title: Randomised controlled trial of GP-led in-hospital management of homeless people ('Pathway').
abstract: 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.
authors.affiliation: Medical Director Pathway, University College Hospital Homeless Team, London, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Hewett
authors.affiliation: Health E1 Homeless Medical Centre, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Buchman
authors.affiliation: Barts Health NHS Trust, London, UK, and Division of Medical Education, Brighton and Sussex Medical School, Brighton, UK.
authors.forename: Jeflyn
authors.initials: J
authors.lastname: Musariri
authors.affiliation: Brighton and Sussex University Hospital, Brighton, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Sargeant
authors.affiliation: Brighton and Sussex University Hospital, Brighton, UK.
authors.forename: Penny
authors.initials: P
authors.lastname: Johnson
authors.affiliation: Queen Mary University of London, London, UK.
authors.forename: Kushala
authors.initials: K
authors.lastname: Abeysekera
authors.affiliation: Queen Mary University of London, London, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Grant
authors.affiliation: Queen Mary University of London, London, UK.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Oliver
authors.affiliation: Centre for Health Service Economics and Organisation, Department of Primary Care, University of Oxford, Oxford, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Eleftheriades
authors.affiliation: Centre for Health Service Economics and Organisation, Department of Primary Care, University of Oxford, Oxford, UK.
authors.forename: Barry
authors.initials: B
authors.lastname: McCormick
authors.affiliation: Pathway, RIP, Central Manchester University Hospitals NHS Trust and University of Manchester, Manchester, UK.
authors.forename: Aidan
authors.initials: A
authors.lastname: Halligan
authors.affiliation: Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK.
authors.forename: Nadine
authors.initials: N
authors.lastname: Marlin
authors.affiliation: Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Kerry
authors.affiliation: Queen Mary University of London, London, UK.
authors.forename: Graham R
authors.initials: GR
authors.lastname: Foster
mesh_terms: D000328:Adult; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons / Q000523:psychology* / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D011788:Quality of Life
keywords: Homeless; Pathway; addiction; mental health; randomised controlled trial; service provision