{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T16:05:30Z","timestamp":1784217930085,"version":"3.55.0"},"reference-count":42,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"unspecified","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001921","name":"Public Health Research Programme","doi-asserted-by":"publisher","award":["17\/44\/40"],"award-info":[{"award-number":["17\/44\/40"]}],"id":[{"id":"10.13039\/501100001921","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,4,29]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To measure differences in hospital use between homeless adults using the homeless health peer advocacy (HHPA) service (clients) and non-clients in London.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>We conducted a cohort study with linkage to Hospital Episode Statistics (HES) 1 year prior and postenrolment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>London, UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population<\/jats:title>\n                    <jats:p>People who are homeless in London aged over 18 years residing in a hostel, attending a day centre or being referred by a homelessness service; experiencing difficulties accessing healthcare; and speaking either English or Polish. Participants were required to provide consent for linkage to HES. To be classified as a client, individuals must have used the HHPA service at least once between January and July 2021; non-clients were those who had never used the service.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>Peer advocacy is the provision of support by volunteer-trained advocates with lived experience of homelessness to individuals to overcome barriers to accessing health services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>The primary outcome was not attending a scheduled outpatient appointment (\u2018did-not-attend\u2019) over 12 months postrecruitment, commencing from their baseline interview date. Secondary outcomes included the number of accident and emergency (A&amp;E) and inpatient admissions (all and planned admissions) during that same period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We estimated the probability of non-attendance using Poisson regression and the number of inpatient admissions and A&amp;E visits using negative binomial regression models. Models included: (1) propensity score weights and (2) propensity score weights and imbalanced confounders. Sensitivity analyses assumed that participants who did not link to HES had no hospital attendance. Exploratory analyses examined differential effects of peer advocacy by clients\u2019 type of peer advocacy engagement (new vs ongoing clients; supported vs unsupported) and by clients\u2019 anxiety or depression symptom scores measured with the Patient Health Questionnaire-4 (PHQ4).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>153 clients and 158 non-clients were recruited between July and December 2021. Most were male (77.5%) with a median age of 48 years. Weighted regression models suggested no evidence of effect of peer advocacy on non-attendance (rate ratio (RR) 0.97 (95%\u2009CI 0.67 to 1.42)), no difference in the mean number of A&amp;E visits (2.59 95% CI 1.93, 3.24 vs 1.76 95% CI 1.13, 2.40) but more inpatient admissions (1.65 95% CI 1.10, 2.20 vs. 0.53 95% CI 0.27, 0.82) for HHPA clients vs non-clients respectively. This was supported in sensitivity analyses. In exploratory analyses, clients with PHQ4 scores of 9\u201312 had greater probability of non-attendance at outpatient appointments (RR 1.98 (95%\u2009CI 1.0 to 3.89)) compared to non-clients. Those with scores of 6\u20138 had 5.86 (95% CI 2.73 to 9.0) completed appointments versus 1.87 (95% CI 0.41 to 3.34) among non-clients and 1.13 (95% CI 0.01 to 0.27) inpatient admissions compared with 0.13 (95% CI \u22120.01 to \u22120.27) among non-clients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Following COVID-related disruptions to the work of peer advocates and health services, we found mixed evidence on the effect of peer advocacy: with no evidence of impact on outpatient appointments or use of emergency services; but increased inpatient admissions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-107422","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T15:25:38Z","timestamp":1784215538000},"page":"e107422","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Peer advocacy and access to hospital care for people who are homeless in London, UK, 2019\u20132023: a cohort study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0943-0045","authenticated-orcid":false,"given":"Lucy","family":"Platt","sequence":"first","affiliation":[{"name":"Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0981-4663","authenticated-orcid":false,"given":"Andrew","family":"Guise","sequence":"additional","affiliation":[{"name":"Population