Rishika Kaushal1, Parbir Jagpal1, Saval Khanal2, Neha Vohra1, Richard Lowrie3, Jaspal Johal4, Duncan Jenkins4, Karen Saunders5, Vibhu Paudyal6. 1. College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. 2. Behavioural Science Group, Warwick Business School, University of Warwick, Coventry, UK. 3. NHS Greater Glasgow and Clyde, Glasgow, UK. 4. Dudley Integrated Health and Care NHS Trust, Dudley, UK. 5. Public Health England West Midlands, Birmingham, UK. 6. College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK v.paudyal@bham.ac.uk.
Abstract
BACKGROUND: Epidemiological studies focused on primary healthcare needs of persons experiencing homelessness (PEH) are often based on data from specialist homeless healthcare services. AIM: The aim of this study is to explore the presentation of PEH, coding of homelessness and associated health conditions in mainstream primary care general practices in England. DESIGN & SETTING: EMIS electronic database search of medical records was conducted across 48 general practices in a Clinical Commissioning Group (CCG), representing one of the most socioeconomically deprived regions in England, which also lacks a specialist primary healthcare service for PEH. METHOD: Key terms and codes were used to identify PEH, their respective diagnoses across 22 health conditions and prescribed medications over the past 4 years. RESULTS: From a population of approximately 321,000, 43 (0.013%) persons were coded as PEH compared to a homelessness prevalence of 0.5% in the English general population. Mental health conditions were the most prevalent diagnoses amongst the PEH registrants (62.3%); the recorded prevalence of other common long-term conditions in PEH was lower than the levels observed in PEH registered with specialist homelessness health services. CONCLUSION: In a population with approximately four times higher rate of statutory homelessness, PEH representation in mainstream general practices was underrepresented by several folds. As homelessness overlaps with mental health, substance misuse and long term health conditions, consistent coding of homelessness in medical records is imperative to offer tailored support and prevention actions when patients present for services.
BACKGROUND: Epidemiological studies focused on primary healthcare needs of persons experiencing homelessness (PEH) are often based on data from specialist homeless healthcare services. AIM: The aim of this study is to explore the presentation of PEH, coding of homelessness and associated health conditions in mainstream primary care general practices in England. DESIGN & SETTING: EMIS electronic database search of medical records was conducted across 48 general practices in a Clinical Commissioning Group (CCG), representing one of the most socioeconomically deprived regions in England, which also lacks a specialist primary healthcare service for PEH. METHOD: Key terms and codes were used to identify PEH, their respective diagnoses across 22 health conditions and prescribed medications over the past 4 years. RESULTS: From a population of approximately 321,000, 43 (0.013%) persons were coded as PEH compared to a homelessness prevalence of 0.5% in the English general population. Mental health conditions were the most prevalent diagnoses amongst the PEH registrants (62.3%); the recorded prevalence of other common long-term conditions in PEH was lower than the levels observed in PEH registered with specialist homelessness health services. CONCLUSION: In a population with approximately four times higher rate of statutory homelessness, PEH representation in mainstream general practices was underrepresented by several folds. As homelessness overlaps with mental health, substance misuse and long term health conditions, consistent coding of homelessness in medical records is imperative to offer tailored support and prevention actions when patients present for services.