Comparing the impact of primary care practice design in two inner city UK homelessness services

Zeitler, M., Williamson, A. E., Budd, J., Spencer, R., Queen, A. and Lowrie, R. (2020) Comparing the impact of primary care practice design in two inner city UK homelessness services. Journal of Primary Care and Community Health, (doi: 10.1177/2150132720910568) (PMID:32129134) (Early Online Publication)

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Abstract

Background: 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. Aim: 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. Method: 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. Results: 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. Conclusion: 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.

Item Type:Articles
Status:Early Online Publication
Refereed:Yes
Glasgow Author(s) Enlighten ID:Williamson, Dr Andrea and Spencer, Dr Ruth and Queen, Dr Anton and Lowrie, Dr Richard
Authors: Zeitler, M., Williamson, A. E., Budd, J., Spencer, R., Queen, A., and Lowrie, R.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Journal of Primary Care and Community Health
Publisher:SAGE Publications
ISSN:2150-1319
ISSN (Online):2150-1327
Published Online:04 March 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in Journal of Primary Care and Community Health 2020
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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