Medicines prescribing for homeless persons: analysis of prescription data from specialist homelessness general practices

Abstract

Background Specialist homelessness practices remain the main primary care access point for many persons experiencing homelessness. Prescribing practices are poorly understood in this population. Objective This study aims to investigate prescribing of medicines to homeless persons who present to specialist homelessness primary care practices and compares the data with the general population. Setting Analyses of publicly available prescribing and demographics data pertaining to primary care in England. Methods Prescribing data from 15 specialist homelessness practices in England were extracted for the period 04/2019-03/2020 and compared with data from (a) general populations, (b) the most deprived populations, and (c) the least deprived populations in England. Main outcome measure Prescribing rates, measured as the number of items/1000 population in key disease areas. Results Data corresponding to 20,572 homeless persons was included. Marked disparity were observed in regards to prescribing rates of drugs for Central Nervous System disorders. For example, prescribing rates were 83-fold (mean (SD) 1296.7(1447.6) vs. 15.7(9.2) p = 0.033) items), and 12-fold (p = 0.018) higher amongst homeless populations for opioid dependence and psychosis disorders respectively compared to the general populations. Differences with populations in the least deprived populations were even higher. Prescribing medicines for other long-term conditions other than mental health and substance misuse was lower in the homeless than in the general population. Conclusions Most of the prescribing activities in the homeless population relate to mental health conditions and substance misuse. It is possible that other long-term conditions that overlap with homelessness are under-diagnosed and under-managed. Wide variations in data across practices needs investigation.

Homelessness and the use of Emergency Department as a source of healthcare: a systematic review

“…Innovative methods of support offered to PEH during the pandemic need to be sustained, for example emergency housing and the use of technology-assisted methods of counselling and communication, [ 59 ]. Strengthening primary care, including specialist homelessness services [ 60 ], community pharmacy [ 61 ], and enabling ED personnel to triage and treat PEH for overlapping health conditions, is imperative to prevent ill health and promote outcomes when they present to the ED. Clinical guidelines need to be further inclusive of multi-morbidity, including dual diagnosis of substance misuse and mental health, to prevent and mitigate the impact of homelessness on health [ 62 ].…”

Medication-Related Outcomes and Health Equity: Evidence for Pharmaceutical Care

“…Such inequities in medication-related experiences and outcomes can occur in any stage of the medication use process, such as the prescription, dispensing and administration of medication, and a sample of these issues is presented in Table 2. The available evidence suggests that members of ethnic minority groups [4,5,[15][16][17][18][19][20], people who are institutionalised [17,21], incarcerated [22,23] or homeless [24][25][26] and people of sexual minority groups [27] are more likely to experience medication-related problems than the general population. This is also true for people with certain health statuses, such as those with sensory impairment, either auditory or visual [17,28], older people with intellectual disabilities [29] and those who experience cognitive impairment, severe mental illness and frailty [17].…”

“…Homeless [24][25][26] Significantly increased rates of prescription of medication indicated for opioid dependence and psychosis disorder and reduced rates of medication indicated for the management of long-term conditions, relative to the general population. High prevalence of potentially inappropriate medication use among homeless people experiencing schizophrenia and bipolar disorder.…”