DETERMINANTS OF REGULAR SOURCE OF CARE AMONG HOMELESS ADULTS IN LOS-ANGELES

OBJECTIVES. The authors explore the determinants of having a regular s ource of care in a community-based probability sample of homeless adul ts in Los Angeles. Results from this study should be more representati ve than those from previous studies of the homeless that are clinic- o r shelter-based. In addition to those factors found to be barriers to regular sources of care in the general population, we hypothesized tha t psychosocial characteristics of the homeless and the homeless lifest yle would negatively impact their likelihood of having a regular sourc e of care. METHODS. The authors conducted a multiple logistic regressi on to predict regular source of care among the homeless, using an adap tation of the Behavioral Model of health services utilization as an an alytic framework, RESULTS. Fifty-seven percent of the sample reported that they had a regular source of care. Of those with a source of care , 30% reported a hospital outpatient department; 25% reported a commun ity or homeless clinic; 23% reported a hospital emergency room; 14% re ported a government clinic; and 9% reported a private physician's offi ce as their source of care. Some factors found to be barriers to havin g a regular source of care in the general population (male, Hispanic, young age) also were barriers among homeless adults. Additional barrie rs in this sample included homelessness-related characteristics such a s competing needs, long-term homelessness, and social isolation. Chron ic mental illness and chronic substance dependence were not related to having a source of care among the homeless. Characteristics that incr eased the likelihood of having a regular source of care in the general population (poor health status, Medicaid) were not related to having a regular source of care among the homeless. CONCLUSIONS. In a context of limited resources, the distribution of regular source of care amon g the homeless appears to be highly inequitable. Although some of the characteristics identifying those with a regular source of care sugges t differential patterns of behavior across subgroups, others suggest d ifferential advantage in access to care and a lack of fit between the needs of the homeless and the organization of health services.