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. 2020 Dec 15;4(5):bjgpopen20X101089.
doi: 10.3399/bjgpopen20X101089. Print 2020 Dec.

Accident and emergency department attendance rates of people experiencing homelessness by GP registration: a retrospective analysis

Johanna Reilly  1 , Khalil Hassanally  2 , John Budd  3 , Stewart Mercer  4
Affiliations

Accident and emergency department attendance rates of people experiencing homelessness by GP registration: a retrospective analysis

Johanna Reilly et al. BJGP Open. .

Abstract

Background: People experiencing homelessness are known to have complex health needs and to be high users of hospital accident and emergency (A&E) departments. It is unclear whether access to a day-time specialist homeless medical practice, as opposed to routine general practice, influences A&E attendance rates.

Aim: This study investigated whether registration with a specialist homeless service would alter A&E attendance rates in a single geographical region in Scotland.

Design & setting: A health board area with a specialist service for people experiencing homelessness was selected. Data were obtained from the hospital records of 4408 A&E attendances by people experiencing homelessness at NHS Lothian (based on a broad definition of homelessness and including those in temporary accommodation) between January 2015 and July 2017.

Method: The attendances were compared between people registered with a specialist service and those registered with a mainstream GP.

Results: The reasons for attendance and urgency of attendance were broadly similar between the two groups. Repeat attendance was similarly high in both groups. Almost 70% in both groups attended with problems deemed urgent, very urgent, or requiring immediate resuscitation. The patients registered with the specialist homeless service were more likely to be older and male; however, this did not affect the frequency of attendance.

Conclusion: People experiencing homelessness attending A&E mainly do so for urgent or very urgent problems. This was not related to the type of day-time primary care service they had access to. Strategies to reduce attendances, such as out-of-hours mobile medical units, should be explored.

Keywords: community care; emergency service, hospital; harm reduction; inequalities; people experiencing homelessness; socioeconomic factors.

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