College of Medical and Dental Sciences, University of Birmingham, United Kingdom.
College of Medical and Dental Sciences, University of Birmingham, United Kingdom.
Public Health. 2021 Jul;196:117-123. doi: 10.1016/j.puhe.2021.05.007. Epub 2021 Jun 25.
Persons experiencing homelessness (PEH) are known to be often excluded from primary health care and community prevention programmes leading to high use of hospital emergency departments (EDs). This study aimed to identify demographic features, clinical characteristics and attendance outcomes of PEH presenting to ED.
Analysis of routinely collected data set.
Clinical presentations and drug prescription data of PEH who presented a major ED in the West Midlands region of England from 2014 to 2019 were extracted and analysed using descriptive and inferential statistics.
During the study period, 3271 of 596,198 presentations were made by PEH; 74% PEH attendees were male. Drug- and alcohol-related conditions, as well as pain and injury constituted the most frequent reasons for presentation, contributing to over half of all presentations. A significantly higher proportion of males (n = 481, 20.3%) presented with drug and alcohol problems than females (n = 93, 11.2%) (P ≤ 0.001). However, pain was the primary reason for presentation for twice as many female patients (n = 189, 22.8%) compared with males (n = 305, 12.9%) (P < 0.001). Nearly one in five left the ED before being assessed and a total of 39 patients (1.2%) died in the ED and 785 (24.0%) required in-patient admissions to the same hospital.
Drug, alcohol and pain including the need of opioid analgesics constituted the majority of presentations made by PEH in ED. The observed rate of death of PEH in ED is 12 times higher than the general population. A very high proportion of PEH also leave the ED before being treated. Future research should focus on strengthening community interventions, particularly to improve access to those at risk of dual diagnoses of substance misuse and mental health problems. Interventions involving multisector collaborations are needed to improve seamless discharge from ED and minimise repeat attendance. Gender differences in the nature of presentations and ED outcomes needs to be investigated further.
无家可归者（PEH）经常被排除在初级保健和社区预防计划之外，导致他们大量使用医院急诊部（ED）。本研究旨在确定在 ED 就诊的 PEH 的人口统计学特征、临床特征和就诊结果。
对常规收集的数据进行分析。
从 2014 年至 2019 年英格兰西米德兰兹地区的主要 ED 就诊的 PEH 中提取并分析了临床表现和药物处方数据，使用描述性和推断性统计。
在研究期间，596198 次就诊中有 3271 次是由 PEH 就诊；74%的 PEH 就诊者为男性。药物和酒精相关疾病，以及疼痛和损伤是最常见的就诊原因，占所有就诊的一半以上。男性（n=481，20.3%）就诊时存在药物和酒精问题的比例明显高于女性（n=93，11.2%）（P≤0.001）。然而，女性因疼痛就诊的比例是男性的两倍（n=189，22.8%），而男性因疼痛就诊的比例为 n=305，12.9%）（P<0.001）。近五分之一的患者在接受评估前离开 ED，共有 39 名患者（1.2%）在 ED 死亡，785 名患者（24.0%）需要在同一家医院住院治疗。
药物、酒精和疼痛，包括阿片类镇痛药的需求，构成了 ED 就诊的 PEH 的大部分就诊原因。ED 中 PEH 的观察死亡率是普通人群的 12 倍。很大一部分 PEH 也在接受治疗前离开 ED。未来的研究应重点加强社区干预，特别是改善对有药物滥用和精神健康问题双重诊断风险的人的服务。需要多部门合作的干预措施来改善 ED 的顺利出院并减少重复就诊。还需要进一步调查性别差异在就诊性质和 ED 结果方面的表现。
