has also developed national training programs and curricula for community health workers as part of a health care team to improve health outcomes. Dr. Rajabiun spent a decade working on community based programs to improve maternal and child health and nutrition and HIV prevention in Latin America and Africa.