The Musculoskeletal Injury Patterns In Homeless Patients: Poor Compliance With Outpatient Follow-Up

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.