Targeting a Hard to Access Population—Heart Failure and Homelessness in Sydney

Abstract

Homeless people find accessing health services difficult due to their living situation and complex physical and mental health issues. Homelessness affects a large number of people with 310 rough sleepers and 451 occupying hostel beds in the City of Sydney Area 2012 Homeless Count. Chronic heart failure disease management programs (CHF-MP) are effective in reducing hospitalisations but require that the service is accessed after discharge. This under serviced group of people are likely to have numerous risk factors for the development of cardiovascular disease and heart failure (HF) such as smoking and high alcohol intake and many also live with undiagnosed or untreated hypertension and diabetes. The St Vincent's CHF-MP was referred to 13 homeless patients for follow-up in 2011, 12 of these patients were lost to follow-up. In order to improve the management of this group, the CHF-MP worked in collaboration with a local homeless hostel to establish an outreach clinic providing multidisciplinary HF care to complex patients with multi-morbidity. To date, seven patients have been regularly presenting for the past five months. In this time initiation and uptitration of HF medications have been achieved, HF symptoms have improved; referrals have been made to other health professionals. None of these patients have had a HF related admission during this time. The collaborative approach between these services can improve outcomes for this complex group of people. This presentation will discuss the strategies used to access and manage this group and the lessons we have learnt so far.