Can a targeted GP-led clinic improve outcomes for street sex workers who use heroin?

Litchfield, Jane; Maronge, Andrew; Rigg, Tim; Rees, Benjamin; Harshey, Ravi; Keen, Jenny

doi:10.3399/bjgp10x514774

Cited by 8 publications

(25 citation statements)

References 6 publications

(5 reference statements)

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“…One randomised controlled trial (RCT) 24 and five before and after studies 25–29 were included. There were 806 participants in the RCT and the number of participants in the observational studies ranged between 27 and 54.…”

Section: Resultsmentioning

confidence: 99%

“…The three substitute prescribing based studies 25 28 29 were in clinical settings. The oldest 1986 study 29 was in-patient based, the slightly later 1993 study 28 outpatient based and the 2010 study 25 based in a community clinic. All the non-clinical interventions were based in a community outreach setting.…”

Section: Resultsmentioning

confidence: 99%

“…Interventions were of three types: substitute prescribing based, 25 28 29 educational 24 26 and motivational interviewing (MI). 27 …”

Section: Resultsmentioning

confidence: 99%

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Systematic review of interventions to reduce illicit drug use in female drug-dependent street sex workers

et al. 2015

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ObjectivesMost female street-based sex workers (SSWs) are drug users and this group experience particularly poor outcomes in achieving and maintaining abstinence. In 2010 the UK adopted a recovery-orientated Drug Strategy. This strategy did not specifically highlight the complex drug treatment needs of SSWs. Therefore we sought to synthesise and critically appraise existing evidence of interventions to reduce illicit drug use in this group, in order to guide service change toward better provision for the drug treatment needs of SSWs.MethodsA systematic review of evidence on the effectiveness of interventions to reduce illicit drug use in female SSWs. Following the PRISMA guidelines, a structured search strategy was used. Searches included databases, organisational and government websites to identify published and grey literature, as well as contacting experts in the field, and hand-searching reference lists and journals.ResultsSix studies, one experimental and five observational, were identified which met review inclusion criteria. Intervention approaches evaluated included substitute prescribing, educational sessions and motivational interviewing. All studies reported a positive intervention effect but the five observational studies were all subject to a relatively high risk of bias. By contrast, the experimental study provided little or no evidence of positive effect (OR for reduction of illicit drug in intervention compared to controls 1.17 95%CI 0.84–1.66 at 3 months and 1.14 (95% CI 0.8 to 1.61) at 6 months follow-up). All six studies described challenges and solutions to study recruitment, retention and follow-up, which were influenced by issues affecting SSWs’ health and social stability.ConclusionsThere is currently no strong evidence for effectiveness of interventions to reduce illicit drug use in female SSWs with problematic drug use. Thus, the development and robust evaluation of effective interventions should be a priority if recovery-orientated goals are to become more achievable for this group.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Systematic review of interventions to reduce illicit drug use in female drug-dependent street sex workers

et al. 2015

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“…Studies also demonstrated significant reductions in criminal activities as determined by rates of incarceration , probability of arrests , illegal incomes , frequency of crime , and Addiction Severity Index (ASI) legal composite score . Finally, for functioning and quality of life, although less studied, the results were consistent: significant increase in productivity , significant improvement in ASI family/social composite score , and significant improvement in well‐being as determined by the Christo Inventory score .…”

Section: Resultsmentioning

confidence: 84%

Long term outcomes of pharmacological treatments for opioid dependence: does methadone still lead the pack?

García-Portilla

Bobes-Bascaran

Bascarán

et al. 2014

Brit J Clinical Pharma

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The aim of this review was to update and summarize the scientific knowledge on the long term outcomes of the different pharmacological treatment options for opioid dependence currently available and to provide a critical discussion on the different treatment options based on these results. We performed a literature search using the PubMed databases and the reference lists of the identified articles. Data from research show that the three pharmacological options reviewed are effective treatments for opioid dependence with positive long term outcomes. However, each one has its specific target population and setting. While methadone and buprenorphine are first line options, heroin-assisted treatment is a second line option for those patients refractory to treatment with methadone with concomitant severe physical, mental, social and/or functional problems. Buprenorphine seems to be the best option for use in primary care offices. The field of opioid dependence treatment is poised to undergo a process of reinforcement and transformation. Further efforts from researchers, clinicians and authorities should be made to turn new pharmacological options into clinical reality and to overcome the structural and functional obstacles that maintenance programmes face in combatting opioid dependence.

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“…However, it has been shown that over 48 % experienced psychological problems or depression compared to 33 % of other offenders [ 24 ]. 68 % of women in prostitution meet the criteria for Post Traumatic Stress Disorder, in the same range as victims of torture and combat veterans undergoing treatment [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Access to healthcare for long-term conditions in women involved in street-based prostitution: a qualitative study

2015

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BackgroundWomen involved in street-based prostitution (SBP) have well-documented health problems specific to their occupation, but access to care for other chronic health problems has not been explored. Primary care is seen as the optimal context to deliver care for people with long-term conditions because it is accessible, efficient, and can tackle inequalities related to socioeconomic deprivation. We aimed to explore the perspectives of women involved in SBP about access to health care for their long-term conditions.MethodsThis was a qualitative study with women accessing a third sector organization in North West England. Semi-structured interviews were conducted with sixteen women involved in SBP and accessing support. Data were analysed using the principles of constant comparison and a framework approach.ResultsWomen described how they were living with ill health, which they found difficult to manage, and often impacted on their work. Women reported poor access to care and viewed any ensuing consultations in primary care as unsatisfactory.ConclusionThis study highlights the unmet health needs of women who work in SBP, not just related to their occupation, but due to their co-morbid long-term conditions. Access to primary care was reported to be problematic and interactions with general practitioners not fulfilling their expectations, which impacted on future consultation behaviour. Understanding the health-seeking behaviours and self-management strategies of women involved in SBP with chronic health problems is essential in the design and commissioning of services and may reduce unscheduled care in this under-served group.

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Can a targeted GP-led clinic improve outcomes for street sex workers who use heroin?

Cited by 8 publications

References 6 publications

Systematic review of interventions to reduce illicit drug use in female drug-dependent street sex workers

Systematic review of interventions to reduce illicit drug use in female drug-dependent street sex workers

Long term outcomes of pharmacological treatments for opioid dependence: does methadone still lead the pack?

Access to healthcare for long-term conditions in women involved in street-based prostitution: a qualitative study

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