What keeps you coming back? Health care experience and determinants of consistent follow-up among persons experiencing homelessness in Atlanta, GA

ABSTRACT

People experiencing homelessness have difficulties accessing primary care and maintaining follow-up. Little is known about what factors contribute to satisfaction with care and subsequent return visits. In this 2019 qualitative study of 20 individuals experiencing homelessness at an urban non-profit clinic in Atlanta, GA, we conducted a hybrid deductive-inductive thematic analysis to identify factors that impacted satisfaction with care and encouraged consistent follow-up. A comprehensive care model – including psychiatry and dental services, access to medication, and housing – supported ongoing utilization of primary care. However, it was also essential to promote dignity and respect, and foster emotional connection with and trust between patients and clinic staff. Many also reported religion or spirituality as an important factor. In their prior experience, when these same factors were absent, participants were less likely to follow-up consistently. These findings will help to encourage consistent follow-up and create opportunities to treat chronic conditions that require consistent medical care.

KEYWORDS:

• Homelessness
• patient satisfaction
• patient follow-up
• primary care
• patient provider relationship

Acknowledgements

The authors thank the staff, volunteers, and patients at Good Samaritan Health Center. We also thank faculty from Emory University Rollins School of Public Health for helpful reviews and insights.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Richard Feng

Richard Feng graduated with a B.S. in chemistry, followed by a Master of Public Health with an Environmental Health concentration in 2020. He received both degrees at Emory University. He volunteered with the Good Samaritan Health Clinic in Atlanta, GA, to become more involved with local community members and help provide healthcare. Currently, he is completing medical school at Texas A&M Health Science Center and will begin his residency training in orthopedic surgery soon after.

Breanna Lathrop

Breanna Lathrop, DNP, MPH, FNP-BC is the chief operating officer and nurse practitioner at the Good Samaritan Health Center in Atlanta, GA where she provides executive leadership and direct patient care. She has spent over sixteen years providing health care to individuals and families who lack health insurance. She earned her doctor of nursing practice from Georgia Southern University, her master of nursing and master of public health from Emory University, and a bachelor of arts in nursing from St. Olaf College.

Scott Santibañez

Scott Santibañez volunteered as a primary care physician at The Good Samaritan Health Center from 2012 to 2024. He has provided care for over 30 years for people experiencing homelessness in New York City, Pittsburgh, New Orleans, and Atlanta. Scott has a doctorate from seminary and enjoys teaching people of faith and others about the importance of social justice and service to underserved populations. In his day job, he is the Chief Medical Officer at the Centers for Disease Control and Prevention Division of Infectious Disease Readiness and Innovation.