scholarly journals Multimorbidity and emergency department visits by a homeless population: a database study in specialist general practice

2019 ◽  
Vol 69 (685) ◽  
pp. e515-e525 ◽  
Author(s):  
Matthew Bowen ◽  
Sarah Marwick ◽  
Tom Marshall ◽  
Karen Saunders ◽  
Sarah Burwood ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hepatitis C ◽  
General Population ◽  
Alcohol Dependence ◽  
Homeless People ◽  
Multidisciplinary Care ◽  
Emergency Department Visits ◽  
Homeless Population ◽  
Healthcare Needs ◽  
Primary Healthcare Centre

BackgroundEstimating healthcare needs of the homeless is associated with challenges in identifying the eligible population.AimTo explore the demographic characteristics, disease prevalence, multimorbidity, and emergency department visits of the homeless population.Design and settingEMIS electronic database of patient medical records and Quality and Outcomes Framework (QOF) data of all 928 patients registered with a major specialist homeless primary healthcare centre based in the West Midlands in England, from the period of October 2016 to 11 October 2017.MethodPrevalence data on 21 health conditions, multimorbidity, and visits to emergency departments were explored and compared with the general population datasets.ResultsMost homeless people identified were male (89.5%), with a mean age of 38.3 (SD = 11.5) years, and of white British origin (22.1%). Prevalence of substance (13.5%) and alcohol dependence (21.3%), hepatitis C (6.3%), and multimorbidity (21.3%) were markedly higher than in the general population. A third (32.5%) had visited the emergency department in the preceding 12 months. Emergency department visits were associated with a patient history of substance (odds ratio [OR] = 2.69) and alcohol dependence (OR = 3.14).ConclusionA high prevalence of substance and alcohol dependence, and hepatitis C, exists among the homeless population. Their emergency department visit rate is 60 times that of the general population and the extent of multimorbidity, despite their lower mean age, is comparable with that of 60–69-year-olds in the general population. Because of multimorbidity, homeless people are at risk of fragmentation of care. Diversification of services under one roof, preventive services, and multidisciplinary care are imperative.

scholarly journals Screening of problem gambling among a homeless population in Warsaw

2019 ◽  
Vol 36 (6) ◽  
pp. 542-555 ◽  
Author(s):  
Łukasz Wieczorek ◽  
Jakub Stokwiszewski ◽  
Justyna I Klingemann
Keyword(s):  
Public Health ◽  
General Population ◽  
Problem Gambling ◽  
Homeless People ◽  
Severity Index ◽  
Homeless Persons ◽  
Health Concern ◽  
Homeless Population ◽  
Addictive Disorders ◽  
Prevention Programmes

Background: While homelessness and problem gambling are both recognised as social and public health concerns and the prevalence of addictive disorders among homeless populations tends to be high. These questions have been studied predominantly independently. Aim: The aim of the study was to explore the co-occurrence of the two phenomena among the homeless population using shelters and night shelters in Warsaw, and, more specifically, to provide information about the forms and frequency of gambling in this homeless population. Method: Homeless persons ( N = 690) were interviewed in rehabilitation-shelters ( n = 17) and night-shelters ( n = 2) in Warsaw from November 2015 until January 2016. The core component of the questionnaire was a screening test (Problem Gambling Severity Index). In addition, data regarding the intensity of gambling and various types of games or settings were collected. Results: The prevalence of problem gambling in this population of homeless people was 11.3%, whereas the prevalence of problem gambling in the general population in Poland is much lower (0.7%). Similarly to the general population, the most prevalent gambling games in the homeless population were lotteries; however, homeless people gambled in lotteries almost three times more often compared to the general population. Conclusions: This is the first study examining the prevalence of problem gambling in the homeless population in Poland. The findings of the study suggest that problem gambling among the homeless is a significant social and public health concern. High rates of problem gambling in the homeless population show the need to identify and monitor this problem in shelters and consequently to provide easier access to gambling treatment or prevention programmes.

scholarly journals Rising Trends in Emergency Department Visits Associated With Hepatitis C Virus Infection in the United States, 2006-2014

