{
  "abstract": "Background There is a well-documented link between homelessness and secondary care use. People experiencing homelessness face pronounced health inequalities and, because of this, use ambulance, A&E and inpatient care at higher frequency than the general population. This study explores factors associated with high secondary care access among adults experiencing homelessness in England.Methods Using secondary analysis of Homeless Health Needs Audit data (n=2792), a national survey conducted by Homeless Link, the study explores healthcare use and health status of people experiencing homelessness. Secondary care was measured through self-reported contact with ambulance, A&E and inpatient care across the previous 12 months.Results Over half of the sample (55%, n=1303) accessed secondary care at least once in the previous 12 months and 10% had more than 8 contacts during that period. Contrary to common assumptions, most participants had also accessed primary care (n=1160), with only a small minority (n=143) accessing secondary care exclusively. This disputes the narrative that higher secondary care use among people experiencing homelessness is caused by an outright inability to access primary care, and instead suggests deeper issues with the quality, accessibility and appropriateness of care that may limit its preventative impact. Ordinal logistic regression analysis identified several predictors of higher secondary care use, including recent primary care engagement, unmet health needs, substance use, and gender. The most significant cumulative predictor was the presence of additional inclusion health markers including incarceration, severe mental illness and experience of care. It also highlights key divergent health trends, with age showing no association despite acting as a powerful predictor in the general population.Conclusion These findings highlight the need for more integrated, person-centred models of care, with improved homelessness prevention, multidisciplinary working and action on inclusion health risk factors to significantly reduce rates of complex ill-health and avoidable secondary care use among people experiencing homelessness.",
  "authors": [
    {
      "affiliations": [
        "Advanced Care Research Centre, University of Edinburgh, Edinburgh, UK",
        "Centre for Homelessness and Inclusion Health, University of Edinburgh, Edinburgh, UK",
        "Homeless Link, London, UK"
      ],
      "name": "Cat Tottie"
    }
  ],
  "title": "P18-2 Factors associated with high secondary care use among adults experiencing homelessness in England: secondary analysis of homeless health needs data",
  "uid": "38e90ef7-49bf-58da-8294-8c3c419fbd2f"
}