Pharmacist led homeless outreach engagement and non-medical independent prescribing (Rx) (PHOENIx) intervention for people experiencing homelessness: a non- randomised feasibility study

Abstract

Background Homelessness and associated mortality and multimorbidity rates are increasing. Systematic reviews have demonstrated a lack of complex interventions that decrease unscheduled emergency health services utilisation or increase scheduled care. Better evidence is needed to inform policy responses. We examined the feasibility of a complex intervention (PHOENIx: Pharmacist led Homeless Outreach Engagement Nonmedical Independent prescribing (Rx)) to inform a subsequent pilot randomised controlled trial (RCT). Methods Non-randomised trial with Usual Care (UC) comparator group set in Greater Glasgow and Clyde Health Board, Scotland. Participants were adult inpatients experiencing homelessness in a city centre Glasgow hospital, referred to the PHOENIx team at the point of hospital discharge, from 19th March 2018 until 6th April 2019. The follow up period for each patient started on the day the patient was first seen (Intervention group) or first referred (UC), until 24th August 2019, the censor date for all patients. All patients were offered and agreed to receive serial consultations with the PHOENIx team (NHS Pharmacist prescriber working with Simon Community Scotland (third sector homeless charity worker)). Patients who could not be reached by the PHOENIx team were allocated to the UC group. The PHOENIx intervention included assessment of physical/mental health, addictions, housing, benefits and social activities followed by pharmacist prescribing with referral to other health service specialities as necessary. All participants received primary (including specialist homelessness health service based general practitioner care, mental health and addictions services) and secondary care. Main outcome measures were rates of: recruitment; retention; uptake of the intervention; and completeness of collected data, from recruitment to censor date. Results Twenty four patients were offered and agreed to participate; 12 were reached and received the intervention as planned with a median 7.5 consultations (IQR3.0–14.2) per patient. The pharmacist prescribed a median of 2 new (IQR0.3–3.8) and 2 repeat (1.3–7.0) prescriptions per patient; 10(83%) received support for benefits, housing or advocacy. Twelve patients were not subsequently contactable after leaving hospital, despite agreeing to participate, and were assigned to UC. Two patients in the UC group died of drug/alcohol overdose during follow up; no patients in the Intervention group died. All 24 patients were retained in the intervention or UC group until death or censor date and all patient records were accessible at follow up: 11(92%) visited ED in both groups, with 11(92%) hospitalisations in intervention group, 9(75%) UC. Eight (67%) intervention group patients and 3(25%) UC patients attended scheduled out patient appointments. Conclusions Feasibility testing of the PHOENIx intervention suggests merit in a subsequent pilot RCT.

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

“…Outreach-based interventions offered by non-medical prescribers, including pharmacists and nurses, have been shown to be effective in identifying undiagnosed health conditions and minimising use of emergency departments. 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 .…”

Provision of services to persons experiencing homelessness during the COVID‐19 pandemic: A qualitative study on the perspectives of homelessness service providers

“…Services that have managed to remain open during the pandemic and those that are accessible such as the community pharmacies can be strengthened to offer tailored advice and support to PEH (Jagpal et al., 2019 ; Paudyal et al., 2019 ) as well as to offer COVID‐19 vaccines to PEH in the community (Paudyal, Fialová, et al., 2021 ; Paudyal, Racine, et al, 2021 ). In addition, outreach‐based services are most likely to address key barriers to service access by PEH (Lowrie et al., 2021 ). Perspectives of PEH, health and social care professionals must be explored to improve current support and developments for the future.…”

Identifying Challenges and Solutions to Providing Diabetes Care for Those Experiencing Homelessness

“…Multidisciplinary teams which target all aspects of physical health, in addition to social services, were also effective; adding a pharmacist to primary care teams increased opportunities to provide patient education, medication management, improved patient follow-up with their healthcare provider, and medication compliance (Albertson et al, 2020;Johnsen et al, 2021;Lowrie et al, 2021). Incorporating dental care into an existing community health centre serving individuals experiencing homelessness led to improvement in the self-perception of oral health (Hawkesford et al, 2020).…”