Multimorbidity and emergency department visits by a homeless population: a database study in specialist general practice

Abstract

BackgroundEstimating healthcare needs of the homeless is associated with challenges in identifying the eligible population.AimTo explore the demographic characteristics, disease prevalence, multimorbidity, and emergency department visits of the homeless population.Design and settingEMIS electronic database of patient medical records and Quality and Outcomes Framework (QOF) data of all 928 patients registered with a major specialist homeless primary healthcare centre based in the West Midlands in England, from the period of October 2016 to 11 October 2017.MethodPrevalence data on 21 health conditions, multimorbidity, and visits to emergency departments were explored and compared with the general population datasets.ResultsMost homeless people identified were male (89.5%), with a mean age of 38.3 (SD = 11.5) years, and of white British origin (22.1%). Prevalence of substance (13.5%) and alcohol dependence (21.3%), hepatitis C (6.3%), and multimorbidity (21.3%) were markedly higher than in the general population. A third (32.5%) had visited the emergency department in the preceding 12 months. Emergency department visits were associated with a patient history of substance (odds ratio [OR] = 2.69) and alcohol dependence (OR = 3.14).ConclusionA high prevalence of substance and alcohol dependence, and hepatitis C, exists among the homeless population. Their emergency department visit rate is 60 times that of the general population and the extent of multimorbidity, despite their lower mean age, is comparable with that of 60–69-year-olds in the general population. Because of multimorbidity, homeless people are at risk of fragmentation of care. Diversification of services under one roof, preventive services, and multidisciplinary care are imperative.

Clinical Pharmacy Intervention for Persons Experiencing Homelessness: Evaluation of Patient Perspectives in Service Design and Development

“…Participants in these public involvement sessions said that they would trust pharmacists to prescribe medicines to them. Cardiovascular diseases, mental health and substance misuse issues are often undiagnosed and under-treated [6,10,11], and pharmacists have the potential to address these issues.…”

“…They die at an average age of 43 to 45 years [5]. A recent study conducted with over 900 homeless people in England showed a high prevalence of severe mental health problems, alcohol dependence, substance misuse and infectious hepatitis C [6]. A study in Scotland showed that the extent of multi-morbidity in homeless population, with a mean age of 40 years, was comparable to persons over 85 years in the general population [7].…”

‘If I die, I die, I don’t care about my health’: Perspectives on self‐care of people experiencing homelessness

“…The results of this study suggest that promotion of self-care among Poor mental health, including the experience of stigma and discrimination was a recurrent theme in the data. Poor mental health can often be the cause and consequences of homelessness (Bowen et al, 2019). Various barriers to people's access to mental health services have been described in the literature with concurrent substance misuse and history of self-harm often excluding patients access to mental health services (Gunner et al, 2019).…”

Pharmacist Led Homeless Outreach Engagement and Non-Medical Independent Prescribing (Rx) (PHOENIx) Intervention for People Experiencing Homelessness: A Non- Randomised Feasibility Study

“…10,11 Mental illness, pain and addictions may be poorly managed 12 with evidence suggesting under prescribing and low rates of prescription adherence 13,14 Patterns and reasons for emergency healthcare utilisation differ between people experiencing homelessness and those who are housed: ED visits, hospitalisations and readmissions are higher. 15,16 Availability and uptake of preventative healthcare is lower 9,16,17 and presentations to Family (General) Practitioners tend to be reactive. 18 Almost one third of homeless deaths are preventable by timely and effective use of health services 6 yet there is a lack of community based effective and cost effective complex interventions by healthcare professionals, proven to increase anticipatory care and reducing unscheduled care.…”