Secondary Care for People Experiencing Homelessness in Scotland: a Retrospective Cohort Study

Overview

Journal BMJ Public Health

Publisher BMJ Publishing Group

Date 2025 Mar 7

PMID 40051542

Authors

Anna Ct Gordon

Haris Haseeb

Sarah Johnsen

Claire Mackintosh

Affiliations

Soon will be listed here.

Abstract

Introduction: People experiencing homelessness (PEH) face multimorbidity and poor health outcomes alongside deep exclusion in accessing health and social care. A large proportion of PEH use unscheduled emergency care heavily due to a multitude of barriers to primary care. No existing research in Scotland has explored experiences of PEH in secondary care.

Methods: In view of new national guidelines for the care of PEH, we conducted a retrospective study of 230 unscheduled presentations to secondary care, comparing 115 PEH with 115 patients matched by age and sex (July to December 2021). We aimed to profile morbidity, mortality and explore measures of quality of secondary care, particularly the involvement of multidisciplinary teams (MDTs), readmission rates, attendance at follow-up appointments and place of discharge.

Findings: Our findings demonstrate that the PEH population were young (mean age 43.9), 79% of whom experience multimorbidity, with a mortality rate of 13% at 1 year (mean age of death 47.3). 86.09% of PEH experienced additional disadvantages including problematic alcohol use or illicit drug use, and over a third experience two. Despite this, few PEH were seen by relevant hospital MDT members during admission. 8% were discharged to permanent accommodation, 14% were discharged to rooflessness (without shelter) and 8.7% chose to terminate their admission. Significantly less PEHs were offered outpatient follow-up (52% compared with 80%) or attended follow-up (47% compared with 87%), and readmission rates within 1 month were double in the PEH cohort.

Conclusions: Data clearly demonstrate the need for specialist support for PEH within secondary care during admission and integrated care beyond.

References

Johnsen S, Cuthill F, Blenkinsopp J . Outreach-based clinical pharmacist prescribing input into the healthcare of people experiencing homelessness: a qualitative investigation. BMC Health Serv Res. 2021; 21(1):7. PMC: 7780619. DOI: 10.1186/s12913-020-06013-8. View

Iacobucci G . Homeless people's A&E visits treble in seven years. BMJ. 2019; 364:l323. DOI: 10.1136/bmj.l323. View

Paudyal V, Vohra N, Price M, Jalal Z, Saunders K . Key causes and long-term trends related to emergency department and inpatient hospital admissions of homeless persons in England. Int J Emerg Med. 2023; 16(1):48. PMC: 10405435. DOI: 10.1186/s12245-023-00526-9. View

Elwell-Sutton T, Fok J, Albanese F, Mathie H, Holland R . Factors associated with access to care and healthcare utilization in the homeless population of England. J Public Health (Oxf). 2016; 39(1):26-33. DOI: 10.1093/pubmed/fdw008. View

Moss C, Sutton M, Cheraghi-Sohi S, Sanders C, Allen T . Comparative 4-year risk and type of hospital admission among homeless and housed emergency department attendees: longitudinal study of hospital records in England 2013-2018. BMJ Open. 2021; 11(7):e049811. PMC: 8314693. DOI: 10.1136/bmjopen-2021-049811. View

OCarroll A, Wainwright D . Doctor-patient interactions that exclude patients experiencing homelessness from health services: an ethnographic exploration. BJGP Open. 2021; 5(3). PMC: 8278504. DOI: 10.3399/BJGPO.2021.0031. View

Lewer D, Aldridge R, Menezes D, Sawyer C, Zaninotto P, Dedicoat M . Health-related quality of life and prevalence of six chronic diseases in homeless and housed people: a cross-sectional study in London and Birmingham, England. BMJ Open. 2019; 9(4):e025192. PMC: 6501971. DOI: 10.1136/bmjopen-2018-025192. View

Vohra N, Paudyal V, Price M . Homelessness and the use of Emergency Department as a source of healthcare: a systematic review. Int J Emerg Med. 2022; 15(1):32. PMC: 9330962. DOI: 10.1186/s12245-022-00435-3. View

Field H, Hudson B, Hewett N, Khan Z . Secondary care usage and characteristics of hospital inpatients referred to a UK homeless health team: a retrospective service evaluation. BMC Health Serv Res. 2019; 19(1):857. PMC: 6868755. DOI: 10.1186/s12913-019-4620-1. View

10.

McNeill S, ODonovan D, Hart N . Access to healthcare for people experiencing homelessness in the UK and Ireland: a scoping review. BMC Health Serv Res. 2022; 22(1):910. PMC: 9281084. DOI: 10.1186/s12913-022-08265-y. View

11.

Aldridge R, Story A, Hwang S, Nordentoft M, Luchenski S, Hartwell G . Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. Lancet. 2017; 391(10117):241-250. PMC: 5803132. DOI: 10.1016/S0140-6736(17)31869-X. View

12.

Ni Cheallaigh C, Cullivan S, Sears J, Lawlee A, Browne J, Kieran J . Usage of unscheduled hospital care by homeless individuals in Dublin, Ireland: a cross-sectional study. BMJ Open. 2017; 7(11):e016420. PMC: 5719262. DOI: 10.1136/bmjopen-2017-016420. View

13.

Vallesi S, Tuson M, Davies A, Wood L . Multimorbidity among People Experiencing Homelessness-Insights from Primary Care Data. Int J Environ Res Public Health. 2021; 18(12). PMC: 8296483. DOI: 10.3390/ijerph18126498. View

14.

Hewett N, Halligan A, Boyce T . A general practitioner and nurse led approach to improving hospital care for homeless people. BMJ. 2012; 345:e5999. DOI: 10.1136/bmj.e5999. View

15.

Aldridge R, Menezes D, Lewer D, Cornes M, Evans H, Blackburn R . Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England. Wellcome Open Res. 2019; 4:49. PMC: 6449792. DOI: 10.12688/wellcomeopenres.15151.1. View

16.

Gunner E, Chandan S, Marwick S, Saunders K, Burwood S, Yahyouche A . Provision and accessibility of primary healthcare services for people who are homeless: a qualitative study of patient perspectives in the UK. Br J Gen Pract. 2019; 69(685):e526-e536. PMC: 6650120. DOI: 10.3399/bjgp19X704633. View

17.

Malden S, Doi L, Ng L, Cuthill F . Reducing hospital readmissions amongst people experiencing homelessness: a mixed-methods evaluation of a multi-disciplinary hospital in-reach programme. BMC Public Health. 2023; 23(1):1117. PMC: 10258765. DOI: 10.1186/s12889-023-16048-1. View