Browsing this month’s British Journal of General Practice, we came across an interesting study looking at health problems in the homeless population. The team of academics responsible for the study looked at the data for 928 patients registered with a specialist homeless primary healthcare centre in the West Midlands and compared the results to the general population datasets. The results are shocking.
Multimorbidity
In medicine, multimorbidity is the condition of having two or more chronic illnesses at the same time. This has obvious repercussions in the possible fragmentation of care and the dangers of mixing treatments. The rates of multimorbidity in the examined homeless population (average age 38) was around one in five. The general population can expect to be well into their 60s before encountering a >20% chance of multimorbidity.
Substance and Alcohol Abuse
The figures for drug and alcohol dependence show a much higher prevalence in the homeless population than the general population. 13.5% of the overwhelmingly male homeless population in this study were addicted to drugs. 21.3% were dependent on alcohol. The equivalent figures in the general population are <1% for problem use of drugs and 1.4% for alcohol dependence.
Emergency Room Visits
Perhaps the most shocking statistic of the report (the one that made the headline of a Guardian article about the study) is the revelation that a homeless person is 60 times more likely to use an Accident and Emergency department of a hospital than a member of the general population.
Limitations of the Analysis
Comparisons of this kind are likely to be underestimates of the scale of the problem. All of the homeless people who agreed to take part were registered at the health centre. There is likely to be a significant number of homeless people who are not registered with healthcare services and for whom therefore there is no data.
Conclusions
The report concludes that the arrangement of healthcare services most likely to help the homeless population are diverse services available in a single location and an increase in the provision of multidisciplinary measures aimed at preventing the prevalence of substance and alcohol misuse.
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