The musculoskeletal injury patterns in homeless patients: poor compliance with outpatient follow-up

ABSTRACT

Injuries are a leading cause of hospital presentation in the street homeless population. We aimed to determine attendance patterns at outpatient surgical clinics and the seeking of alternative care at a homeless medicine practice by street homeless patients with musculoskeletal injuries. This study investigates the number of street homeless patients over a two-year period with injuries requiring follow-up who did not attend outpatient clinic (OPC) appointments and their subsequent presentations to emergency departments (ED), readmission rates and presentation to alternative care. We found 206 street homeless patients were identified of which 57 (27%) required follow-up care in an orthopedic or plastic surgery OPC. 31 (55%) did not attend their scheduled follow-up outpatient appointments but were seen in ED for their primary injury within a 3-month period after discharge. Ten patients (18%) required readmission for their primary injury. Of the 31 patients who did not attend surgical OPCs, 15 presented to ED and seven individuals sought follow-up care at the Homeless Healthcare GP practice. Eight patients had no known follow up. This study provides further evidence that people who are homeless are poor attenders at scheduled OPC and instead they often attend ED and homeless clinics.

KEYWORDS:

• Homelessness
• street
• outpatient clinic
• follow up
• orthopedics

Acknowledgements

The authors would like to thank Royal Perth Hospital, in particular, the Orthopaedic and Plastic Surgery departments, the RPH outpatient clinic staff and the RPH Homeless team. I would also wish to acknowledge the assistance of Dr Cecily Strange of the Dept Population Health, University of WA in the preparation of this paper.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability

The data that support the findings of this study are openly available in “The musculoskeletal injury patterns in homeless patients: poor compliance with outpatient follow-up”, https://doi.org/10.7910/DVN/8KSF8M, Harvard Dataverse.

Additional information

Notes on contributors

Omid Nazifi

Dr Omid Nazifi is an orthopaedic registrar at Royal Perth Hospital with a background in physiotherapy and exercise physiology.

Andrew Linden Stuart

Dr Andrew Linden Stuart is a General surgery registrar at Royal Perth Hospital with a background in International Studies.

Richard Beaver

Richard Beaver is a Senior Orthopaedic Surgeon at Royal Perth Hospital and clinical director of the joint replacement outcomes unit.

Amanda Stafford

Amanda Stafford is an Emergency Consultant and lead clinician of Royal Perth hospital's homeless team.