ObjectivesHomeless people lack a secure, stable place to live and experience higher rates of serious illness than the housed population. Studies, mainly from the USA, have reported increased use of unscheduled healthcare by homeless individuals.We sought to compare the use of unscheduled emergency department (ED) and inpatient care between housed and homeless hospital patients in a high-income European setting in Dublin, Ireland.SettingA large university teaching hospital serving the south inner city in Dublin, Ireland. Patient data are collected on an electronic patient record within the hospital.ParticipantsWe carried out an observational cross-sectional study using data on all ED visits (n=47 174) and all unscheduled admissions under the general medical take (n=7031) in 2015.Primary and secondary outcome measuresThe address field of the hospital’s electronic patient record was used to identify patients living in emergency accommodation or rough sleeping (hereafter referred to as homeless). Data on demographic details, length of stay and diagnoses were extracted.ResultsIn comparison with housed individuals in the hospital catchment area, homeless individuals had higher rates of ED attendance (0.16 attendances per person/annum vs 3.0 attendances per person/annum, respectively) and inpatient bed days (0.3 vs 4.4 bed days/person/annum). The rate of leaving ED before assessment was higher in homeless individuals (40% of ED attendances vs 15% of ED attendances in housed individuals). The mean age of homeless medical inpatients was 44.19 years (95% CI 42.98 to 45.40), whereas that of housed patients was 61.20 years (95% CI 60.72 to 61.68). Homeless patients were more likely to terminate an inpatient admission against medical advice (15% of admissions vs 2% of admissions in homeless individuals).ConclusionHomeless patients represent a significant proportion of ED attendees and medical inpatients. In contrast to housed patients, the bulk of usage of unscheduled care by homeless people occurs in individuals aged 25–65 years.

The Extension of Community Healthcare Outcomes (ECHO) project is a novel educational intervention designed in New Mexico to transfer subspecialty knowledge about hepatitis C virus (HCV) to primary care providers, thereby increasing patient access to HCV care. The ECHO model has been shown to deliver educational benefits and to result in good treatment outcomes for HCV-infected individuals in the USA; however, this approach has not been assessed in a European setting.We sought to evaluate the feasibility, acceptability and implementation of the ECHO model in Ireland using a pilot study. We present a descriptive review of recruitment, participation, retention and cost of the intervention as well as a qualitative review of the views of participants on the barriers, benefits and acceptability of the ECHO model. In the original Project ECHO in New Mexico, geographical distance posed the greatest barrier to accessing HCV care. In Ireland, people who inject drugs (PWID) were identified by interviewees as the main group facing barriers to accessing specialist HCV care. State-employed doctors and nurses caring for large numbers of HCV-infected PWID in opiate substitution treatment centres and homeless hostels were successfully recruited to participate in the project. Self-employed general practitioners did not participate, due mainly to a lack of time and the absence of reimbursement for participation. Practitioners who participated in the pilot reported benefits to themselves and their patients and would like to continue to participate in similar multidisciplinary, multisite educational interventions in the future.

With the use of a pre-and posttest design, the effect of a one-week camping experience researched knowledge, attitude toward diabetes, and self-concept of diabetic and nondiabetic children in an integrated residential camp. Subjects for this study were 63 children with diabetes and 18 children without, ages 8 to 14. A modified Etzwiler Diabetic Knowledge Questionnaire, a modified Attitude toward Disabled People Scale, and a Piers-Harris Children's Self-concept Scale were administered on days one and six. Subject characteristics considered to be related to the variables under study were assessed. Paired t-tests, analysis of covariance with repeated measures, and Pearson correlation techniques were used in data analysis. While both the diabetic and nondiabetic groups significantly increased in knowledge about the disease, in neither group was their change in attitude toward the disease significant nor did the nondiabetic subjects demonstrate a statistically significant difference on this variable. Age of onset was inversely correlated with knowledge gain scores, and self-concept were positively correlated with the knowledge scores. The groups did not differ in

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Background: The pilot Inclusion Health Service was a multi-component intervention designed to improve outcomes for adults experiencing homelessness accessing hospital care. The objectives of this report are to describe the development and evaluation of the Inclusion Health Service. Method: Observational study reporting on a multi-component intervention including comprehensive assessment and case management of homeless adult inpatients, case management advice to emergency department- and community-based health, and social care providers and education sessions for hospital and community-based staff. Results: The Inclusion Health Service assessed and developed a comprehensive discharge plan for 262 patients admitted to the hospital. 51 weekly interagency case management meetings took place during the one-year pilot. Additional interventions included education sessions for hospital and community-based health and social care providers; case management advice to ED and community-based health providers and provision of clothes and personal hygiene items to homeless inpatients. During the intervention, declines in the rate of ED presentations and admissions for homeless adults, compared with the prior year, were observed in the participating hospital. Lengths of stay remained the same. Conclusion: An Inclusion Health assessment and integrated discharge plan are feasible and acceptable and may have reduced the need for unscheduled healthcare.