Puentes clinic: an integrated model for the primary care of vulnerable populations

Traditional primary care models for medically vulnerable populations such as the homeless and injection-drug users do not deliver optimal and efficient medical care. We propose an integrated model for the delivery of primary care to a vulnerable population emphasizing open access, outreach, groups, and a team approach to care.

We monitored the health care use patterns of a group of 408 injection-drug users during a five-year period at Puentes Clinic, an integrated primary care site within a larger county health care system, Santa Clara Valley Health and Hospital System of California. We specifically compared use patterns before and after the inception of this new primary care site.

Emergency Department and urgent care visit rates decreased from 3.8 visits in the 18 months prior to the clinic's opening to 0.8 visits in the first 18 months of the clinic's operation. Simultaneously, primary care visits increased from 2.8 visits per 18 months prior to the clinic's operation to a current use rate of 5.9 visits per 18 months.

This changing health care use pattern after the implementation of an integrated primary care model suggests that a "medical home" for a vulnerable population can influence the way that populations interact with a larger health care system.