Integration of Substance Use Disorder Services in Veterans Affairs Primary Care Clinics Serving Homeless Women

Women experiencing homelessness (WEH) often face barriers to accessing substance use disorder (SUD) treatment. The Veterans Health Administration (VHA) has invested in primary care redesign efforts for women's health (women's primary care clinics, "PCCs") and for homelessness (homeless-tailored PCCs). There have been no comparative examinations of SUD integration in these PCCs. We aim to compare VHA SUD integration across homeless-tailored and women's PCCs, identifying areas to improve care for WEH.

A 40-question provider survey was administered online. PCC physicians, nurses, and mental health providers were randomly sampled from 57 VHAs across the United States. Likert-type items assessed active service arrangement, active communication, same-day reachability of SUD specialists, collaboration with SUD specialists, and preparedness to meet women's needs and SUD needs. Multiple-choice items assessed time to referral completion, location of routine and urgent treatment, medication, counseling, staffing, and resource needs. Ordinal logistic regressions assessed Likert-type measures. χ 2 tests assessed multiple-choice items.

Based on 114 respondents (response=23.6%), women's PCCs scored below homeless-tailored PCCs on several items: collaboration via shared patient discussions, service consults, and treatment plan coordination; women's health preparedness; SUD preparedness; urgent treatment location; and medication availability (all P values<0.05). Most providers (90% and 86%) reported access to staff with mental health or addiction expertise, but SUD treatment remained predominantly confined to specialty care rather than primary care. The most frequently endorsed resource need was on-demand access to addiction specialists.

VHA PCCs that serve WEH report modest SUD integration; lessons from homeless-tailored PCCs could strengthen SUD practices in women's PCCs.