2019 ◽  
Vol 134 (6) ◽  
pp. 685-694
Author(s):  
Shaoman Yin ◽  
Laurie Barker ◽  
Eyasu H. Teshale ◽  
Ruth B. Jiles
Keyword(s):  
United States ◽  
Emergency Department ◽  
Hepatitis C ◽  
Baby Boomers ◽  
The United States ◽  
Emergency Department Visits ◽  
Medicare Beneficiaries ◽  
Compensated Cirrhosis ◽  
Ed Visits ◽  
Medicaid Beneficiaries

Objective: Emergency departments (EDs) are critical settings for hepatitis C care in the United States. We assessed trends and characteristics of hepatitis C–associated ED visits during 2006-2014. Methods: We used data from the 2006-2014 Nationwide Emergency Department Sample to estimate numbers, rates, and costs of hepatitis C–associated ED visits, defined by either first-listed diagnosis of hepatitis C or all-listed diagnosis of hepatitis C. We assessed trends by demographic characteristics, liver disease severity, and patients’ disposition by using joinpoint analysis, and we calculated the average annual percentage change (AAPC) from 2006 to 2014. Results: During 2006-2014, the rate per 100 000 visits of first-listed and all-listed hepatitis C–associated ED visits increased significantly from 10.1 to 25.4 (AAPC = 13.0%; P < .001) and from 484.4 to 631.6 (AAPC = 3.4%; P < .001), respectively. Approximately 70% of these visits were made by persons born during 1945-1965 (baby boomers); 30% of visits were made by Medicare beneficiaries and 40% by Medicaid beneficiaries. Significant rate increases were among visits by baby boomers (first-listed: AAPC = 13.8%; all-listed: AAPC = 2.6%), persons born after 1965 (first-listed: AAPC = 14.3%; all-listed: AAPC = 9.2%), Medicare beneficiaries (first-listed: AAPC = 18.0%; all-listed: AAPC = 3.9%), and persons hospitalized after ED visits (first-listed: AAPC = 20.0%; all-listed: AAPC = 2.3%; all P < .001). Increasing proportions of compensated cirrhosis were among visits by baby boomers (first-listed: AAPC = 11.5%; all-listed: AAPC = 6.3%). Annual hepatitis C–associated total ED costs increased by 400.0% (first-listed) and 192.0% (all-listed) during 2006-2014. Conclusion: Public health efforts are needed to address the growing burden of hepatitis C care in the ED.

Mental health, health and healthcare utilization of asylum seeking and refugee children in Germany

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Costa ◽  
L Biddle ◽  
K Bozorgmehr
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Psychosocial Functioning ◽  
Unmet Need ◽  
Emergency Department Visits ◽  
Refugee Children ◽  
Healthcare Use ◽  
Physical Limitation ◽  
Medical Needs ◽  
Healthcare Needs

Abstract Background The mental health condition and healthcare needs of asylum seeking and refugee (ASR) children are essential aspects of health services organization. We describe the relation between psychosocial functioning, health status and healthcare use of ASR children in Germany using a cross-sectional population-based survey. Methods 560 ASR adults in 58 collective accommodations in Germany's 3rd largest federal state were randomly sampled and assessed in 2018 (response rate: 42%). 126 participants answered the Strengths and Difficulties Questionnaire (SDQ) to assess children' psychosocial functioning with higher scores suggesting poorer functioning. SDQ dimensions (Emotional; Conduct; Peer; Hyperactivity; ProSocial; Total) were compared by demographics, health (long-lasting illness, physical limitation, pain) and healthcare use (unmet need for a pediatrician/specialist, hospital/emergency department visits). Age and sex-adjusted odds ratios (AOR, 95%CI, Confidence Intervals) for presenting borderline/abnormal scores for each SDQ dimension were computed using logistic regression models depending on children' health and healthcare use. Results Valid data of 90 ASR children was analyzed: 57% girls; 40% 10-17 years; 58% from East/West Asia; 56% in Germany for more than a year. A borderline/abnormal SDQ Total score was associated with pain (compared to no pain, AOR, 95%CI=3.14, 1.21-8.10) and with an unmet need for a specialist (4.57, 1.09-19.16). High scores (borderline/abnormal) in the SDQ Emotional dimension were positively associated with a long-lasting illness (5.25, 1.57-17.55), physical limitation (4.28, 2.48-12.27) and pain (3.00, 1.10-8.22), and negatively associated with visiting a pediatrician (0.23, 0.07-0.78), a specialist (0.16, 0.04-0.69) and the emergency department (0.27, 0.08-0.96). Conclusions Somatic clinical encounters with ASR children should include the assessment of mental health symptomatology, especially in those with worst physical health conditions. Key messages Among asylum seeking and refugee children, a poor physical condition and unmet medical needs are linked with poorer mental health. Provision of care to this vulnerable group must include mental health.

