Doran Elisabeth, Barron Enda, Healy Laura, O'Connor Lorraine, Synnott Cara, Ní Cheallaigh Clíona, Doherty Colin
Neurology, Saint James's Hospital, Dublin, Ireland
Neurologie, Sankt Georg Hospital Group, Leipzig, Germany.
BMJ Open Qual. 2021 Apr;10(2). doi: 10.1136/bmjoq-2021-001367.
Homelessness is associated with significant psychosocial and health disparities. The rate of epilepsy among this cohort is eight times greater than that in the settled population, and the associated morbidity is higher due to lack of integrated care, difficulties with treatment adherence, substance abuse and poor social circumstances. There is a high rate of seizure-related death in homeless patients. Seizures are one of the most common neurological cause for emergency department presentation among this population. The aim of this quality improvement project was to use a multistakeholder co-production approach to design a new pathway of care for homeless patients with epilepsy to improve access to specialist epilepsy care and to strengthen the links between hospital and community teams who manage this population. After several years of observation, stakeholder engagement and numerous tests of change, we have created a new care pathway and developed bespoke tools for primary care providers and for physicians working in the emergency department to enable them to assess and manage patients as they present, as well as provide access to remote epilepsy specialist support.
无家可归与严重的心理社会和健康差距相关。这一群体中的癫痫发病率比定居人群高八倍，由于缺乏综合护理、治疗依从性困难、药物滥用和恶劣的社会环境，相关发病率更高。无家可归患者中与癫痫发作相关的死亡率很高。癫痫发作是这一人群中急诊科就诊最常见的神经学原因之一。这个质量改进项目的目的是采用多利益相关方共同生产的方法，为无家可归的癫痫患者设计一条新的护理途径，以改善获得专科癫痫护理的机会，并加强管理这一人群的医院和社区团队之间的联系。经过数年的观察、利益相关方参与和多次变革测试，我们创建了一条新的护理途径，并为初级保健提供者和急诊科医生开发了定制工具，使他们能够在患者就诊时进行评估和管理，同时提供远程癫痫专家支持。
