Comparing the Impact of Primary Care Practice Design in Two Inner City UK Homelessness Services

Area of Science:

• Public Health
• Primary Health Care
• Health Services Research

Background:

• Specialist homeless primary health care services in the UK address unique patient needs.
• The design characteristics of these services, including long-term condition (LTC) prevalence, health care utilization, and prescribing patterns, are under-explored.
• Understanding service configuration is crucial for assessing its impact on patient outcomes.

Purpose of the Study:

• To describe the practice design of specialist homeless general practitioner services in Glasgow and Edinburgh.
• To explore how differences in service configuration affect LTC prevalence, health care utilization, and prescribing.
• To compare infrastructure, staff expertise, and patient data between the two services.

Main Methods:

• Patient data were extracted from computerized general practitioner records in Glasgow (2015) and Edinburgh (2016).
• Homeless health service configurations were documented, including staff, skill mix, registration, and follow-up systems.
• Anonymized patient data on demographics, LTCs, service utilization, and prescribing were summarized and compared.

Main Results:

• Significant differences in infrastructure, registration processes, service integration, recording systems, and staff expertise were observed between Glasgow and Edinburgh practices.
• Patient populations differed in LTC diagnoses, with higher rates of mental health, addiction, cardiovascular, and respiratory conditions in Edinburgh.
• Edinburgh saw more consultations with nurses and other staff, while Glasgow had more with pharmacists; medication adherence and appointment attendance were low in both.

Conclusions:

• Service design and professional skill mix influence the recording of LTCs, service uptake, and health condition management.
• The configuration of homeless health services, including skill mix and resources, significantly impacts diagnoses, health care utilization, and prescribing.
• Optimizing the design of homeless health services is essential for effectively caring for this vulnerable population.