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

Abstract

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.

A Scoping Review of the Health Impact of the COVID-19 Pandemic on Persons Experiencing Homelessness in North America and Europe

“…While this review found that the pandemic exacerbated many barriers to health and support services for PEH, it also provided unique opportunities to improve access and enhance services for some PEH. Proactive outreach to PEH concerning substance use issues has been shown to improve linkages to treatment and prevent drug-induced deaths [ 146 , 147 , 148 ], findings that were supported by studies in this review. Additionally, several studies have found that on-site service delivery within accommodations facilitates access and may lead to better outcomes for PEH [ 149 , 150 , 151 , 152 ].…”

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

“…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. 30 – 33 Clinical guidelines should be inclusive of social outcomes, such as homelessness, when providing services for substance misuse and severe mental illnesses. 34 , 35 As this research only covered general practices within one CCG, a large-scale study capturing wider areas of the UK is needed to improve the generalisability of the findings.…”

“…42 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. [43][44][45][46] Clinical guidelines should be inclusive of social outcomes such as homelessness when providing services for substance misuse and severe mental illnesses. [47][48]…”

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

“…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.…”