Health Sciences, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2654-5431","authenticated-orcid":false,"given":"Paniz","family":"Hosseini","sequence":"additional","affiliation":[{"name":"Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Bowgett","sequence":"additional","affiliation":[{"name":"Groundswell, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Murphy","sequence":"additional","affiliation":[{"name":"Groundswell, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mani","family":"Cudjoe","sequence":"additional","affiliation":[{"name":"Groundswell, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9322-5078","authenticated-orcid":false,"given":"PJ","family":"Annand","sequence":"additional","affiliation":[{"name":"Centre for Care, Social Research Institutes, The University of Sheffield Faculty of Social Sciences, Sheffield, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Spike","family":"Hudson","sequence":"additional","affiliation":[{"name":"Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maame Esi D","family":"Yankah","sequence":"additional","affiliation":[{"name":"Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1628-1228","authenticated-orcid":false,"given":"Dee","family":"Menezes","sequence":"additional","affiliation":[{"name":"Institute of Health Informatics Research, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Legood","sequence":"additional","affiliation":[{"name":"Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0542-0816","authenticated-orcid":false,"given":"Rob W","family":"Aldridge","sequence":"additional","affiliation":[{"name":"Institute of Health Informatics Research, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Hayward","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology and Healthcare, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Luchenski","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology and Healthcare, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Williamson","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8783-7724","authenticated-orcid":false,"given":"Sujit D","family":"Rathod","sequence":"additional","affiliation":[{"name":"Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"2026071608251563000_16.7.e107422.1","unstructured":"Department for Levelling Up Housing & Communities . Ending rough sleeping for good. London Department for Levelling Up Housing & Communities; 2022."},{"key":"2026071608251563000_16.7.e107422.2","unstructured":"Department for Levelling Up Housing & Communities . Official Statistics. Rough sleeping snapshot in England: autumn 2023. London Department for Levelling Up, Housing & Communities; 2024."},{"key":"2026071608251563000_16.7.e107422.3","unstructured":"Homeless Link Research Team . Support for single homeless people in England: Annual Review 2022. Homeless Link; 2023."},{"key":"2026071608251563000_16.7.e107422.4","unstructured":"Homeless Link . The Unhealthy State of Homelessness 2022. Findings from the Homeless Health Needs Audit. Homeless Link; 2022."},{"key":"2026071608251563000_16.7.e107422.5","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-025192","article-title":"Health-related quality of life and prevalence of six chronic diseases in homeless and housed people: a cross-sectional study in London and Birmingham, England","volume":"9","author":"Lewer","year":"2019","journal-title":"BMJ Open"},{"key":"2026071608251563000_16.7.e107422.6","unstructured":"Aldridge RW , Story A , Hwang SW , et al . The health impact of social exclusion: a systematic review and meta-analysis of morbidity and mortality data from homeless, prison, sex work and substance use disorder populations in high-income countries. Lancet 2017."},{"key":"2026071608251563000_16.7.e107422.7","doi-asserted-by":"crossref","first-page":"506","DOI":"10.7861\/clinmedicine.16-6-506","article-title":"Hospital care and costs for homeless people","volume":"16","author":"McCormick","year":"2016","journal-title":"Clin Med (Lond)"},{"key":"2026071608251563000_16.7.e107422.8","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp11X561203"},{"key":"2026071608251563000_16.7.e107422.9","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1446.2008.00726.x"},{"key":"2026071608251563000_16.7.e107422.10","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-022-08265-y","article-title":"Access to healthcare for people experiencing homelessness in the UK and Ireland: a scoping