Volume 10 Supplement 1

Abstracts from the 2014 Addiction Health Services Research (AHSR) Conference

Open Access

Primary care provider experience and social support among homeless-experienced persons with tri-morbidity

  • Erin J Stringfellow1Email author,
  • Theresa W Kim2,
  • David E Pollio3 and
  • Stefan G Kertesz4, 5
Addiction Science & Clinical Practice201510(Suppl 1):A64

DOI: 10.1186/1940-0640-10-S1-A64

Published: 20 February 2015

Background

Persons living with mental illness, substance use disorder, and medical conditions, or “tri-morbidity,” have complex health needs. Tri-morbidity may be common among those who are homeless, and who face considerable obstacles to obtaining the high-quality, patient-centered health care and strong social support they need.

Measures

Tri-morbidity was operationalized as meeting the following criteria: 1) probable mental illness or major psychiatric distress, based on reporting a diagnosis of post-traumatic stress disorder or schizophrenia, having ever taken psychiatric medication for a significant period of time, or a score of 30+ on the Colorado Symptom Index (range: 5–70) [1]; 2) lifetime moderate- or high-risk alcohol or illicit drug use, as measured using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) v. 3 [2]; and 3) reporting at least 1 of 14 physician-diagnosed chronic medical conditions.

Primary care experience was measured using the Primary Care Quality-Homeless (PCQ-H) tool (range: 1–4) [3]. Social support was measured using the "strong ties" scale (range: 3–15) [4], which queries the degree to which persons are bothered by not having a close companion, enough friendships, or people to whom they feel close.

Methods

Patients (N = 601) from five geographically diverse primary care sites (four from the Department of Veterans Affairs [VA] and one health care for homeless program) were surveyed. Pearson’s chi-square, correlations, and t-tests assessed bivariate relationships. Multiple linear regression tested whether tri-morbidity predicted lower social support, compared to those without tri-morbidity, controlling for characteristics associated with strong ties.

Results

Tri-morbidity was present in 39 percent of this sample of primary care-engaged, homeless, and formerly homeless persons (Table 1). Associated characteristics are shown in Table 2. Primary care experience was positive overall, as well as on all four subscales, and did not differ for persons with tri-morbidity (all p > .15). In the multiple regression model, persons with tri-morbidity had lower levels of social support (about 1.2 points on the strong ties scale; p < .0001) than those without tri-morbidity; controlling for financial hardship, minority, employment, and housing statuses; PCQ-H score; and having a live-in partner.
Table 1

Tri-morbidity among Primary Care-Engaged Formerly and Currently Homeless Persons (N = 601)

 

N

%

Probable mental Illness or major psychiatric distress

428

71

Lifetime moderate- or high-risk alcohol or illicit drug use

357

59

At least 1 chronic medical condition

537

89

Tri-Morbidity (All of the above)

233

39

Table 2

Bivariate Comparisons of Characteristics by Tri-morbid Status (% and Means) (N = 601)

 

Tri-morbid

Not Tri-Morbid

Primary Care Experience and Social Support

  

Primary care provider experience (PCQ-H mean)

3.13

3.16

Social support (“strong ties” scale mean)

9.16

10.64*

Live-in partner (%)

10

10

Socioeconomic Status (%)

  

Housed

54

68*

Working full- or part-time

13

22*

Hard to pay for basics

75

64*

Patient at VA Primary Care Site (%)

63

70

Demographics

  

Gender (% male)

84

86

Minority (% non-white)

70

69

Average age

51.5

54.1*

*p < .05

  

Conclusions

Tri-morbidity was common in this sample of primary care-engaged formerly and currently homeless persons. Despite their increased complexity, the patient-reported primary care experience was not worse in the presence of tri-morbidity. Their lower social support, even compared to other homeless-experienced patients, might be relevant for primary care providers’ treatment plans.

Declarations

Acknowledgments

This research was supported by the VA Veterans Health Administration, Health Services Research & Development Branch Award (IAA 07-069-2) and National Institute on Drug Abuse (NIDA) T32 Award (DA01035). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIDA, the National Institutes of Health, or the VA.

Authors’ Affiliations

(1)
Brown School of Social Work, Washington University in St. Louis
(2)
Boston University School of Medicine
(3)
University of Alabama at Birmingham, Department of Social Work
(4)
School of Medicine, University of Alabama at Birmingham
(5)
Clinical Addiction Research & Education Unit, Birmingham VA Medical Center

References

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Copyright

© Stringfellow et al; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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