Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2017 Dec 1;7(11):e016420.
doi: 10.1136/bmjopen-2017-016420.

Usage of unscheduled hospital care by homeless individuals in Dublin, Ireland: a cross-sectional study

Clíona Ní Cheallaigh  1   2   3 , Sarah Cullivan  1 , Jess Sears  4 , Ann Marie Lawlee  1 , Joe Browne  1 , Jennifer Kieran  1 , Ricardo Segurado  5 , Austin O'Carroll  6   7   8 , Fiona O'Reilly, Donnacha Creagh  1   2 , Colm Bergin, Rose Anne Kenny  1   2 , Declan Byrne  1   2
Affiliations
Observational Study

Usage of unscheduled hospital care by homeless individuals in Dublin, Ireland: a cross-sectional study

Clíona Ní Cheallaigh et al. BMJ Open. .

Abstract

Objectives: Homeless people lack a secure, stable place to live and experience higher rates of serious illness than the housed population. Studies, mainly from the USA, have reported increased use of unscheduled healthcare by homeless individuals.We sought to compare the use of unscheduled emergency department (ED) and inpatient care between housed and homeless hospital patients in a high-income European setting in Dublin, Ireland.

Setting: A large university teaching hospital serving the south inner city in Dublin, Ireland. Patient data are collected on an electronic patient record within the hospital.

Participants: We carried out an observational cross-sectional study using data on all ED visits (n=47 174) and all unscheduled admissions under the general medical take (n=7031) in 2015.

Primary and secondary outcome measures: The address field of the hospital's electronic patient record was used to identify patients living in emergency accommodation or rough sleeping (hereafter referred to as homeless). Data on demographic details, length of stay and diagnoses were extracted.

Results: In comparison with housed individuals in the hospital catchment area, homeless individuals had higher rates of ED attendance (0.16 attendances per person/annum vs 3.0 attendances per person/annum, respectively) and inpatient bed days (0.3 vs 4.4 bed days/person/annum). The rate of leaving ED before assessment was higher in homeless individuals (40% of ED attendances vs 15% of ED attendances in housed individuals). The mean age of homeless medical inpatients was 44.19 years (95% CI 42.98 to 45.40), whereas that of housed patients was 61.20 years (95% CI 60.72 to 61.68). Homeless patients were more likely to terminate an inpatient admission against medical advice (15% of admissions vs 2% of admissions in homeless individuals).

Conclusion: Homeless patients represent a significant proportion of ED attendees and medical inpatients. In contrast to housed patients, the bulk of usage of unscheduled care by homeless people occurs in individuals aged 25-65 years.

Keywords: epidemiology; homeless; hospitalised.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form and declare: support from the Health Research Board, Ireland (HRB) and the Health Services Executive, Ireland (HSE) for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years, no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
Age of housed and homeless ED attenders. ED, emergency department.
Figure 2
Figure 2
Age of unscheduled medical admissions.
Figure 3
Figure 3
Bed days by age group.
See this image and copyright information in PMC

References

    1. Fazel S, Geddes JR, Kushel M. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet 2014;384:1529–40. 10.1016/S0140-6736(14)61132-6 - DOI - PMC - PubMed
    1. FEANTSA. “On the Way Home?” FEANTSA Monitoring Report on Homelessness and Homelessness Policies in Europe. 2012.
    1. Kuhn R, Culhane DP. Applying cluster analysis to test a typology of homelessness by pattern of shelter utilization: results from the analysis of administrative data. Am J Community Psychol 1998;26:207–32. 10.1023/A:1022176402357 - DOI - PubMed
    1. Dublin regional homeless executive, 2015.
    1. Brett T, Arnold-Reed DE, Troeung L, et al. . Multimorbidity in a marginalised, street-health Australian population: a retrospective cohort study. BMJ Open 2014;4:e005461 10.1136/bmjopen-2014-005461 - DOI - PMC - PubMed

Publication types

MeSH terms