| Description |
The risk of developing substance use disorder (SUD) is particularly high among women Veterans experiencing homelessness. Access to high-quality tailored healthcare in Veterans' primary care centers-known as Patient-Aligned Care Teams (PACTs)-is needed in order to address the unique combination of gender-specific needs, housing- related challenges, and high psychiatric burden faced by this vulnerable population of homeless women Veterans. The U.S. Veterans Health Administration offers the option to attend a non-tailored PACT, a homeless-tailored PACT, or a women-tailored PACT, but there are no PACTs designed for Veterans who are both women and homeless. Thus, many women Veterans experiencing homelessness may choose to attend women's PACTs in order to receive gender-sensitive care, but in turn, they forego access to housing- related support, and certain aspects of mental healthcare that may be prioritized at a homeless PACT, such as SUD treatment. Previous literature suggested that the high prevalence of SUD among homeless individuals typically compelled the Veterans Health Administration to provide especially high-quality SUD treatment in their homeless PACTs, but it remained uncertain how SUD care in homeless PACTs compared to SUD care in other PACTs, such as women's PACTs. This study aimed to evaluate the perspectives of clinicians at homeless PACTs and women's PACTs regarding the availability of SUD care at their respective clinics, in order to better inform homeless women Veterans in deciding which PACT to attend, as well as to identify areas of improvement for SUD services for homeless women Veterans. The healthcare expertise of these PACT clinicians, combined with their frequent interactions with patients who are either women, homeless, or both, qualified them as the ideal candidates to assess the needs and inadequacies of SUD care, and ultimately, to shape the future of primary care for homeless women Veterans. It was hypothesized that clinician perceptions would reflect a lack of SUD treatment integration in women's PACTs compared to homeless PACTs, highlighting a need to improve SUD care in women's PACTs. Potential study participants included physicians, nurses, and mental healthcare providers at both homeless and women's PACTs in 60 different facility sites containing homeless PACTs across the U.S. The participants were emailed a link to a voluntary, 40-question online survey which consisted of scale rating and multiple-choice questions measuring their perceptions of mental health and SUD treatment needs, timing, availability, and coordination at their respective clinics. Survey responses (n=119, 20%) were compared between homeless PACT clinicians and women's PACT clinicians. Across 10 different measures of SUD healthcare integration, five measures yielded statistically significant differences between PACT types, with women's PACTs scoring lower than homeless PACTs for each of the five measures. The findings ultimately suggested a need for improvement of SUD services in both women's PACTs and non-tailored PACTs- particularly in regards to prescription of pharmaceutical medication, coordination with specialty SUD providers, and overall PACT suitability to treat homeless SUD patients- and highlighted the potential benefit of homeless women Veterans attending homeless PACTs to receive SUD treatment. |
