| Titre : | Applying the Chronic Care Model to Homeless Veterans : Effect of a Population Approach to Primary Care on Utilization and Clinical Outcomes. (2010) |
| Auteurs : | Thomas-P O'TOOLE ; Jonathan BLUMEN ; Claire BOURGAULT ; Lauren BUCKEL ; Peter FRIEDMANN ; . LAN JIANG ; Stephen-G REDIHAN ; Providence Veterans Affairs Medical Center for Systems Outcomes and Quality in Chronic Disease and Rehabilitation. Providence. RI. USA |
| Type de document : | Article |
| Dans : | American journal of public health (vol. 100, n° 12, 2010) |
| Pagination : | 2493-2499 |
| Langues: | Anglais |
| Mots-clés : | Sans domicile fixe ; Population ; Utilisation ; Evolution ; Pronostic ; Amérique ; Maladie chronique ; Amérique du Nord |
| Résumé : | [BDSP. Notice produite par INIST-CNRS R0xD98Et. Diffusion soumise à autorisation]. Objectives. We compared a population-tailored approach to primary care for homeless veterans with a usual care approach. Methods. We conducted a retrospective prolective cohort study of homeless veterans enrolled in a population-tailored primary care clinic matched to a historical sample in general internal medicine clinics. Overall, 177 patients were enrolled : 79 in the Homeless-Oriented Primary Care Clinic and 98 in general internal medicine primary care. Results. Homeless-oriented primary care-enrolled patients had greater improvements in hypertension, diabetes, and lipid control, and primary care use was higher during the first 6 months (5.96 visits per person vs 1.63 for general internal medicine) but stabilized to comparable rates during the second 6 months (2.01 vs 1.31, respectively). Emergency department (ED) use was also higher (2.59 vs 1.89 visits), although with 40% lower odds for nonacute ED visits than for the general internal medicine group (95% confidence interval=0.2,0.8). Excluding substance abuse and mental health admissions, hospitalizations were reduced among the homeless veterans between the 2 periods (28.6% vs 10.8% ; P<. 01) compared with the general internal medicine group (48.2% vs 44.4% ; P=6 ; difference of differences, P<. 01). Conclusions. Tailoring primary care to homeless veterans can decrease unnecessary ED use and medical admissions and improve chronic disease management. |
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