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

Paudyal, V, Ghani, A, Shafi, T, Punj, E, Saunders, K, Vohra, N, Hughes, HE, Elliot, AJ ORCID: 0000-0002-6414-3065, Lowrie, R and Pucci, M (2021) Clinical characteristics, attendance outcomes and deaths of homeless persons in the emergency department: implications for primary health care and community prevention programmes. Public health, 196. pp. 117-123.

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Official URL: http://dx.doi.org/10.1016/j.puhe.2021.05.007

Abstract

<h4>Objectives</h4>Persons experiencing homelessness (PEH) are known to be often excluded from primary health care and community prevention programmes leading to high use of hospital emergency departments (EDs). This study aimed to identify demographic features, clinical characteristics and attendance outcomes of PEH presenting to ED.<h4>Study design</h4>Analysis of routinely collected data set.<h4>Methods</h4>Clinical presentations and drug prescription data of PEH who presented a major ED in the West Midlands region of England from 2014 to 2019 were extracted and analysed using descriptive and inferential statistics.<h4>Results</h4>During the study period, 3271 of 596,198 presentations were made by PEH; 74% PEH attendees were male. Drug- and alcohol-related conditions, as well as pain and injury constituted the most frequent reasons for presentation, contributing to over half of all presentations. A significantly higher proportion of males (n = 481, 20.3%) presented with drug and alcohol problems than females (n = 93, 11.2%) (P ≤ 0.001). However, pain was the primary reason for presentation for twice as many female patients (n = 189, 22.8%) compared with males (n = 305, 12.9%) (P < 0.001). Nearly one in five left the ED before being assessed and a total of 39 patients (1.2%) died in the ED and 785 (24.0%) required in-patient admissions to the same hospital.<h4>Conclusions</h4>Drug, alcohol and pain including the need of opioid analgesics constituted the majority of presentations made by PEH in ED. The observed rate of death of PEH in ED is 12 times higher than the general population. A very high proportion of PEH also leave the ED before being treated. Future research should focus on strengthening community interventions, particularly to improve access to those at risk of dual diagnoses of substance misuse and mental health problems. Interventions involving multisector collaborations are needed to improve seamless discharge from ED and minimise repeat attendance. Gender differences in the nature of presentations and ED outcomes needs to be investigated further.

Item Type:	Article
Uncontrolled Keywords:	Humans, Patient Admission, Population Groups, Emergency Service, Hospital, Primary Health Care, Female, Male, Ill-Housed Persons
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Population Health
Depositing User:	Symplectic Admin
Date Deposited:	08 Feb 2023 16:25
Last Modified:	14 Feb 2023 17:43
DOI:	10.1016/j.puhe.2021.05.007
Open Access URL:	http://pure-oai.bham.ac.uk/ws/files/136930152/Clin...
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3168294