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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
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Page 1: A comparative study of the health and healthcare ...

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

Page 2: A comparative study of the health and healthcare ...

OVERVIEW

• Introduction

• Methods

• Results

• Discussion

Page 3: A comparative study of the health and healthcare ...

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

Page 4: A comparative study of the health and healthcare ...

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.

Page 5: A comparative study of the health and healthcare ...

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

Page 6: A comparative study of the health and healthcare ...

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

Page 7: A comparative study of the health and healthcare ...

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)

Page 8: A comparative study of the health and healthcare ...

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

Page 9: A comparative study of the health and healthcare ...

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)

Page 10: A comparative study of the health and healthcare ...

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)

Page 11: A comparative study of the health and healthcare ...

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)

Page 12: A comparative study of the health and healthcare ...

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

Page 13: A comparative study of the health and healthcare ...

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)

Page 14: A comparative study of the health and healthcare ...

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.


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