Suchergebnisse

Background Public Health Wales developed its long-term strategy with the purpose of 'Working to Achieve a Healthier Future for Wales'. This study is motivated by one of the strategic priorities, 'Influencing the wider determinants of health' with an emphasis on homelessness prevention.
Main AimTo understand health needs of homeless health service users from routinely collected health data in Wales. To quantify the corresponding differences from general population.
MethodsScoping work has completed collaborating with academic researchers, third sectors, clinical professionals, Office for National Statistics, and housing stats of Welsh Government. To construct study cohort, we will perform linkage exercise among Annual District Death Extract, Emergency Department Data Set, Outpatient Dataset for Wales, Patient Episode Database for Wales, Substance Misuse Data Set and Welsh Longitudinal General Practice dataset (from 2007 to 2018) stored in Secure Anonymised Information Linkage (SAIL) Databank. Study cohort includes all patients with an indication (i.e. clinical codes) of homelessness in their registration information and/or health records. We propose to adapt propensity score matching to construct matched case and control groups. This method will assign each homeless individual to individual without homeless flag with same or similar propensity score. We will then proceed to test for the significance of the homelessness and each health and wellbeing indicators (i.e. physical health, mental wellbeing and substance misuse) in the presence of confounders, and estimate the effects of homelessness on these indicators.
ResultsThis study will demonstrate how linked data provide a more comprehensive review of the health needs of a vulnerable population, the homeless groups in Wales, and be able to explore changes over time.
ConclusionThe relationship between homelessness and health issues is bi-directional. Findings from this study will have implications for health, housing, social, and homelessness policy at both local and national level; as well as contributing to the ability to providing tailored health services to targeted homeless populations groups.

Cold homes and fuel poverty have been identified as factors in health and social inequalities that could be alleviated through energy efficiency interventions. Research on fuel poverty and the health impacts of affordable warmth initiatives have to date primarily been conducted using quantitative and statistical methods, limiting the way how fuel poverty is understood. This study took a longitudinal focus group approach that allowed exploration of lived experiences of fuel poverty before and after an energy efficiency intervention. Focus group discussions were held with residents from three low-income communities before (n = 28) and after (n = 22) they received energy efficiency measures funded through a government-led scheme. The results show that improving the energy efficiency of homes at risk of fuel poverty has a profound impact on wellbeing and quality of life, financial stress, thermal comfort, social interactions and indoor space use. However, the process of receiving the intervention was experienced by some as stressful. There is a need for better community engagement and communication to improve the benefits delivered by fuel poverty programmes, as well as further qualitative exploration to better understand the wider impacts of fuel poverty and policy-led intervention schemes.

ABSTRACT
ObjectivesOver £68M was invested in a housing regeneration programme (Arbed) in 2010-2011 to improve the energy performance of houses in a number of deprived areas across Wales. Houses within the areas were retrofitted with measures, such as external wall insulation, solar hot water systems, solar panels and air source heat pumps. The study aims to establish whether such interventions improve residents' physical and mental health, and the economic impact of change in health outcomes.
ApproachAddress and intervention data were collected from 28 administrative centres and anonymously linked within the SAIL (Secure Anonymised Information Linkage) databank. Two comparator groups were created, one consisting of social houses, another from properties situated in the most deprived areas of Wales. Individuals with continuous residence of at least 60 days over a 10 year period were selected to create a dynamic cohort. Data on emergency hospital admissions and primary care records were extracted from SAIL to assess the impact of investments on healthcare utilisation for cardiovascular and respiratory conditions. Healthcare utilisation data also contributed towards an economic evaluation and excess winter admissions analyses.
ResultsThe final dataset comprises data from over half a million people contributing more than 3 million person years of exposure time to build up trends of hospital admissions across the study period. The intervention cohort consists of over 35,000 people, with about 7,000 separate hospital admissions recorded for our primary outcome. The analysis is based on a pooled time series regression using a difference-in-difference approach to estimate the health impact of the programme.
Conclusion Retrospective analysis of such a natural experiment using routinely collected health data is possible using data linkage techniques. Final results will show whether social programmes to improve energy efficiency to homes in fuel poor areas have a wider impact on the healthcare resource utilisation of residents. We discuss the requirement for more standardised, accurate and timely data capture at the time of such economic investments to ensure the future feasibility of such studies.
This project was funded by the National Institute for Health Research, Public Health Research (PHR) program (project number 11/3020/05)(http://www.nets.nihr.ac.uk/projects/phr/11302005).