Primary care provider experience and social support among homeless-experienced persons with tri-morbidity
© Stringfellow et al; licensee BioMed Central Ltd. 2015
Published: 20 February 2015
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.
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) ; 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 ; 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) . Social support was measured using the "strong ties" scale (range: 3–15) , which queries the degree to which persons are bothered by not having a close companion, enough friendships, or people to whom they feel close.
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.
Tri-morbidity among Primary Care-Engaged Formerly and Currently Homeless Persons (N = 601)
Probable mental Illness or major psychiatric distress
Lifetime moderate- or high-risk alcohol or illicit drug use
At least 1 chronic medical condition
Tri-Morbidity (All of the above)
Bivariate Comparisons of Characteristics by Tri-morbid Status (% and Means) (N = 601)
Primary Care Experience and Social Support
Primary care provider experience (PCQ-H mean)
Social support (“strong ties” scale mean)
Live-in partner (%)
Socioeconomic Status (%)
Working full- or part-time
Hard to pay for basics
Patient at VA Primary Care Site (%)
Gender (% male)
Minority (% non-white)
*p < .05
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.
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.
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