Longitudinal experience of primary care in a cohort of multiply diagnosed persons with HIV experiencing homelessness

Increasing evidence shows benefit of patient-tailored medical care on patients' experiences of care and, consequently, retention in care and clinical outcomes. Many studies of patient experience use cross-sectional data sampled from broad patient populations. In this study, we assessed longitudinal patient experience of tailored care in a cohort of homeless persons diagnosed with HIV and substance use/mental health disorders. This population faces compounding challenges and, accordingly, has greater need for personalized care to meet clinical needs. At nine tailored medical sites, respondents were surveyed at 3- and 12-months using the Primary Care Quality-Homeless Survey (PCQ-H). The PCQ-H yields an average score of simple statements rated on a 4-point Likert scale about four components of patient experience: access/coordination, patient-clinician relationship, cooperation, and homeless-specific needs. Scores were assessed as continuous and dichotomous (favorable/unfavorable experience). Generalized linear models were run to assess longitudinal trends in patient experience overall and among subgroups. Among 383 respondents, patient experience was broadly favorable and remained stable over time: mean (standard deviation) PCQ-H score at both months 3 and 12 was 3.1 (0.4) (p = 0.38). Differential changes were observed among various subgroups of HIV populations. These findings can inform providers on where to focus advancements in HIV care.