review","volume":"22","author":"McNeill","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"2026071608251563000_16.7.e107422.11","doi-asserted-by":"publisher","DOI":"10.1111\/hsc.12857"},{"key":"2026071608251563000_16.7.e107422.12","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1177\/10497323221083356","article-title":"What Makes Intentional Unidirectional Peer Support for Homeless People Work? An Exploratory Analysis Based on Clients\u2019 and Peer Workers\u2019 Perceptions","volume":"32","author":"Schel","year":"2022","journal-title":"Qual Health Res"},{"key":"2026071608251563000_16.7.e107422.13","doi-asserted-by":"crossref","DOI":"10.1186\/1471-244X-14-39","article-title":"A systematic review and meta-analysis of randomised controlled trials of peer support for people with severe mental illness","volume":"14","author":"Lloyd-Evans","year":"2014","journal-title":"BMC Psychiatry"},{"key":"2026071608251563000_16.7.e107422.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12954-021-00461-z","article-title":"Peer driven or driven peers? A rapid review of peer involvement of people who use drugs in HIV and harm reduction services in low- and middle-income countries","volume":"18","author":"Chang","year":"2021","journal-title":"Harm Reduct J"},{"key":"2026071608251563000_16.7.e107422.15","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-019-1300-2","article-title":"Improving engagement with healthcare in hepatitis C: a randomised controlled trial of a peer support intervention","volume":"17","author":"Stagg","year":"2019","journal-title":"BMC Med"},{"key":"2026071608251563000_16.7.e107422.16","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugpo.2020.103089","article-title":"Practising critical resilience as an advanced peer support worker in London: A qualitative evaluation of a peer-led hepatitis C intervention amongst people experiencing homelessness who inject drugs","volume":"91","author":"Surey","year":"2021","journal-title":"Int J Drug Policy"},{"key":"2026071608251563000_16.7.e107422.17","doi-asserted-by":"publisher","DOI":"10.3310\/AAFO2475"},{"key":"2026071608251563000_16.7.e107422.18","doi-asserted-by":"crossref","unstructured":"Aldridge RW , Hayward AC , Hemming S , et al . Effectiveness of peer educators on the uptake of mobile X-ray tuberculosis screening at homeless hostels: a cluster randomised controlled trial. BMJ Open 2015;5. doi:10.1136\/bmjopen-2015-008050","DOI":"10.1136\/bmjopen-2015-008050"},{"key":"2026071608251563000_16.7.e107422.19","doi-asserted-by":"crossref","first-page":"223","DOI":"10.7861\/clinmedicine.16-3-223","article-title":"Randomised controlled trial of GP-led in-hospital management of homeless people ('Pathway\u2019)","volume":"16","author":"Hewett","year":"2016","journal-title":"Clin Med (Lond)"},{"key":"2026071608251563000_16.7.e107422.20","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/S0140-6736(17)31959-1","article-title":"What works in inclusion health: overview of effective interventions for marginalised and excluded populations","volume":"391","author":"Luchenski","year":"2018","journal-title":"The Lancet"},{"key":"2026071608251563000_16.7.e107422.21","doi-asserted-by":"publisher","DOI":"10.1007\/s10597-017-0102-2"},{"key":"2026071608251563000_16.7.e107422.22","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-050717","article-title":"Peer advocacy and access to healthcare for people who are homeless in London, UK: a mixed method impact, economic and process evaluation protocol","volume":"11","author":"Rathod","year":"2021","journal-title":"BMJ Open"},{"key":"2026071608251563000_16.7.e107422.23","doi-asserted-by":"crossref","unstructured":"Guise A , Annand PJ , Hosseini P , et al . Building and Boosting Capitals for Health Care Access: A Qualitative Study of Homeless Health Peer Advocacy in London, UK. Sociology Health &Amp; Illness 2026;48. doi:10.1111\/1467-9566.70136","DOI":"10.1111\/1467-9566.70136"},{"key":"2026071608251563000_16.7.e107422.24","doi-asserted-by":"crossref","DOI":"10.1111\/1467-9566.70136","article-title":"Building and Boosting Capitals for Health Care Access: A Qualitative Study of Homeless Health Peer Advocacy in London, UK","volume":"48","author":"Guise","year":"2026","journal-title":"Sociol Health Illn"},{"key":"2026071608251563000_16.7.e107422.25","unstructured":"Comarty H . Coronavirus: Support for rough sleepers. England: House of Commons Library HM Government, 2021."},{"key":"2026071608251563000_16.7.e107422.26","unstructured":"Finlayson S , Boelman V , Young R , et al . Saving lives, saving money. How homeless health peer advocacy reduces health inequalities. London: Young Foundation, 2016."