title: Health and use of health services of people who are homeless and at risk of homelessness who receive free primary health care in Dublin.
abstract: BACKGROUND
  Homeless populations experience poorer physical and mental health, and more barriers to accessing adequate healthcare. This study investigates the health of this population, following the provision of a free to access primary care service for homeless people in Dublin (Safetynet). The health of this group will be compared to previous studies on homelessness conducted in Dublin prior to the establishment of this service (in 1997 and 2005).
  
  
  METHODS
  Participants were recruited through Safetynet clinics. A 133-item questionnaire was administered to determine participants' physical and mental well-being, use of health services and healthcare needs. Prescription data was extracted from participants' electronic health records.
  
  
  RESULTS
  A total of 105 participants were recruited. The majority were < 45 years of age (69%), male (75%), single (52%), Irish (74%) and had children (52%). Multimorbidity was common; with 5.3 ± 2.7 (mean ± SD) physical conditions reported per person. A large proportion of participants had at some point received a formal diagnosis of a mental health condition (70%; 73/105), including depression (50%; 52/105), addiction disorder (39%), anxiety (36%; 38/105), schizophrenia (13%; 14/105) and bipolar disorder (6%; 6/105). With regards to illicit drug use, 60% (63/105) of participants reported ever using drugs, while 33% (35/105) reported being active drug users. Based on AUDIT C criteria, 53% had an alcohol problem. Compared to previous studies, participants reported more positive ratings of health (70% vs. 57% in 1997 and 46% in 2005). The proportion of participants on one or more prescription medication was higher than in previous studies (81% vs. 32% in 1997 and 49% in 2005) and there was a decrease in attendance at outpatients departments (17% vs. 27% in 2005) and a trend towards a decrease in attendance at Accident and Emergency departments (A & E) (29% vs. 37% in 2005).
  
  
  CONCLUSIONS
  This vulnerable population has many physical and mental health problems. Use of drugs, alcohol and smoking is common. Following the establishment of Safetynet, self-reported health was rated more positively, there was also a decrease in the use of A & E and outpatient services and an increase in prescription medicines.
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland. claire.keogh@gmail.com.
authors.forename: Claire
authors.initials: C
authors.lastname: Keogh
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland. kirstyobrien@rcsi.ie.
authors.forename: Kirsty K
authors.initials: KK
authors.lastname: O'Brien
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland. anthohan@rcsi.ie.
authors.forename: Anthony
authors.initials: A
authors.lastname: Hoban
authors.affiliation: Safetynet, Coolmine House, 19 Lord Edward Street, Dublin 2, Ireland. austinoc@hotmail.com.
authors.forename: Austin
authors.initials: A
authors.lastname: O'Carroll
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland. tomfahey@rcsi.ie.
authors.forename: Tom
authors.initials: T
authors.lastname: Fahey
mesh_terms: D000328:Adult; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006304:Health Status; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000628:therapy*; D011795:Surveys and Questionnaires