Improving access to epilepsy care for homeless patients in the Dublin Inner City: a collaborative quality improvement project joining hospital and community care

BMJ Open Quality

article

Elisabeth Doran¹  Enda Barron³  Laura Healy⁴  Lorraine O'Connor⁵  Cara Synnott¹  Clíona Ní Cheallaigh⁶  Colin P Doherty¹ 

[1] Neurology , Saint James's Hospital;Neurologie , Sankt Georg Hospital Group;Primay Care;Clinical Nutrition , Saint James's Hospital;Epilepsy Action Australia;Inclusion Health , Saint James's Hospital;Clinical Medicine , Trinity College Dublin;Neurology;FutureNeuro SFI research center for rare and chronic neurological diseases , Royal College of Surgeon's in Ireland

关键词: healthcare quality improvement;    standards of care;    patient-centred care;    chronic disease management;   

DOI  :  10.1136/bmjoq-2021-001367

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

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.healthcare quality improvementstandards of carepatient-centred carechronic disease managementhttp://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND