Outreach-based clinical pharmacist prescribing input into the healthcare of people experiencing homelessness: a qualitative investigation

Abstract

Background Severely and multiply disadvantaged members of the homeless population are disproportionately vulnerable to exceptionally high levels of multi-morbidity and premature death. Given widespread calls for the development of interventions that might improve the uptake and effectiveness of healthcare for this population, this study investigated patient and other stakeholder perspectives regarding an outreach service, delivered by prescribing pharmacists in collaboration with a local voluntary sector provider, within homelessness services and on the street in Glasgow (UK). Methods The qualitative study involved semi-structured face-to-face interviews with 40 purposively sampled individuals with current or recent experience of homelessness (32 of whom had direct experience of the service and 8 of whom did not), all (n = 4) staff involved in frontline delivery of the service, and 10 representatives of stakeholder agencies working in partnership with the service and/or with the same client group. Pseudonymised verbatim interview transcriptions were analysed systematically via thematic and framework analysis. Results The service was effective at case finding and engaging with patients who were reluctant to utilise or physically unable to access existing (mainstream or specialist ‘homeless’) healthcare provision. It helped patients overcome many of the barriers that homeless people commonly face when attempting to access healthcare, enabled immediate diagnosis and prescription of medication, and catalysed and capitalised on windows of opportunity when patients were motivated to address healthcare needs. A number of improvements in health outcomes, including but not limited to medication adherence, were also reported. Conclusions A proactive, informal, flexible, holistic and person-centred outreach service delivered within homelessness service settings and on the street can act as a valuable bridge to both primary and secondary healthcare for people experiencing homelessness who would otherwise ‘fall through the gaps’ of provision. Prescribing pharmacist input coupled with third sector involvement into healthcare for this vulnerable population allows for the prompt treatment of and/or prescription for a range of conditions, and offers substantial potential for improving health-related outcomes.

‘Treat my whole person, not just my condition’: qualitative explorations of hepatitis C care delivery preferences among people who inject drugs

“…We also learned that models of delivery of HCV care should be collaborative and patient-centered, and that they should also be “low-barrier” with flexible scheduling and multiple opportunities for engagement. These learnings echo the findings of other studies that have explored the perspectives of PWID and people experiencing homelessness related to receiving healthcare [ 41 , 42 ], and reinforce the role of multi-level stigma as a major barrier to HCV care. The acceptability of a community pharmacy model for HCV among these PWID was mixed, and appeared in part influenced by a lack of familiarity with pharmacists’ training and scope of practice.…”

“…Pharmacy models have also been demonstrated to reduce barriers to care for people experiencing homelessness. Johnsen, et al (2021), for example, found that not only was their outreach pharmacist model acceptable for people experiencing homelessness, it reduced barriers and further encouraged engagement in care by “capitalizing on windows of opportunity” that patients had to get treated [ 41 ].…”

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

“… 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.…”

Assessing the feasibility, acceptability and accessibility of a peer-delivered intervention to reduce harm and improve the well-being of people who experience homelessness with problem substance use: the SHARPS study

“…Caseloads for the full intervention were experienced as high overall, but the flexibility of the role allowed the PNs to respond nimbly, providing more or less intensive support to individuals at any given time to manage this. This was experienced as following a PIEs approach, as well as fitting with an emerging evidence base which highlights the importance of flexible and person-centred support for those that are severely and multiply disadvantaged [ 94 ]. The PNs were proud of their role and the achievements of participants.…”