A Comprehensive Evaluation of Feasibility and Acceptability of a Nurse-Managed Health Clinic for Homeless and Working Poor Populations: A 3-Year Study.

Background/

Objectives

Homeless populations have higher rates of chronic illness and mortality than more advantaged peers but have low primary care engagement. Nurse-managed clinics emerged as a possible solution to increase healthcare access for marginalized populations. This paper presents a comprehensive evaluation of feasibility (conceptualized as patient recruitment and retention) and acceptability (conceptualized as patient satisfaction) of a nurse-managed primary care clinic tailored to people experiencing homelessness and poverty.

Methods

This is a three-year retrospective chart review study of the clinic's services, patient characteristics, and patient satisfaction. All adult patients for the three-year period were included (N = 514). Feasibility was measured by the number of unique patients seen and visits completed, ratio of completed to scheduled visits, and number of returning patients. Acceptability was measured by a 19-item Likert format (1-5) patient satisfaction survey. Patient characteristics were captured from intake forms.

Results

Most patients were male, African American or White, and non-Hispanic. Regarding social determinants of health (SDOH), most patients did not have college education, were unemployed or unable to work, experienced homelessness, had no primary care provider, and no health insurance. Over three years, 1972 visits were scheduled and 1372 (69.6%) completed. A total of 514 patients were seen (37.5% of all visits), with 858 follow-up visits (62.5%). Returning patients (≥2 visits) totaled 59.1%. Yearly data shows steady growth in recruitment and retention. Patient satisfaction with facets of care (access, communication, interpersonal relations) was very high (Mrange = 4.63-4.69), including with Nurse Practitioner care, as was global satisfaction (M = 4.71; SD = 0.61; 76.3% very satisfied).

Conclusions

Results indicate that a homeless-tailored nurse-managed clinic can recruit and retain homeless and working poor patients (feasibility), with high patient satisfaction with its services and staff (acceptability), independently of patient demographics or SDOH. Challenges related to retention deserve further study as well as the impact of services on the continuity of care, health, and well-being.