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. 2017 Oct 4;1(3):bjgpopen17X100941.
doi: 10.3399/bjgpopen17X100941.

Multimorbidity, disadvantage, and patient engagement within a specialist homeless health service in the UK: an in-depth study of general practice data

Anton B Queen  1 , Richard Lowrie  2 , Janice Richardson  3 , Andrea E Williamson  4
Affiliations

Multimorbidity, disadvantage, and patient engagement within a specialist homeless health service in the UK: an in-depth study of general practice data

Anton B Queen et al. BJGP Open. .

Abstract

Background: There is a paucity of current health data regarding users of a specialist homeless health service in the UK.

Aim: To describe the health of users of a specialist homeless health service by assessing levels of multimorbidity, social exclusion - by measuring severe and multiple disadvantage (SMD) - and patient engagement with health care.

Design & setting: Analysis of patient-level data from computerised records of patients registered with a specialist homeless health service in Glasgow, Scotland.

Method: Data for 133 patients were extracted using a data extraction form. Multimorbidity and SMD were described using categorisation adapted from previous literature in this field. Stepwise regression analysis was carried out to assess the relationship between domains of SMD experienced and the number of long-term conditions (LTCs) a patient had.

Results: The average age of patients in the cohort was 42.8 years, however levels of multimorbidity were comparable to those aged ≥85 years in the general population. The average number of LTCs was 2.8 per patient, with 60.9% of patients having both mental and physical comorbidity. SMD was categorised into three domains: homelessness; substance misuse; and previous imprisonment. More than 90.0% of patients experienced ≥2 domains of SMD, and SMD experiences were associated with multimorbidity: as domains of SMD experiences increased, so did the number of LTCs a patient was recorded as having.

Conclusion: This cohort of patients has a complex burden of health and social care needs, which may act as barriers in the provision of effective health care.

Keywords: chronic disease; delivery of healthcare; homeless persons; vulnerable populations.

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Figures

Figure 1.
Figure 1.. Prevalence of LTCs of high prevalence in homeless cohorts.,, aClinically recorded data. bSelf-reported data. Figures for population-representative sample for long-term mental health problem are based on data for the socioeconomic class of greatest deprivation.
Figure 2.
Figure 2.. Prevalence of depression in this study versus other homeless cohorts,, and a population-representative sample from general practice records.  aClinically recorded data. bSelf-reported data. HHS = Homeless Healthcare Service.
Figure 3.
Figure 3.. Prevalence of viral hepatitis C in this study versus other homeless cohorts,, and a population-representative sample from general practice records. aClinically record data. bSelf-reported data. cNo data available.
Figure 4.
Figure 4.. Relationship between domains of severe and multiple disadvantage experienced and long-term conditions. SMD = severe and multiple disadvantage. PI = prediction interval.
See this image and copyright information in PMC

References

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