Graduate School of Nursing
Community Health and Preventive Medicine | Health Services Administration | Health Services Research | Public Health and Community Nursing
BACKGROUND: While dual usage of US Department of Veterans Affairs (VA) and non-VA health services increases access to care and choice for veterans, it is also associated with a number of negative consequences including increased morbidity and mortality. Veterans with multiple health conditions, such as the homeless, may be particularly susceptible to the adverse effects of dual use. Homeless veteran dual use is an understudied yet timely topic given the Patient Protection and Affordable Care Act and Veterans Choice Act of 2014, both of which may increase non-VA care for this population. The study purpose was to evaluate homeless veteran dual use of VA and non-VA health care by describing the experiences, perspectives, and recommendations of community providers who care for the population.
METHODS: Three semi-structured focus group interviews were conducted with medical, dental, and behavioral health providers at a large, urban Health Care for the Homeless (HCH) program. Qualitative content analysis procedures were used.
RESULTS: HCH providers experienced challenges coordinating care with VA medical centers for their veteran patients. Participants lacked knowledge about the VA health care system and were unable to help their patients navigate it. The HCH and VA medical centers lacked clear lines of communication. Providers could not access the VA medical records of their patients and felt this hampered the quality and efficiency of care veterans received.
CONCLUSIONS: Substantial challenges exist in coordinating care for homeless veteran dual users. Our findings suggest recommendations related to education, communication, access to electronic medical records, and collaborative partnerships. Without dedicated effort to improve coordination, dual use is likely to exacerbate the fragmented care that is the norm for many homeless persons.
Care coordination, Homelessness, Veterans
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Copyright © The Author(s). 2016. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 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.
DOI of Published Version
LaCoursiere Zucchero T, McDannold S, McInnes DK. "Walking in a maze": community providers' difficulties coordinating health care for homeless patients. BMC Health Serv Res. 2016 Sep 7;16:480. doi: 10.1186/s12913-016-1722-x. PubMed PMID: 27604833; PubMed Central PMCID: PMC5015348. Link to article on publisher's website
BMC health services research
LaCoursiere Zucchero T, McDannold S, McInnes DK. (2016). "Walking in a maze": community providers' difficulties coordinating health care for homeless patients. Graduate School of Nursing Publications. https://doi.org/10.1186/s12913-016-1722-x. Retrieved from https://escholarship.umassmed.edu/gsn_pp/49
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.