Primary care-based housing intervention linked to fewer visits, better health outcomes

Key takeaways:

• Program enrollees had 2.5 fewer primary care visits and 3.6 fewer outpatient visits annually.
• The program also helped to build a stronger connection between patients and their PCPs.

A primary care-based housing program helped to reduce the number of annual primary care and outpatient visits among participants while improving mental and physical health, researchers found.

“It is very hard to get a patient’s blood pressure under control if they are worried about where they are going to sleep,” MaryCatherine Arbour, MD, MPH, medical director of the social care team at Brigham and Women’s Hospital’s Primary Care Center, said in a press release. “A person’s health is extremely at risk if their housing is unstable. And since the pandemic, there has been an enormous increase in housing needs.”

In 2018, Brigham and Women’s Hospital began screening for social determinants of health and hired two housing advocates — community workers specializing in housing needs — after 20% of patients screened for unsafe or unstable housing.

These housing advocates supported patients by helping them for 6 months with shelter placement, housing applications, landlord or property management negotiations and other services.

Arbour and colleagues conducted a mixed-methods study of the program, involving 1,139 patients aged 18 years and older who participated between October 2018 and March 2021. Their findings were published in Health Affairs.

The cohort mostly consisted of non-English-speaking, Hispanic and younger women who had more chronic conditions and higher ED use than a control population (n = 5,524) that was matched based on age, sex, insurance type, primary care site and the date of encounter.

Overall, patients who participated in the program had 2.5 (95% CI, 2.9 to 2.2) fewer primary care visits and 3.6 (95% CI, 4.8 to 2.4) fewer outpatient visits per year vs. those who were not enrolled.

“The reduction in outpatient care was driven mostly by less urgent care, behavioral health, and social work utilization, which suggests that the program is having important effects on mental health and behavioral health,” Arbour said.

Additionally, patients reported mental and physical health benefits and a stronger connection to their primary care providers.

The study was limited by its sample size and follow-up period of 1 year, which “may be insufficient to detect effects on health care use and chronic disease indicators,” the researchers wrote.

“What makes this program special is that it is embedded in primary care and uses a triaged approach to identify housing types that are more likely to be affecting someone's health,” Arbour said. “It is a unique, integrated approach that partners community resource specialists and community health workers with the primary care team and partners the primary care team with community-based partners, including legal partners.”

References:

• Arbour M, et al. Health Aff. 2024;doi:10.1377/hlthaff.2023.01046.
• Primary care housing intervention linked to improved patient health outcomes. https://www.brighamandwomens.org/about-bwh/newsroom/press-releases-detail?id=4645. Published Feb. 6, 2024. Accessed Feb. 6, 2024.