What keeps you coming back? Health care experience and determinants of consistent follow-up among persons experiencing homelessness in Atlanta, GA

Abstract

ABSTRACT People experiencing homelessness have difficulties accessing primary care and maintaining follow-up. Little is known about what factors contribute to satisfaction with care and subsequent return visits. In this 2019 qualitative study of 20 individuals experiencing homelessness at an urban non-profit clinic in Atlanta, GA, we conducted a hybrid deductive-inductive thematic analysis to identify factors that impacted satisfaction with care and encouraged consistent follow-up. A comprehensive care model – including psychiatry and dental services, access to medication, and housing – supported ongoing utilization of primary care. However, it was also essential to promote dignity and respect, and foster emotional connection with and trust between patients and clinic staff. Many also reported religion or spirituality as an important factor. In their prior experience, when these same factors were absent, participants were less likely to follow-up consistently. These findings will help to encourage consistent follow-up and create opportunities to treat chronic conditions that require consistent medical care.