A comparative study of the health and healthcare utilisation
of people experiencing homelessness in Edinburgh and
Glasgow Martina Zeitler, Richard Lowrie, John Budd, Andrea Williamson, Ruth Spencer
OVERVIEW
• Introduction
• Methods
• Results
• Discussion
INTRODUCTION
Health: average age of death 45 years(1)
• poorer physical + mental health(2)
• ↑ substance abuse + health harming behaviours (2)
• ↑ multimorbidity(3)
= uncoordinated service utilisation(2)
6,213.24
266.64
2011/2012 2012/2013 2013/2014 2014/2015 2015/2016 2016/2017
AE/minor injuries attendance:(4)
(per 1000)
HHS
Other GPs
METHODS
Comparison of cross-sectional samples of patient level data from Glasgow Homeless Health Service and Edinburgh Homeless Access Practice
Work based on: Queen A, Lowrie R, Richardson J, Williamson A. Multimorbidity, disadvantage, and patient engagement within a specialist homeless health service in the UK: an in-depth study of general practice data. BJGP Open. 2017.
Analysis
Data Collection
Setting
METHODS Glasgow
all registered patients (October 2015)
n=133
Edinburgh random 25% sample
(October 2016)
n=150
extracted from EMIS + Docman
1. Service utilisation and prescribing
2. Multimorbidity and health behaviours
3. Mental health and addictions.
• descriptive • comparative statistical analysis using MINITAB 17
RESULTS – Characteristics of services
• Other collocated services
• EDIN 1 set of records, GLA different records for different services
EDINBURGH practice staff (‘16) GLASGOW practice staff (‘15)
599 permanently registered patients 133 permanently registered patients
Practice manager Generic administration manager
2.5 WTE GPs 2 WTE GPs
2.5 practice nurses No practice nurses
Practice MH team: 6 WTE CPNs Part-time clinical psychologist
5 joint addiction/general nurses
Healthcare assistant Healthcare assistant
RESULTS 1 – Demographics and health burden
• age ≈ 40 yrs • majority male • 85% from UK • majority single
0
5
10
15
20
25
30
0 2 4 6 8 10 12 14 16 18
nu
mb
er o
f p
atie
nts
number of LTCs
Multimorbidity: LTCs per patient
EDIN (n=150) GLA (n=133)
RESULTS 2 – Service utilisation
85
3
26 26
nurse pharmacist
% o
f p
atie
nts
Practice appointments
EDIN (n=150) GLA (n=133)
11 9
80
48
17
35
neverattended
sometimes alwaysattended
Attendance of referrals
EDIN GLA
RESULTS 3 – Physical LTCs
• >80% of all patients had recorded physical LTC (median= 3/patient)
•
28
19
35
15 11
18
11 16
24
37
pain CV resp GI fractures
% o
f p
atie
nts
Differences: EDIN (n=150) GLA (n=133)
RESULTS 4 – Mental health LTCs
• EDIN: 87% of patients had recorded mental health LTC (median= 3/patient) vs GLA: 65% of patients (median= 1/patient)
• D
55 65
15 13
31 33
15 7 4 2
depression anxiety personalitydisorder
PTSD complextrauma
% o
f p
atie
nts
EDIN (n=150) GLA (n=133)
RESULTS 5 – Addictions
• Alcohol EDIN 37% vs GLA 54% of patients with recorded problem
• Drugs EDIN 73% vs GLA 62% of patients with recorded problem
27 30
3
19
9 14 15 14
5 1
cannabis other opiates cocaine NPSs valium
% o
f p
atie
nts
EDIN (n=150) GLA (n=133)
RESULTS 6 – Prescribing and adherence
84
68
3
9
13
22
EDIN
GLA
Physical conditions
44
93
13
3.5
43
3.5
Mental health conditions
50
86
18
6
32
8
EDIN
GLA
% non-adherers % partial adherers % adherers
DISCUSSION
Differences in:
• Staff skill-mix
• Service utilisation
? Impact on:
• Diagnoses?
• Medicines use?
in a patient cohort not known to attend for preventative healthcare (↑ AE attendance)(5)
THANK YOU FOR YOUR ATTENTION
Contact: [email protected]
Acknowledgement - with special thanks to AB Queen. References
(1) Thomas B. Homelessness kills: An analysis of the mortality of homeless people in early twenty-first century England. London: Crisis; 2012.
(2) Fazel S, Geddes J, Kushel M. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet. 2014;384(9954):1529-40.
(3) Queen A, Lowrie R, Richardson J, Williamson A. Multimorbidity, disadvantage, and patient engagement within a specialist homeless health service in the UK: an in-depth study of general practice data. BJGP Open. 2017.
(4) NHS GGC data request
(5) Lowrie R, Williamson A, Spencer R, Hair A, Gallacher I, Hewett N. Collaborative Engagement for Long Term Conditions by clinical pharmacists for people who are homeless in Glasgow, Scotland. FEANTSA. 2017.