University of Glasgow, Glasgow, UK.
NHS Greater Glasgow and Clyde, Glasgow, UK.
J Prim Care Community Health. 2020 Jan-Dec;11:2150132720910568. doi: 10.1177/2150132720910568.
Specialist homeless primary health care services in the United Kingdom have arisen from the need for bespoke approaches to providing health care for people experiencing homelessness but descriptions of the design characteristics of homeless health services together with associated long-term condition (LTC) prevalence, health care utilization, and prescribing remain unexplored, thereby limiting our understanding of potential impact of service configuration on outcomes. Description of specialist homeless general practitioner services in Glasgow and Edinburgh, in terms of practice design (staff, skill mix, practice systems of registration, and follow-up); and exploration of the potential impact of differences on LTC prevalence, health care utilization, and prescribing. Patient data were collected from computerized general practitioner records in Glasgow (2015, n = 133) and Edinburgh (2016, n = 150). Homeless health service configuration and anonymized patient data, including demographics, LTCs service utilization, and prescribing were summarized and compared. Marked differences in infrastructure emerged between 2 practices, including the patient registration process, segmentation versus integration of services, recording systems, and the availability of staff expertise. Patient characteristics differed in terms of LTC diagnoses, health care utilization and prescribing. Higher rates of recorded mental health and addiction problems were found in Edinburgh, as well as higher rates of physical LTCs, for example, cardiovascular and respiratory conditions. There were significantly higher rates of consultations with nurses and other staff in Edinburgh, although more patients had consultations with pharmacists in Glasgow. Medication adherence was low in both cohorts, and attendance at referral appointments was particularly poor in Glasgow. Service design and professional skill mix influence recording of LTCs, service uptake, and identification and management of health conditions. Service configuration, professional skill mix, and resources may profoundly affect diagnoses, utilization of health care, and prescribing. Attention to homeless service design is important when providing care to this disadvantaged patient group.
英国的专业流浪人员初级卫生保健服务源于为无家可归者提供医疗保健的独特方法的需求，但有关无家可归者健康服务的设计特点以及相关的长期病症（LTC）患病率、医疗保健利用和处方情况仍未得到探索，从而限制了我们对服务配置对结果的潜在影响的理解。 描述格拉斯哥和爱丁堡的专科流浪全科医生服务，包括实践设计（人员、技能组合、注册和随访的实践系统）；并探讨差异对 LTC 患病率、医疗保健利用和处方的潜在影响。 从格拉斯哥（2015 年，n = 133）和爱丁堡（2016 年，n = 150）的计算机化全科医生记录中收集患者数据。总结并比较了无家可归者卫生服务配置和匿名患者数据，包括人口统计学、LTC 服务利用和处方。 两所实践之间出现了基础设施的显著差异，包括患者注册过程、服务的细分与整合、记录系统以及员工专业知识的可用性。患者特征在 LTC 诊断、医疗保健利用和处方方面存在差异。爱丁堡记录的精神健康和成瘾问题以及身体 LTC 发生率较高，例如心血管和呼吸系统疾病。爱丁堡的护士和其他工作人员咨询率明显较高，而格拉斯哥的患者与药剂师的咨询率较高。在两个队列中，药物依从性都较低，格拉斯哥的转诊预约出勤率特别差。 服务设计和专业技能组合影响 LTC 的记录、服务利用率以及健康状况的识别和管理。服务配置、专业技能组合和资源可能会深刻影响诊断、医疗保健的利用和处方。在为这一弱势群体提供护理时，关注流浪人员服务设计很重要。
