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

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Pharmacist led homeless outreach engagement and non-medical independent prescribing (Rx) (PHOENIx) intervention for people experiencing homelessness : a non- randomised feasibility study. / Lowrie, Richard; Stock, Kate; Lucey, Sharon; Knapp, Megan; Williamson, Andrea; Montgomery, Margaret; Lombard, Cian; Maguire, Donogh; Allan, Rachael; Blair, Rebecca; Paudyal, Vibhu; Mair, Frances S.

In: International Journal for Equity in Health, Vol. 20, No. 1, 19, 07.01.2021.

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Lowrie, Richard ; Stock, Kate ; Lucey, Sharon ; Knapp, Megan ; Williamson, Andrea ; Montgomery, Margaret ; Lombard, Cian ; Maguire, Donogh ; Allan, Rachael ; Blair, Rebecca ; Paudyal, Vibhu ; Mair, Frances S. / Pharmacist led homeless outreach engagement and non-medical independent prescribing (Rx) (PHOENIx) intervention for people experiencing homelessness : a non- randomised feasibility study. In: International Journal for Equity in Health. 2021 ; Vol. 20, No. 1.

Bibtex

@article{6f36b6a238434aea8581c8683adc8df7,
title = "Pharmacist led homeless outreach engagement and non-medical independent prescribing (Rx) (PHOENIx) intervention for people experiencing homelessness: a non- randomised feasibility study",
abstract = "BackgroundHomelessness 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).MethodsNon-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.ResultsTwenty 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.ConclusionsFeasibility testing of the PHOENIx intervention suggests merit in a subsequent pilot RCT.",
keywords = "Homelessness inequality policy service, Pharmacist, Prescribing",
author = "Richard Lowrie and Kate Stock and Sharon Lucey and Megan Knapp and Andrea Williamson and Margaret Montgomery and Cian Lombard and Donogh Maguire and Rachael Allan and Rebecca Blair and Vibhu Paudyal and Mair, {Frances S.}",
year = "2021",
month = jan,
day = "7",
doi = "10.1186/s12939-020-01337-7",
language = "English",
volume = "20",
journal = "International Journal for Equity in Health",
issn = "1475-9276",
publisher = "Springer",
number = "1",

}

RIS

TY - JOUR

T1 - Pharmacist led homeless outreach engagement and non-medical independent prescribing (Rx) (PHOENIx) intervention for people experiencing homelessness

T2 - a non- randomised feasibility study

AU - Lowrie, Richard

AU - Stock, Kate

AU - Lucey, Sharon

AU - Knapp, Megan

AU - Williamson, Andrea

AU - Montgomery, Margaret

AU - Lombard, Cian

AU - Maguire, Donogh

AU - Allan, Rachael

AU - Blair, Rebecca

AU - Paudyal, Vibhu

AU - Mair, Frances S.

PY - 2021/1/7

Y1 - 2021/1/7

N2 - BackgroundHomelessness 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).MethodsNon-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.ResultsTwenty 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.ConclusionsFeasibility testing of the PHOENIx intervention suggests merit in a subsequent pilot RCT.

AB - BackgroundHomelessness 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).MethodsNon-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.ResultsTwenty 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.ConclusionsFeasibility testing of the PHOENIx intervention suggests merit in a subsequent pilot RCT.

KW - Homelessness inequality policy service

KW - Pharmacist

KW - Prescribing

UR - http://www.scopus.com/inward/record.url?scp=85098843987&partnerID=8YFLogxK

U2 - 10.1186/s12939-020-01337-7

DO - 10.1186/s12939-020-01337-7

M3 - Article

C2 - 33413396

VL - 20

JO - International Journal for Equity in Health

JF - International Journal for Equity in Health

SN - 1475-9276

IS - 1

M1 - 19

ER -