RT Journal Article
SR Electronic
T1 Randomised controlled trial of GP-led in-hospital management of homeless people (‘Pathway’)
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 223
OP 229
DO 10.7861/clinmedicine.16-3-223
VO 16
IS 3
A1 Nigel Hewett
A1 Peter Buchman
A1 Jeflyn Musariri
A1 Christopher Sargeant
A1 Penny Johnson
A1 Kushala Abeysekera
A1 Louise Grant
A1 Emily A Oliver
A1 Christopher Eleftheriades
A1 Barry McCormick
A1 Aidan Halligan
A1 Nadine Marlin
A1 Sally Kerry
A1 Graham R Foster
YR 2016
UL http://www.rcpjournals.org/content/16/3/223.abstract
AB Homeless people have complex problems. GP enhanced care (Pathway) has shown benefits. We performed a randomised, ­parallel arm trial at two large inner city hospitals. Inpatient homeless adults were randomly allocated to either standard care (all management by the hospital-based clinical team) or enhanced care with input from a homeless care team. The hospital data system provided healthcare usage information, and we used questionnaires to assess quality of life. 206 patients were allocated to enhanced care and 204 to usual care. Length of stay (up to 90 days after admission) did not differ between groups (standard care 14.0 days, enhanced care 13.3 days). Average reattendance at the emergency department within a year was 5.8 visits in the standard care group and 4.8 visits with enhanced care, but this decrease was not significant. ­Quality of life scores after discharge (in 108 patients) improved with enhanced care (EQ-5D-5L score increased by 0.12 [95% CI 0.032 to 0.22] compared wtih 0.03 [–0.1 to 0.15; p=0.076] with standard care). The proportion of people sleeping on the streets after discharge was 14.6% in the standard care arm and 3.8% in the enhanced care arm (p=0.034). The quality-of-life cost per quality-adjusted life-year was £26,000. The Pathway approach doesn’t alter length of stay but improves quality of life and reduces street ­homelessness.