},{"key":"2026071608251563000_16.7.e107422.27","unstructured":"Pavement T . The Pavement London 2005, Available: https:\/\/www.thepavement.org.uk\/about"},{"key":"2026071608251563000_16.7.e107422.28","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2021-055088"},{"key":"2026071608251563000_16.7.e107422.29","doi-asserted-by":"crossref","unstructured":"Elwell-Sutton T , Fok J , Albanese F , et al . Factors associated with access to care and healthcare utilization in the homeless population of England. J Public Health 2017;39. doi:10.1093\/pubmed\/fdw008","DOI":"10.1093\/pubmed\/fdw008"},{"key":"2026071608251563000_16.7.e107422.30","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1017\/S147474641100025X","article-title":"Multiple Exclusion Homelessness in the UK: Key Patterns and Intersections","volume":"10","author":"Fitzpatrick","year":"2011","journal-title":"Social Policy &Amp; Society"},{"key":"2026071608251563000_16.7.e107422.31","doi-asserted-by":"crossref","unstructured":"Annand PJ , Marshall A , Guise A , et al . Peer progression: impact of homelessness health peer advocacy on peer advocates. Pathways from Homelessness; 2021 doi:10.1016\/j.socscimed.2022.114770","DOI":"10.1016\/j.socscimed.2022.114770"},{"key":"2026071608251563000_16.7.e107422.32","unstructured":"Guise A , Annand PJ , Hosseini P , et al . Building cultural health capital to manage stigma and health care access: an evaluation of a homeless health peer support service in london, uk. British Sociological Association Medical Sociology Conference; 2022"},{"key":"2026071608251563000_16.7.e107422.33","doi-asserted-by":"crossref","unstructured":"Guise A , Burridge S , Annand PJ , et al . Why were COVID-19 infections lower than expected amongst people who are homeless in London, UK in 2020? Exploring community perspectives and the multiple pathways of health inequalities in pandemics. SSM Qual Res Health 2022;2. doi:10.1016\/j.ssmqr.2021.100038","DOI":"10.1016\/j.ssmqr.2021.100038"},{"key":"2026071608251563000_16.7.e107422.34","doi-asserted-by":"publisher","DOI":"10.1176\/appi.psy.50.6.613"},{"key":"2026071608251563000_16.7.e107422.35","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2009.06.019"},{"key":"2026071608251563000_16.7.e107422.36","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-007575","article-title":"A systematic review of the predictors of health service utilisation by adults with mental disorders in the UK","volume":"5","author":"Twomey","year":"2015","journal-title":"BMJ Open"},{"key":"2026071608251563000_16.7.e107422.37","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-019-4620-1","article-title":"Secondary care usage and characteristics of hospital inpatients referred to a UK homeless health team: a retrospective service evaluation","volume":"19","author":"Field","year":"2019","journal-title":"BMC Health Serv Res"},{"key":"2026071608251563000_16.7.e107422.38","unstructured":"England NHS . Reducing Did No Attends (DNAs) in Outpatient Services. NHS England, 2023."},{"key":"2026071608251563000_16.7.e107422.39","doi-asserted-by":"crossref","DOI":"10.1192\/bjo.2024.34","article-title":"Epidemiological features of depression and anxiety among homeless adults with healthcare access problems in London, UK: descriptive cross-sectional analysis","volume":"10","author":"Rathod","year":"2024","journal-title":"BJPsych Open"},{"key":"2026071608251563000_16.7.e107422.40","unstructured":"Keats H , Maguire N , Johnson R , et al . Psychologically informed services for homeless people. London: Department for Communities and Local Government, 2012."},{"key":"2026071608251563000_16.7.e107422.41","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-019282","article-title":"Outcomes of specialist discharge coordination and intermediate care schemes for patients who are homeless: analysis protocol for a population-based historical cohort","volume":"7","author":"Blackburn","year":"2017","journal-title":"BMJ Open"},{"key":"2026071608251563000_16.7.e107422.42","doi-asserted-by":"crossref","DOI":"10.1136\/bmjph-2025-002978","article-title":"Estimating the scale of hospital admissions for people experiencing homelessness in England: a population-based multiple systems estimation study using national Hospital Episode Statistics","volume":"3","author":"Luchenski","year":"2025","journal-title":"BMJ Public Health"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-107422","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T15:25:45Z","timestamp":1784215545000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-107422"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":42,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,16]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bmjopen-2025-107422"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-107422","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}