Increasing multimorbidity in an Australian street health service: A 10-year retrospective cohort study

Abstract

Street-based clinics provide general practice services to marginalised and homeless persons. The objective of this study was to examine prevalence, patterns and severity of multimorbidity in patients attending one such service. A retrospective cohort study (2006–15), comprising medical record review of patients (n = 4285), was undertaken. A Cumulative Illness Rating Scale (CIRS) was used to assess multimorbidity. Average age of patients was 38.2 ± 17.9 years. Of 31.5% Aboriginal patients, 50.8% were female (37.6% in non Aboriginal patients). Of all patients, 53% had multimorbidity. Aboriginal patients had higher rates of multimorbidity than non-Aboriginal patients (58.0% vs 50.6%, P <0.001). Psychiatric, musculoskeletal (especially skin) and respiratory conditions were most common. Disease severity was mild to moderate, with 26.8% having at least one severe or extremely severe condition. Multimorbidity and disease severity increased between 2006–11 and 2012–15. Aboriginality was the strongest predictor of multimorbidity (odds ratio [OR] = 2.1; 95% confidence interval [CI]: 1.8–2.4; P <0.001). Street-based general practice services are critical to facilitate easy access to primary and secondary management of chronic multimorbid conditions in marginalised (especially Aboriginal) patients.