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Research

Risk factors for unplanned hospital admission in a specialist homeless general practice population: case–control study to investigate the relationship with tri-morbidity

Catherine Himsworth, Priyamvada Paudyal and Christopher Sargeant
British Journal of General Practice 2020; 70 (695): e406-e411. DOI: https://doi.org/10.3399/bjgp20X710141
Catherine Himsworth
Department of Medical Education;
Roles: Medical student
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Priyamvada Paudyal
Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton.
Roles: Senior lecturer in public health
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Christopher Sargeant
ARCH Healthcare, Education Fellow Pathway; Department of Medical Education, Brighton and Sussex Medical School, Brighton.
Roles: GP and director
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Abstract

Background ‘Tri-morbidity’ describes the complex comorbidity of chronic physical illness, mental illness, and alcohol and/or drug misuse within the homeless population. Poor health outcomes of homeless people are reflected by the higher rate of unplanned hospital admissions compared with the non-homeless population.

Aim To identify whether tri-morbidity is a risk factor for unplanned hospital admissions in the homeless population.

Design and setting A case–control study of patients who were registered with a specialist homeless GP surgery in Brighton (72 cases and 72 controls).

Method Cases were defined as those who had ≥1 overnight hospital admission within a 12-month period. Controls were matched for demographics but with no hospital admission. The primary care record was analysed, and tri-morbidity entered into binomial logistic regression with admission as the dichotomous dependent variable.

Results The logistic regression analysis demonstrated that other enduring mental health disorders and/or personality disorder (odds ratio [OR] 3.84, 95% confidence interval [CI] = 1.56 to 9.44), alcohol use (OR 2.92, 95% CI = 1.42 to 5.98), and gastrointestinal disorder (OR 2.90, 95% CI = 1.06 to 7.98) were independent risk factors for admission. Tri-morbidity increased odds of admission by more than four-fold (OR 4.19, 95% CI = 1.90 to 9.27).

Conclusion This study shows that tri-morbidity is an important risk factor for unplanned hospital admissions among the homeless population, and provides an interesting starting point for the development of a risk stratification tool to identify those at risk of unplanned admission in this population.

  • emergency service, hospital
  • general practice
  • homeless persons
  • risk factors
  • tri-morbidity
  • unplanned admissions
  • Received March 17, 2019.
  • Revision requested May 24, 2019.
  • Accepted October 2, 2019.
  • © British Journal of General Practice 2020
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British Journal of General Practice: 70 (695)
British Journal of General Practice
Vol. 70, Issue 695
June 2020
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Risk factors for unplanned hospital admission in a specialist homeless general practice population: case–control study to investigate the relationship with tri-morbidity
Catherine Himsworth, Priyamvada Paudyal, Christopher Sargeant
British Journal of General Practice 2020; 70 (695): e406-e411. DOI: 10.3399/bjgp20X710141

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Risk factors for unplanned hospital admission in a specialist homeless general practice population: case–control study to investigate the relationship with tri-morbidity
Catherine Himsworth, Priyamvada Paudyal, Christopher Sargeant
British Journal of General Practice 2020; 70 (695): e406-e411. DOI: 10.3399/bjgp20X710141
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Keywords

  • emergency service, hospital
  • general practice
  • homeless persons
  • risk factors
  • tri-morbidity
  • unplanned admissions

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