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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah Johnsen ◽  
Fiona Cuthill ◽  
Janice Blenkinsopp
Keyword(s):  
Third Sector ◽  
Homeless People ◽  
Premature Death ◽  
Homeless Population ◽  
Recent Experience ◽  
Framework Analysis ◽  
Healthcare Provision ◽  
Outreach Service ◽  
Client Group ◽  
Healthcare Needs

Abstract Background Severely and multiply disadvantaged members of the homeless population are disproportionately vulnerable to exceptionally high levels of multi-morbidity and premature death. Given widespread calls for the development of interventions that might improve the uptake and effectiveness of healthcare for this population, this study investigated patient and other stakeholder perspectives regarding an outreach service, delivered by prescribing pharmacists in collaboration with a local voluntary sector provider, within homelessness services and on the street in Glasgow (UK). Methods The qualitative study involved semi-structured face-to-face interviews with 40 purposively sampled individuals with current or recent experience of homelessness (32 of whom had direct experience of the service and 8 of whom did not), all (n = 4) staff involved in frontline delivery of the service, and 10 representatives of stakeholder agencies working in partnership with the service and/or with the same client group. Pseudonymised verbatim interview transcriptions were analysed systematically via thematic and framework analysis. Results The service was effective at case finding and engaging with patients who were reluctant to utilise or physically unable to access existing (mainstream or specialist ‘homeless’) healthcare provision. It helped patients overcome many of the barriers that homeless people commonly face when attempting to access healthcare, enabled immediate diagnosis and prescription of medication, and catalysed and capitalised on windows of opportunity when patients were motivated to address healthcare needs. A number of improvements in health outcomes, including but not limited to medication adherence, were also reported. Conclusions A proactive, informal, flexible, holistic and person-centred outreach service delivered within homelessness service settings and on the street can act as a valuable bridge to both primary and secondary healthcare for people experiencing homelessness who would otherwise ‘fall through the gaps’ of provision. Prescribing pharmacist input coupled with third sector involvement into healthcare for this vulnerable population allows for the prompt treatment of and/or prescription for a range of conditions, and offers substantial potential for improving health-related outcomes.

scholarly journals Long-term risk of seizures in adult survivors of sepsis

Neurology ◽  
2017 ◽  
Vol 89 (14) ◽  
pp. 1476-1482 ◽  
Author(s):  
Michael E. Reznik ◽  
Alexander E. Merkler ◽  
Ali Mahta ◽  
Santosh B. Murthy ◽  
Jan Claassen ◽  
...  
Keyword(s):  
Emergency Department ◽  
General Population ◽  
Claims Data ◽  
Demographic Data ◽  
Hospitalized Patients ◽  
Emergency Department Visits ◽  
Administrative Claims ◽  
Separate Analysis ◽  
Medicare Beneficiaries

