RT Journal Article
SR Electronic
T1 Improving access to epilepsy care for homeless patients in the Dublin Inner City: a collaborative quality improvement project joining hospital and community care
JF BMJ Open Quality
JO BMJ Open Qual
FD British Medical Journal Publishing Group
SP e001367
DO 10.1136/bmjoq-2021-001367
VO 10
IS 2
A1 Elisabeth Doran
A1 Enda Barron
A1 Laura Healy
A1 Lorraine O'Connor
A1 Cara Synnott
A1 Clíona Ní Cheallaigh
A1 Colin P Doherty
YR 2021
UL http://bmjopenquality.bmj.com/content/10/2/e001367.abstract
AB Homelessness is associated with significant psychosocial and health disparities. The rate of epilepsy among this cohort is eight times greater than that in the settled population, and the associated morbidity is higher due to lack of integrated care, difficulties with treatment adherence, substance abuse and poor social circumstances. There is a high rate of seizure-related death in homeless patients. Seizures are one of the most common neurological cause for emergency department presentation among this population. The aim of this quality improvement project was to use a multistakeholder co-production approach to design a new pathway of care for homeless patients with epilepsy to improve access to specialist epilepsy care and to strengthen the links between hospital and community teams who manage this population. After several years of observation, stakeholder engagement and numerous tests of change, we have created a new care pathway and developed bespoke tools for primary care providers and for physicians working in the emergency department to enable them to assess and manage patients as they present, as well as provide access to remote epilepsy specialist support.