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allied
academies
International Conference on
FAMILY MEDICINE AND FAMILY PHYSICIANS
October 16-17, 2017 | Toronto, Canada
Arch Gen Intern Med 2017 | Volume 1 Issue 3
Statement of Problem:
Complex chronic diseases in the
homeless population occur earlier and with worse prognosis
than in the general population; often resulting in unmanaged
suffering and premature death. We identified the prevalence
and mortality from chronic diseases amongst homeless
individuals in Calgary that result in emergency department
(ED) admissions, as an initial step in determining the need
for focused palliative interventions.
Methods:
A retrospective cohort study of homeless
individuals who visited four EDs in the Calgary zone from July
1, 2013-June 30, 2016 was conducted using de-identified
patient data. We included individuals who experienced either
chronic or episodic homelessness by “no fixed address”
labels or the address of shelters or supportive housing. The
data review focused on the following primary ED diagnoses
of homeless patients by using the corresponding ICD-10
codes: respiratory cerebrovascular, cardiovascular and liver
diseases, HIV and renal failure.
Results:
256 homeless individuals visited EDs with
cerebrovascular diseases, heart diseases, HIV, liver diseases,
renal failure, or respiratory diseases resulting in a total of
434 ED visits in the studied time period. Chronic obstructive
pulmonary disease (COPD) accounted for 47% of the 434
visits followed by asthma and liver diseases which consisted
of 13% and 12% of the total ED visits, respectively. COPD and
liver diseases were linked with the highest rate of mortality.
The combined in-hospital and post-discharge mortality rates
for homeless individuals with a primary diagnosis of COPD
was 13 per 100 and 7 per 100 for liver diseases.
Conclusion:
Effective palliative care interventions for end-
stage COPD and liver diseases would impact the greatest
number of homeless individuals who visit EDs for treatment
of chronic conditions. Such interventions could not only
reduce the mortality rate for these conditions but also
improve quality of life.
e:
jennie.ding@ucalgary.caPalliative care needs of homeless patients with chronic diseases who frequent emergency departments in
Calgary: Retrospective cohort study
Jennie Ding, Wang Dongmei, Lang Eddy, Colgan Simon
and
Simon Jessica
University of Calgary, Canada