TY - JOUR
T1 - Outreach-based clinical pharmacist prescribing input into the healthcare of people experiencing homelessness
T2 - A qualitative investigation
AU - Johnsen, Sarah
AU - Cuthill, Fiona
AU - Blenkinsopp, Janice
N1 - Funding Information:
The authors would like to express sincere thanks to the staff, individuals with experience of homelessness, and stakeholder agency representatives who took the time to share their experiences and views. Thanks are also due to Sharon Lucey for assistance with participant recruitment, and to Richard Lowrie and Andrea Williamson for their feedback on a draft of the manuscript. The financial support of the NHS Greater Glasgow and Clyde is also gratefully acknowledged.
Funding Information:
The study was funded by the NHS Greater Glasgow and Clyde. The funding body set the initial research questions and played a major role in developing the research design in liaison with the research team. The funding body played no role in the collection, analysis or interpretation of data, nor writing of the manuscript, but representatives did comment on and approve the final version of this paper.
Publisher Copyright:
© 2021, The Author(s).
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2021/1/4
Y1 - 2021/1/4
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85098635623&partnerID=8YFLogxK
U2 - 10.1186/s12913-020-06013-8
DO - 10.1186/s12913-020-06013-8
M3 - Article
AN - SCOPUS:85098635623
SN - 1472-6963
VL - 21
SP - 1
EP - 10
JO - BMC Health Services Research
JF - BMC Health Services Research
M1 - 7
ER -