Multimorbidity, disadvantage, and patient engagement within a specialist homeless health service in the UK: an in-depth study of general practice data

BACKGROUND: There is a paucity of current health data regarding users of a specialist homeless health service in the UK. AIM: To describe the health of users of a specialist homeless health service by assessing levels of multimorbidity, social exclusion — by measuring severe and multiple disadvantage (SMD) — and patient engagement with health care. DESIGN & SETTING: Analysis of patient-level data from computerised records of patients registered with a specialist homeless health service in Glasgow, Scotland. METHOD: Data for 133 patients were extracted using a data extraction form. Multimorbidity and SMD were described using categorisation adapted from previous literature in this field. Stepwise regression analysis was carried out to assess the relationship between domains of SMD experienced and the number of long-term conditions (LTCs) a patient had. RESULTS: The average age of patients in the cohort was 42.8 years, however levels of multimorbidity were comparable to those aged ≥85 years in the general population. The average number of LTCs was 2.8 per patient, with 60.9% of patients having both mental and physical comorbidity. SMD was categorised into three domains: homelessness; substance misuse; and previous imprisonment. More than 90.0% of patients experienced ≥2 domains of SMD, and SMD experiences were associated with multimorbidity: as domains of SMD experiences increased, so did the number of LTCs a patient was recorded as having. CONCLUSION: This cohort of patients has a complex burden of health and social care needs, which may act as barriers in the provision of effective health care.