Randomised controlled trial of GP-led in-hospital management of homeless people (‘Pathway’)

Hewett, Nigel; Buchman, Peter; Musariri, Jeflyn; Sargeant, Christopher; Johnson, Penny; Abeysekera, Kushala; Grant, L. M.; Oliver, Emily A.; Eleftheriades, Christopher; McCormick, Barry; Halligan, Aidan; Marlin, Nadine; Kerry, Sally; Foster, Graham R.

doi:10.7861/clinmedicine.16-3-223

Cited by 44 publications

(127 citation statements)

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“…The transient nature of homelessness makes comprehensive medical care difficult 34 . Referrals and effective follow‐up are often impossible under traditional models of primary health care, with this population lost to follow‐up when moving from one part of the system to another 10 , 34 , 35 . Fragmented and discontinuous care can be reduced by a specialist homeless service with trained staff working across as much of the system as possible 33 , 36 .…”

Section: Barriers To Accessing Health Carementioning

confidence: 99%

“…Based on personal experience and those of international colleagues, 35 , 37 it is vitally important that general practices specialising in homelessness have strong links to the homelessness sector, particularly services able to connect homeless people to housing 16 . As articulated by the US National Health Care for the Homeless Council, “housing is health care”, 41 and without stable housing, it is difficult to significantly improve a person's health and wellbeing 30 …”

Section: Barriers To Accessing Health Carementioning

confidence: 99%

“…34 Referrals and effective follow-up are often impossible under traditional models of primary health care, with this population lost to follow-up when moving from one part of the system to another. 10,34,35 Fragmented and discontinuous care can be reduced by a specialist homeless service with trained staff working across as much of the system as possible. 33,[36][37][38][39] The multiple morbidities of people who have been homeless requires coordinated case management to connect them to a range of services (both primary and specialist care), and follow-up by trained staff who have established relationships with patients is critical.…”

Section: Continuity Of Health Carementioning

confidence: 99%

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Homeless health care: meeting the challenges of providing primary care

Davies

Wood

2018

Medical Journal of Australia

108

137

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People experiencing homelessness have multiple complex health conditions yet are typically disengaged from primary health care services and place a significant burden on the acute health system. Barriers preventing people who are homeless from accessing primary care can be both personal and practical and include competing needs and priorities, illness and poor health, physical access to health services, difficulty in contacting services, medication security, and the affordability of health care. Differences in social status and perceptions of being judged can lead to relationship barriers to accessing primary care. Key solutions include prioritising access to stable housing, continuity of health care, specialised homeless general practice, hospital inreach, discharge planning and coordinated care, general practice outreach, and medical recovery centres.

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Section: Barriers To Accessing Health Carementioning

confidence: 99%

Section: Barriers To Accessing Health Carementioning

confidence: 99%

Section: Continuity Of Health Carementioning

confidence: 99%

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Homeless health care: meeting the challenges of providing primary care

Davies

Wood

2018

Medical Journal of Australia

108

137

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“…There is mounting evidence about the effectiveness and cost‐effectiveness of intermediate care for people who are homeless both in the UK and internationally. Time limited care co‐ordination interventions that link people who are homeless with sources of ongoing support during critical transition points have been shown in randomised controlled trials to have an enduring positive impact on a range of outcomes such as reducing rehospitalisation (Sadowski, Kee, Vanderweele, & Buchanan, ; Tomita & Herman, ) and improved quality of life (Hewett et al., ). A systematic review of “medical respite” found that it can result in improved health and housing outcomes for service users who are homeless, as well as reductions in hospitalisations and hospital readmissions (Doran, Ragins, Gross, & Zerger, ; Doran, Ragins, Iacomacci, et al., ).…”

Section: Rationale For the Review And The Use Of Realist Synthesismentioning

confidence: 99%

Improving hospital discharge arrangements for people who are homeless: A realist synthesis of the intermediate care literature