Objective:To examine the association between sepsis and the long-term risk of seizures.Methods:We conducted a retrospective population-based cohort study using administrative claims data from all emergency department visits and hospitalizations at nonfederal acute care hospitals in California, Florida, and New York from 2005 to 2013. Using previously validated diagnosis codes, we identified all adult patients hospitalized with sepsis. Our outcome was any emergency department visit or hospitalization for seizure. Poisson regression and demographic data were used to calculate age-, sex-, and race-standardized incidence rate ratios (IRR). To confirm our findings, we used a matched cohort of hospitalized patients without sepsis for comparison and additionally assessed claims data from a nationally representative 5% sample of Medicare beneficiaries.Results:We identified 842,735 patients with sepsis. The annual incidence of seizure was 1.29% (95% confidence interval [CI] 1.27%–1.30%) in patients with sepsis vs 0.16% (95% CI 0.16%–0.16%) in the general population (IRR 4.98; 95% CI 4.92–5.04). A secondary analysis using matched hospitalized patients confirmed these findings (IRR 4.33; 95% CI 4.13–4.55), as did a separate analysis of Medicare beneficiaries, in whom we found a similar strength of association (IRR 2.72; 95% CI 2.60–2.83), as we did in patients ≥65 years of age in our primary statewide data (IRR 2.83; 95% CI 2.78–2.88).Conclusions:We found that survivors of sepsis faced a significantly higher long-term risk of seizures than both the general population and other hospitalized patients. Our findings suggest that sepsis is associated with pathways that lead to permanent neurologic sequelae.

scholarly journals Frequent Emergency Department Visits and Hospitalizations Among Homeless People With Medicaid: Implications for Medicaid Expansion

2015 ◽  
Vol 105 (S5) ◽  
pp. S716-S722 ◽  
Author(s):  
Wen-Chieh Lin ◽  
Monica Bharel ◽  
Jianying Zhang ◽  
Elizabeth O’Connell ◽  
Robin E. Clark
Keyword(s):  
Emergency Department ◽  
Homeless People ◽  
Emergency Department Visits ◽  
Medicaid Expansion

Improving primary healthcare for the homeless

2020 ◽  
Vol 13 (6) ◽  
pp. 361-364
Author(s):  
Aarathi Krishnan ◽  
Neil H Metcalfe
Keyword(s):  
General Practice ◽  
General Population ◽  
Community Setting ◽  
Healthcare Services ◽  
Mortality Rates ◽  
Homeless Population ◽  
Community Healthcare ◽  
Healthcare Needs ◽  
The Uk ◽  
Community Healthcare Services

Homelessness is an increasing problem in the UK. One of the biggest issues faced by the homeless is their health; they have greater healthcare needs and significantly higher morbidity and mortality rates compared with the general population. However, the homeless population is far less likely to engage with community healthcare services, including general practice. Despite measures to help GPs treat the homeless population, there is still a lack of knowledge about how best to manage the health of the homeless within the community setting. This article aims to inform GPs about effective measures to improve the health of homeless patients.

scholarly journals Health status and health behaviour of the Hungarian homeless people

2020 ◽  
Author(s):  
Emese Nagy-Borsy ◽  
Zsolt Vági ◽  
Petra Skerlecz ◽  
Blanka Szeitl ◽  
István Kiss ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Health Status ◽  
General Population ◽  
Homeless People ◽  
Good Health ◽  
Homeless Population ◽  
Income Quintile ◽  
Comprehensive Health ◽  
European Health Interview Survey ◽  
Almost All

Abstract Background Homelessness has risen recently in Europe, but there is lack of comprehensive health data on this population. Our aim was to characterize the health of the Hungarian homeless population.Methods We performed a health survey with 453 homeless individuals. The results were compared to the age and sex standardized data of the general Hungarian population and its lowest income quintile from the European Health Interview Survey 2014. The differences by the ETHOS classification within the homeless population were also studied.Results Significantly fewer homeless people reported good health status than in the general population or in its lowest income quintile (p < 0.001). Of the participants 70% had at least one chronic disease, only 41% of them visited a GP and 35% took medication in the previous 12 months. While 59% of the lowest income quintile and 50% of the general population had at least one chronic disease, almost all of them visited a physician and took medication. The highest prevalence of morbidity (80%) and multimorbidity (46%) was reported in the houseless group. The majority of the homeless people were current smokers, the prevalence was much higher than in the two reference populations (p < 0.001). The prevalence of heavy drinkers was the highest among the roofless participants (40%).Conclusions Homeless people have much poorer health and they utilize health services less than the most disadvantaged quintile of the general population. There is a clear social gradient within the homeless population, as well, which calls for integrated approaches for specific interventions to improve their health.

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