Ní Cheallaigh Clíona, Cullivan Sarah, Sears Jess, Lawlee Ann Marie, Browne Joe, Kieran Jennifer, Segurado Ricardo, O'Carroll Austin, O'Reilly Fiona, Creagh Donnacha, Bergin Colm, Kenny Rose Anne, Byrne Declan
St James's Hospital, Dublin, Ireland.
Trinity College, Dublin, Ireland.
BMJ Open. 2017 Dec 1;7(11):e016420. doi: 10.1136/bmjopen-2017-016420.
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.
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.
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.
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.
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).
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.
无家可归者缺乏安全、稳定的住所，与有住所的人群相比，他们患重病的几率更高。主要来自美国的研究报告称，无家可归者使用非预约医疗服务的情况有所增加。我们试图比较爱尔兰都柏林这一高收入欧洲地区有住所和无家可归的住院患者使用非预约急诊科（ED）和住院治疗的情况。
一家为爱尔兰都柏林市中心南部提供服务的大型大学教学医院。患者数据通过医院的电子病历收集。
我们利用2015年所有急诊科就诊（n = 47174）和普通内科非预约住院（n = 7031）的数据进行了一项观察性横断面研究。
利用医院电子病历中的地址字段来识别居住在紧急收容所或露宿街头的患者（以下简称无家可归者）。提取了人口统计学细节、住院时间和诊断数据。
与医院服务区内有住所的人相比，无家可归者的急诊科就诊率更高（分别为每人每年0.16次就诊和每人每年3.0次就诊），住院天数更多（每人每年0.3天和4.4天）。无家可归者在评估前离开急诊科的比例更高（无家可归者占急诊科就诊人数的40%，有住所者占15%）。无家可归的内科住院患者的平均年龄为44.19岁（95%置信区间42.98至45.40），而有住所患者的平均年龄为61.20岁（95%置信区间60.72至61.68）。无家可归患者更有可能违背医嘱终止住院治疗（占住院人数的15%，有住所者为2%）。
无家可归患者占急诊科就诊者和内科住院患者的很大比例。与有住所的患者相比，无家可归者使用非预约医疗服务的大部分情况发生在25至65岁的人群中。
