Secondary care usage and characteristics of hospital inpatients referred to a UK homeless health team: a retrospective service evaluation

Abstract

BackgroundUK “Pathway” teams offer specialist hospital care coordination for people experiencing homelessness. Emergency healthcare use is high among homeless people, yet “homelessness” is not routinely coded in National Health Service (NHS) data. Pathway team records provide an opportunity to assess patterns in admissions and outcomes for inpatients identified as homeless.MethodsRetrospective analysis of patients referred to “Pathway” homelessness teams in seven UK hospitals to explore the patterns of hospital admission, morbidity, secondary healthcare utilisation and housing status. Each patient was individually identified as experiencing homelessness. Within a six-month period, demographic data, reason for admission, morbidity, mortality and secondary care hospital usage 120-days before and 120-days after the index admission was collected.ResultsA total of 1009 patients were referred, resulting in 1135 admissions. Most admissions had an acute physical health need (94.9%). Co-morbid mental illness and/or substance misuse was common (55.7%). Reasons for admission included mental and behavioral disorders (overdose, alcohol withdrawal or depression, 28.3%), external causes of morbidity and mortality (assault or trauma, 18.7%), and injury, poisoning and external causes (head injury, falls and fractures, 12.4%). Unplanned Emergency Department attendances reduced after index admission and unplanned hospital admissions increased slightly. Planned admissions doubled and total bed days increased. Housing status was maintained or improved for over 60% of inpatients upon discharge. Within 12 months of index admission, 50 patients (5%) died, 15 deaths (30%) occurred during the index admission.ConclusionsDisengagement with health services is common among homeless people. Many deaths are due to treatable medical conditions (heart disease, pneumonia, cancer). Observed increases in planned admissions suggests intervention from Pathway teams facilitates necessary investigations and treatment for homeless people. Equity, parity of care, and value should be inbuilt interventions for inclusion health groups and evaluations need to move beyond simply seeking cost reductions.

Benefits of GP care in outreach settings for people experiencing homelessness: a qualitative study

“…This study examined the experiences of PEH in accessing GP services in community outreach settings in Scotland and England, including staff/volunteer views on the strengths and weaknesses of GP outreach. Findings show that the organisational environment is important in enabling PEH to engage with GP services, challenging the notion that lack of engagement with primary care services by PEH is due to people having 'chaotic' lives [19]. The physical built space and the organisational environment within the outreach setting were the most important factors in enabling PEH to engage with GP outreach services.…”

“…The study found that the organisational environment is important in enabling PEH to engage with GP services, challenging the notion that lack of engagement with primary care services by PEH is a result of people having ‘chaotic’ lives. 19 The physical built space and the organisational environment in the outreach setting were the most important factors in enabling PEH to engage with GP outreach services. Combined, these two factors created a space where professional barriers between the GP and patients were flattened, and time was made available to nurture a therapeutic relationship.…”

Outreach-based clinical pharmacist prescribing input into the healthcare of people experiencing homelessness: a qualitative investigation

“…Resource implications notwithstanding [ 37 ], study findings also demonstrate the value of holistic approaches to health assessments of people experiencing homelessness. The greater time allowed for consultations and emphasis accorded to prevention and management of long-term conditions were welcomed by stakeholders and patients alike, not least because of the influence on engagement and retention levels.…”

Musculoskeletal Injuries and Conditions Among Homeless Patients

“…Of the 29 studies screened, 21 studies (72%) were conducted in the United States, two (7%) in the United Kingdom, 6 , 19 two (7%) in Canada, 31 , 38 and one each in Japan, 34 Amsterdam, 10 Nepal, 35 and the Philippines. 36 Fourteen of the 29 studies (48%) collected data on homeless patients from hospitals and ED settings.…”

“… 36 Fourteen of the 29 studies (48%) collected data on homeless patients from hospitals and ED settings. 3 , 6 , 14 , 15 , 19 , 20 , 22 , 25 , 26 , 28 , 29 , 32 , 37 , 38 Shelters, 4 , 10 , 16 , 30 , 31 , 34 community health clinics, 18 , 23 , 27 , 36 and field surveys 17 , 24 , 33 were also used. Of the six prospective studies included in the analysis, two recruited homeless individuals from shelters, 10 , 23 two recruited those directly from the community through field surveys, 24 , 36 one recruited those from a community health clinic, 18 and one recruited self-identified homeless individuals from a hospital ED.…”