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

• Published in: Public health (London) Vol. 196; pp. 117 - 123
• Main Authors: Paudyal, V., Ghani, A., Shafi, T., Punj, E., Saunders, K., Vohra, N., Hughes, H.E., Elliot, A.J., Lowrie, R., Pucci, M.
• Format: Journal Article
• Language: English
• Published: Houndsmill Elsevier Ltd 01-07-2021; Elsevier Science Ltd
• Subjects: Alcohol; Alcohol abuse; Analgesics; Attendance; Clinical outcomes; Community; Comorbidity; Data collection; Demography; Design analysis; Drug abuse; Drug development; Drugs; Emergency department; Emergency department utilisation; Emergency medical care; Emergency medical services; Emergency services; Gender aspects; Gender differences; Health care; Health problems; Health services; Homeless people; Homelessness; Hospitalization; Injuries; Inpatient care; Intervention; Males; Mental disorders; Mental health; Mental health services; Mortality rates; Opioids; Pain; Patient admissions; Patients; Prevention; Prevention programs; Preventive medicine; Primary care; Sex differences; Social programs; Statistical analysis; Statistical inference; Substance abuse; Drug abuse; Emergency department utilisation; Homelessness; Emergency department; Mental health
• ISSN: 0033-3506; 1476-5616
• DOI: 10.1016/j.puhe.2021.05.007

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.
Analysis of routinely collected data set.
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.
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.
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.