Clinical characteristics, attendance outcomes and deaths of homeless persons in the emergency department: implications for primary health care and community prevention programmes

Paudyal, Vibhu; Ghani, Abdul; Shafi, Tahir; Punj, Ekta; Saunders, Karen; Vohra, Neha; Hughes, Helen E.; Elliot, Alex J; Lowrie, Richard; Pucci, Mark

doi:10.1016/j.puhe.2021.05.007

Cited by 21 publications

(25 citation statements)

References 27 publications

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“…Two of these studies reported that veterans experiencing homelessness contributed to approximately 6.9% of all ED visits made by homeless persons [ 26 , 35 ]. One study [ 51 ] found that homeless VA service users were approximately three times more likely to use the ED than domiciled VA service users.…”

Section: Resultsmentioning

confidence: 99%

“…This study summarises the nature, extent and outcomes of presentations to the ED by PEH using systematic review methodology. PEH experience fragmentation of services, are often denied healthcare based on eligibility criteria and costs, and face stigma and discrimination at healthcare settings [ 12 , 51 – 54 ]. Tailored services, including outreach-based interventions that are able to deliver primary healthcare to patients’ temporary residence or in the urban streets where they frequent, are likely to bring positive changes and minimise the need for ED visits [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

“…Only four papers reported on the number of deaths among PEH in the ED. Recent literature has reported that a very high proportion of PEH leave the ED before being treated [ 51 ]. Further research is required to obtain a more accurate comparison of the death rates in the ED between PEH and the general population.…”

Section: Discussionmentioning

confidence: 99%

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Homelessness and the use of Emergency Department as a source of healthcare: a systematic review

2022

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Background Persons experiencing homelessness (PEH) often use hospital Emergency Department (ED) as the only source of healthcare. The aim of this study was to undertake a systematic review to identify the prevalence, clinical reasons and outcomes in relation to ED visits by PEH. Methods A protocol-led (CRD42020189263) systematic review was conducted using search of MEDLINE, EMBASE, CINAHL and Google Scholar databases. Studies that reported either the prevalence of homelessness in the ED or clinical reasons for presentation to ED by PEH and published in English language were included. Definitions of homelessness used by study authors were accepted. Results From the screening of 1349 unique titles, a total of 36 studies were included. Wide variations in the prevalence and key cause of presentations were identified across the studies often linked to differences in country, study setting, disease classification and data collection methods. The proportion of ED visits contributed by PEH ranged from 0.41 to 19.6%. PEH made an average of 0.72 visits to 5.8 visits per person per year in the ED [rate ratio compared to non-homeless 1.63 to 18.75]. Up to a third and quarter of the visits were contributed by alcohol-related diagnoses and substance poisoning respectively. The percentage of PEH who died in the ED ranged from 0.1 to 0.5%. Conclusions Drug-, alcohol- and injury-related presentations dominate the ED visits by PEH. Wide variations in the data were observed in regard to attendance and treatment outcomes. There is a need for prevention actions in the community, integrated discharge and referral pathways between health, housing and social care to minimise frequent usage and improve attendance outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Homelessness and the use of Emergency Department as a source of healthcare: a systematic review

2022

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“…These factors lead to PEH preferring to use specialist practices for their health services use. PEH are also frequent users of emergency departments and may often be excluded altogether from primary care [ 30 ]. Prescribing data was collected at a practice level, and therefore due to lack of access to patient-level data, it is important to undertake careful consideration.…”

Section: Discussionmentioning

confidence: 99%

Medicines prescribing for homeless persons: analysis of prescription data from specialist homelessness general practices

et al. 2022

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Background Specialist homelessness practices remain the main primary care access point for many persons experiencing homelessness. Prescribing practices are poorly understood in this population. Objective This study aims to investigate prescribing of medicines to homeless persons who present to specialist homelessness primary care practices and compares the data with the general population. Setting Analyses of publicly available prescribing and demographics data pertaining to primary care in England. Methods Prescribing data from 15 specialist homelessness practices in England were extracted for the period 04/2019-03/2020 and compared with data from (a) general populations, (b) the most deprived populations, and (c) the least deprived populations in England. Main outcome measure Prescribing rates, measured as the number of items/1000 population in key disease areas. Results Data corresponding to 20,572 homeless persons was included. Marked disparity were observed in regards to prescribing rates of drugs for Central Nervous System disorders. For example, prescribing rates were 83-fold (mean (SD) 1296.7(1447.6) vs. 15.7(9.2) p = 0.033) items), and 12-fold (p = 0.018) higher amongst homeless populations for opioid dependence and psychosis disorders respectively compared to the general populations. Differences with populations in the least deprived populations were even higher. Prescribing medicines for other long-term conditions other than mental health and substance misuse was lower in the homeless than in the general population. Conclusions Most of the prescribing activities in the homeless population relate to mental health conditions and substance misuse. It is possible that other long-term conditions that overlap with homelessness are under-diagnosed and under-managed. Wide variations in data across practices needs investigation.

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“…Previous qualitative studies suggest PEH exclusion from primary care services (Gunner et al., 2019 ; Paudyal et al., 2020 ) making them further vulnerable with their existing health needs during the crisis. They are reliant on support from health and essential resource services including food banks, housing and legal support (Crisis, 2020b ) and are known to be high users of hospital Emergency Departments (Paudyal, Ghani, et al., 2021 ; Paudyal, Racine, et al., 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Provision of services to persons experiencing homelessness during the COVID‐19 pandemic: A qualitative study on the perspectives of homelessness service providers

Kaur

Jagpal

Paudyal

2021

Health Social Care Comm

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This study aimed to explore the perspectives of homelessness service providers on the impact of the COVID‐19 pandemic on service provision, barriers encountered and learning for the future. Semi‐structured online interviews were conducted with homelessness service providers ( n = 15) identified through the network of homelessness services operating within the United Kingdom. Data were transcribed verbatim and analysed thematically using framework technique. Six key themes were identified including the impact of the pandemic on health and well‐being of persons experiencing homelessness (PEH); the changing needs of service users during the pandemic; impact of emergency provision of housing support on services offered; service adaptations; sustainability of services and learnings from the pandemic. Participants described that being able to offer accommodation through government schemes provided protection to PEH through ‘wrap‐around support’. The pandemic was deemed to have precipitated change and developed resilience in some services. However, lack of resources, donations and sponsors during the pandemic constrained the services forcing many to close or offer reduced services. Reduced face‐to‐face contact with PEH and lack of ability to offer skills sessions led to the exacerbation of mental health concerns amongst clients. The pandemic was also identified to have encouraged positive relationship building between clients and service providers, better communications between service providers and effective housing of PEH. There is a need to address the barriers, sustain the positive learnings and enable organisations and PEH to adapt to the transition when transient and emergency support from the government and local councils ends.

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Clinical characteristics, attendance outcomes and deaths of homeless persons in the emergency department: implications for primary health care and community prevention programmes

Cited by 21 publications

References 27 publications

Homelessness and the use of Emergency Department as a source of healthcare: a systematic review

Homelessness and the use of Emergency Department as a source of healthcare: a systematic review

Medicines prescribing for homeless persons: analysis of prescription data from specialist homelessness general practices

Provision of services to persons experiencing homelessness during the COVID‐19 pandemic: A qualitative study on the perspectives of homelessness service providers

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