Representation of persons experiencing homelessness and coding of homelessness in general practices: descriptive evaluation using healthcare utilisation data

Abstract

BackgroundEpidemiological studies focused on primary healthcare needs of persons experiencing homelessness (PEH) are often based on data from specialist homeless healthcare services.AimThe aim of this study is to explore the presentation of PEH, coding of homelessness and associated health conditions in mainstream primary care general practices in England.Design & settingEMIS electronic database search of medical records was conducted across 48 general practices in a Clinical Commissioning Group (CCG), representing one of the most socioeconomically deprived regions in England, which also lacks a specialist primary healthcare service for PEH.MethodKey terms and codes were used to identify PEH, their respective diagnoses across 22 health conditions and prescribed medications over the past 4 years.ResultsFrom a population of approximately 321,000, 43 (0.013%) persons were coded as PEH compared to a homelessness prevalence of 0.5% in the English general population. Mental health conditions were the most prevalent diagnoses amongst the PEH registrants (62.3%); the recorded prevalence of other common long-term conditions in PEH was lower than the levels observed in PEH registered with specialist homelessness health services.ConclusionIn a population with approximately four times higher rate of statutory homelessness, PEH representation in mainstream general practices was underrepresented by several folds. As homelessness overlaps with mental health, substance misuse and long term health conditions, consistent coding of homelessness in medical records is imperative to offer tailored support and prevention actions when patients present for services.

population level study of SARS-CoV-2 prevalence amongst people experiencing homelessness in Wales, UK

“…Table 2 summarises the characteristics of the homeless and three not-homeless comparator groups. The homeless group were similar to PEH previously identified using administrative data sources [22][23][24][25], whilst conforming to known profiles of PEH from surveys conducted in the UK [36]. PEH were disproportionately male (67.9%), in their 30s to 40s (mean age of 38.5 years old ±14.0 years), and more concentrated in urban than rural local authorities-with Cardiff, Swansea and Newport representing the major urban authorities in Wales.…”

“…We initially identified GP data and SMDS data as sources of information on PEH through exploration and analysis using data assets in the SAIL Databank [22]. We then cross-referenced and extended these initial data sources and codes, drawing on published peer reviewed studies from Canada, England, and Wales which use administrative data to identify PEH [23][24][25]. Based on this literature, we added further codes for extracting PEH from the GP data, along with additional sources (EDDS and PEDW).…”

Key causes and long-term trends related to emergency department and inpatient hospital admissions of homeless persons in England

“…Previous studies show that persons experiencing homelessness are underrepresented in the mainstream practices [ 15 ]. While specialist primary healthcare centres for homeless persons have been established, mainstream services need to be further inclusive of persons experiencing homelessness.…”

Homelessness and primary care: Problems and solutions

“…Data from 48 practices in England that use the EMIS system showed that 0.013% of patients were coded as experiencing homelessness compared with a prevalence of 0.5% in England. Read codes included homeless, homelessness, no fixed abode, sleeping rough, rough sleeper, and lives in lodgings (Kaushal et al., 2021). Use of coding, ensures GPs have a greater awareness of their patients experiencing homelessness and how they use their service.…”