Clinical Pharmacy Intervention for Persons Experiencing Homelessness: Evaluation of Patient Perspectives in Service Design and Development

Jagpal, Parbir; Barnes, Nigel; Lowrie, Richard; Banerjee, Amitava; Paudyal, Vibhu

doi:10.3390/pharmacy7040153

Cited by 15 publications

(17 citation statements)

References 15 publications

(22 reference statements)

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“… 25 , 26 Qualitative studies show that PEH value such dedicated services. 27 , 28 Establishment of tailored interventions, including outreach-based services, have been advocated in the NHS L ong T erm P lan . 29 There is also scope to widen the roles of community pharmacies as PEH utilise pharmacies on a regular basis for substance misuse treatment, needle exchange, and prescription collection.…”

Section: Discussionmentioning

confidence: 99%

Representation of persons experiencing homelessness and coding of homelessness in general practices: descriptive evaluation using healthcare utilisation data

et al. 2021

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BackgroundEpidemiological studies focused on primary healthcare needs of persons experiencing homelessness (PEH) are often based on data from specialist homeless healthcare services.AimThe aim of this study is to explore the presentation of PEH, coding of homelessness and associated health conditions in mainstream primary care general practices in England.Design & settingEMIS electronic database search of medical records was conducted across 48 general practices in a Clinical Commissioning Group (CCG), representing one of the most socioeconomically deprived regions in England, which also lacks a specialist primary healthcare service for PEH.MethodKey terms and codes were used to identify PEH, their respective diagnoses across 22 health conditions and prescribed medications over the past 4 years.ResultsFrom a population of approximately 321,000, 43 (0.013%) persons were coded as PEH compared to a homelessness prevalence of 0.5% in the English general population. Mental health conditions were the most prevalent diagnoses amongst the PEH registrants (62.3%); the recorded prevalence of other common long-term conditions in PEH was lower than the levels observed in PEH registered with specialist homelessness health services.ConclusionIn a population with approximately four times higher rate of statutory homelessness, PEH representation in mainstream general practices was underrepresented by several folds. As homelessness overlaps with mental health, substance misuse and long term health conditions, consistent coding of homelessness in medical records is imperative to offer tailored support and prevention actions when patients present for services.

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Section: Discussionmentioning

confidence: 99%

Representation of persons experiencing homelessness and coding of homelessness in general practices: descriptive evaluation using healthcare utilisation data

et al. 2021

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“…Our study also did not involve PEH participation because this event mainly aimed to draw on the voice of the stakeholder groups involved in the care of PEH. However, the researchers drew their prior experiences of working with PEH when informing the discussion plans for this event [25][26][27][28]. Identifying priority areas of research in the future will require consensus and nominal group techniques [29] for participants to agree on the agenda and future priorities.…”

Section: Limitationsmentioning

confidence: 99%

Research priorities in healthcare of persons experiencing homelessness: outcomes of a national multi-disciplinary stakeholder discussion in the United Kingdom

Jagpal

Saunders

Plahe

et al. 2020

Int J Equity Health

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Background: Persons experiencing homelessness (PEH) face up to twelve times higher mortality rates compared to the general population. There is a need to develop, evaluate and implement novel interventions to minimise such inequalities. This paper aims to present outcomes of a national stakeholder engagement event that was conducted to discuss research priorities around healthcare of PEH in the United Kingdom (UK). Main body: A national stakeholder event was organised in Birmingham, UK. This workshop aimed to engage diverse stakeholders from a variety of background including representations from clinical practice, substance misuse, anti-slavery network, public health practice, local authority, homelessness charities, drugs and alcohol services, Public Health England and academia. A total of five key priority areas for research were identified which included: a) interventions to improve access to health services and preventative services; b) interventions to prevent drug and alcohol related deaths; c) improving existing services through quality improvement; d) identifying PEH's preferences of services; and e) interventions to break the link between vulnerabilities, particularly-modern day slavery and homelessness. Effective partnerships across diverse stakeholder groups were deemed to be imperative in developing, testing and implementing novel interventions. Conclusions: Maximising access to services, prevention of early deaths linked to drugs and alcohol, and identifying effective and ineffective policies and programmes were identified as priority research areas in relation to healthcare of PEH. The outcomes of this discussion will enable design and conduct of interdisciplinary research programmes to address the syndemics of homelessness and linked adverse health outcomes. Priorities identified here are likely to be applicable internationally.

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“…Multi-morbidity including poor mental, physical health and substance misuse and poor access to services can lead to homelessness and social disparities [39][40][41][42]. There is a need to develop innovative services delivery models, such as outreach programmes to support patients with severe mental health [43][44][45] and evaluate their impact on health and quality-of-life outcomes.…”

Section: Future Directionsmentioning

confidence: 99%

Barriers to monitoring and management of cardiovascular and metabolic health of patients prescribed antipsychotic drugs: a systematic review

2020

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Background The use of atypical antipsychotics which currently form the primary choice pharmacotherapy for several mental health conditions have been linked to cardiovascular and metabolic side effects. This systematic review aimed to investigate the barriers to monitoring and management of cardiovascular co-morbidities in patients prescribed antipsychotic medicines. Methods A protocol-led (CRD-42018106002) systematic literature review was conducted by searching Medline, Embase, and PsycINFO databases 2003 until October 2019. Cochrane, Centre for Review and Dissemination (CRD) and PRISMA guidelines were followed. Studies investigating barriers to monitoring and management of cardiovascular co-morbidities in patients prescribed antipsychotic medicines were included. Results A total of 23 records were included. Key barriers included a) health-care system-related factors such as lack of knowledge and expertise amongst care providers, available resources, confusion around remit and roles, fragmentation of care such as across general practitioners and psychiatrists, and time constraints and b) patient-related factors such as disability resulting from mental health conditions, knowledge and skills of the patients. Conclusion Barriers to monitoring and management of cardiovascular and metabolic health of patients taking antipsychotic medicines are multidimensional. Apart from educational interventions directed to both patients and health-care professionals, the results suggest a need for the improvement of wider system-related factors to improve physical health of patients prescribed antipsychotic medicines. Clearer guidelines, clarity of remit and roles amongst service providers are necessary in addition to educational interventions directed at patients and health-care professionals in improving physical health monitoring, counselling and management of patients prescribed antipsychotic medicines. Trial registration A protocol was developed and registered with PROSPERO as per PRISMA-P guidelines (CRD 42018106002).

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Clinical Pharmacy Intervention for Persons Experiencing Homelessness: Evaluation of Patient Perspectives in Service Design and Development

Cited by 15 publications

References 15 publications

Representation of persons experiencing homelessness and coding of homelessness in general practices: descriptive evaluation using healthcare utilisation data

Representation of persons experiencing homelessness and coding of homelessness in general practices: descriptive evaluation using healthcare utilisation data

Research priorities in healthcare of persons experiencing homelessness: outcomes of a national multi-disciplinary stakeholder discussion in the United Kingdom

Barriers to monitoring and management of cardiovascular and metabolic health of patients prescribed antipsychotic drugs: a systematic review

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