A descriptive study of long term conditions, health service utilisation and patient engagement for users of a specialist homeless GP practice in the UK.

Problem

The experience of being homeless carries a large burden of disease and is an independent risk factor for mortality in high income countries (Morrison DS; Int J Epidemiol. 2009). A recent audit of over 2,500 homeless people in England showed that 60% of homeless patients perceived the care received for their physical health needs as inadequate, with 55% perceiving inadequate support for mental health issues and a further 40% stating inadequate support for drug and alcohol issues. Management of long term conditions in multiple exclusion homelessness remains challenging for healthcare systems worldwide. Pragmatic research is vital to ensure adequate service response and inform practice. However, only a paucity of contemporary studies of health service utilisation and patterns of chronic illness in the homeless population exist.The aim of this work is to characterise patients registered with a dedicated general practice for homeless people in an inner city area, in terms of disease burden, use of services, and engagement in treatment for long term conditions.

Approach

Extraction of patient level data from general practice records by a medical student researcher with input from two clinician researchers who work in the practice. Data extraction involved examination of two electronic clinical systems (EMIS and Docman) for each patient registered with the general practice on the agreed extraction date. A template was used to collect information surrounding patients’ health and use of health services. Data surrounding medication, acute health problems, and consultations within the practice was collected over a one year period. Information surrounding chronic health problems, use of secondary care, and social factors were looked at over a period of three years. Findings were then compared with other published studies describing similar populations.

Findings

Based on 133 patients’ GP records, we have generated an in-depth demographic, clinical, prescribing, and engagement review and comparison with homeless populations from other cities. We provide a detailed description of patients’ long term conditions, extent of attainment of surrogate clinical indicators (such as blood pressure or extent of prescribing in relation to authoritative clinical guidance), levels and duration of multi-morbidity. Information surrounding referrals and use of other services will be available, in addition to housing status, periods of imprisonment, employment status and indicators of social exclusion. Patients’ engagement with their health care will also be described, using records of attendance at both primary and secondary care appointments.

Consequences

At a time when health care faces increasing fiscal challenges to offer appropriate healthcare to marginalised groups, this work seeks to inform current practice and health care delivery, with the aim being to improve access and quality of primary care delivered to homeless people across the UK.