THE HOMELESS IN THE EMERGENCY DEPARTMENT - A PATIENT PROFILE

Objective-To explore the possibility that homeless people use the acci dent and emergency (A&E) department as a substitute for primary care a nd to quantify the role of alcohol abuse in their attendances. Methods -The study period lasted six months. Attendances of all patients regis tering with ''No fixed abode'' as their address were analysed from the A&E notes. Information gathered included details of the presenting co mplaint, general practitioner (GP) registration, and alcohol involveme nt in the presentation. Resutts-135 homeless patients attended the dep artment 233 times; 91% of patients were male with an average age of 40 years; 46% of attendances were during office hours; 81.5% of presenta tions were for minor problems; 65.2% of patients had co-existing medic al problems, with 14.8% having a chronic alcohol problem; 23.7% of pat ients gave details of their GP and the remainder were either not regis tered or did not know their GP registration status; 29.6% of attendanc es directly involved alcohol and another 10.3% were requests for inpat ient or outpatient alcohol detoxification; 42.1% of patients questione d said they were aware of the medical facilities available to homeless people in the community; 52.6% of those questioned said they preferre d being seen in the A&E department when ill, with 23.7% preferring GP treatment and 10.5% attending community homeless clinics. Conclusions- The local homeless population may be using the A&E department as a sub stitute for primary care even in the presence of homeless healthcare f acilities in the community. Heightened awareness of these facilities m ay improve their uptake. Alcohol plays a large role in homeless people seeking medical help in the A&E department. More accessible community facilities for dealing with this problem in this patient group are ne eded.