Cornes

Whiteford

Manthorpe

et al. 2017

Health Soc Care Community

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Most of these originated in the UK or the USA and fell within the realist quality rating of "thick description". The synthesis involved using this new evidence to interrogate the utility of earlier programme theories. Overall, the results confirmed the importance of (i) collaborative care planning, (ii) reablement and (iii) integrated working as key to effective intermediate care delivery. However, the additional evidence drawn from the field of homelessness highlighted the potential for some theory refinements.First, that "psychologically informed" approaches to relationship building may be necessary to ensure that service users are meaningfully engaged in collaborative care planning and second, that integrated working could be managed differently so that people are not "handed over" at the point at which the intermediate care episodeends. This was theorised as key to ensuring that ongoing care arrangements do not break down and that gains are not lost to the person or the system vis-à-vis the prevention of readmission to hospital. schemes and empirical research on these is emerging. | INTRODUCTIONThe paper begins with an overview of these recent developments in intermediate care for people who are homeless. We then outline the search strategy and the methods used to synthesise the literature on homelessness, before discussing how this additional evidence "speaks" to the conceptual framework for intermediate care proposed by Pearson et al. (2013Pearson et al. ( , 2015. In the final section, we draw out the implications for service development and future research, and also make recommendations about possible refinements to the original conceptual framework. This review is reported in accordance with the RAMESES publication standards for realist reviews (Wong, Greenhalgh, Westhorp, Buckingham, & Pawson, 2013). Long-term homelessness is characterised by "tri-morbidity", the combination of mental ill-health, physical ill-health, and drug and alcohol misuse (Hewett, Halligan, & Boyce, 2012). People who are home- | INTERMEDIATE CARE AND HOMELESSNESS What is known about this topic• Long-term homelessness is characterised by "tri-morbidity" (the combination of mental ill-health, physical illhealth, and drug and alcohol misuse).• Hospital discharge is often problematic for people who are homeless with high rates of readmission.• Much is known about the design and delivery of intermediate care services for older people, but less is known about how to meet the transitional care needs of people who are homeless. • A reconceptualisation of the intermediate care concept which is designed to prevent these short-term services from becoming "blocked". What this paper adds | e347CORNES Et al. housing legislation and local housing options. Staffing roles include addressing broader health and well-being outcomes by means of advocating for and supporting people who are homeless to engage with the full range of local primary care, mental health, drug and alcohol and social care services. Clinically led Schemes:These are...

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“…Better discharge planning was also a key element of a 2016 randomised controlled trial at the Royal London Hospital . 24 To identify the extent to which the higher rate of selfdischarge for NFA episodes is driven by their HRG mix, a calculation was made of the number of NFA self-discharges that would occur if the NFA group had the same HRG-specific self-discharge rates as the comparison group. The resulting selfdischarge rate is 5.4%.…”

Section: Self-discharge and Emergency Readmissionmentioning

confidence: 99%

Hospital care and costs for homeless people

McCormick

White²

2016

Clinical Medicine

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The national picture of the comparative costs and diagnoses of hospitalised homeless patients are examined using the 'no fixed abode' flag in English hospital statistics. Comparable studies sample patients in single cities, eg New York and Toronto. The most common diagnosis is substance misuse; the share of homeless NHS patients with this diagnosis is rising, and now equals that found in North American cities. About half of the cost of homeless patients relates to diagnoses of mental illness, although these comprise a much smaller share of homeless patients than in North America. Hospital costs for homeless patients -both total and per admissionhave fallen significantly in recent years, primarily because of fewer admissions and shorter lengths of stay for mentally ill patients. Aims to reduce NHS costs at the level of individual institutions have often shaped policy. Broader policy to prevent and reduce homelessness offers substantial long-term reductions in the cost of chronic care.

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Randomised controlled trial of GP-led in-hospital management of homeless people (‘Pathway’)

Abstract: The quality-of-life cost per quality-adjusted life-year was £26,000. The Pathway approach doesn't alter length of stay but improves quality of life and reduces street homelessness.

Cited by 44 publications

References 12 publications

Homeless health care: meeting the challenges of providing primary care

Homeless health care: meeting the challenges of providing primary care

Improving hospital discharge arrangements for people who are homeless: A realist synthesis of the intermediate care literature

Hospital care and costs for homeless people

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