Qualitative Evaluation of Clinical Pharmacist Prescribing Input into the Care of People Experiencing Homelessness

This qualitative evaluation has assessed patient and other stakeholder experiences of, and perspectives regarding, the Pharmacy Homeless Outreach Engagement Non medical Independent Rx (PHOENIx) service in Glasgow. The PHOENIx service is staffed by prescribing clinical pharmacists employed by the NHS and a dedicated worker from the Simon Community Scotland street team. It is delivered within a specialist health clinic for homeless people and via outreach in a range of the city’s day centres, temporary accommodation settings, and on the street. The evaluation involved interviews with all four staff members involved in delivering the service, 10 representatives of stakeholder agencies who support the same patient population, and 40 individuals with current or recent experience of homelessness.
The key findings were as follows:
• The outreach element of the service acts as a critical bridge to both primary and secondary healthcare for people experiencing homelessness who are reluctant to utilise, or physically unable to access, alternative (mainstream or specialist ‘homeless’) healthcare provision.
• The informal, flexible and person-centred approach to service delivery is widely viewed as effective in engaging with, and increasing medicine adherence amongst, those patients who are otherwise reticent to use medical (or other) establishments given past negative experiences.
• The proactive immediacy of response (including provision of prescriptions where relevant) is considered a crucial ingredient in the initiation and maintenance of patient engagement, given the capitalisation of ‘windows of opportunity’ when patients are motivated to address healthcare needs.
• A number of patient interviewees attributed improvements in their health, at least in part, to the service. It also encouraged some to elevate consideration of their health amongst their (many, competing) priorities whilst homeless.
• The service has been welcomed by the providers of temporary accommodation and other (non-health-related) homelessness services (e.g. day centres) given its success in providing, and facilitating access to, healthcare for their clientele.
• The service complements, and alleviates some of the pressure felt by, local homelessness agencies and other healthcare providers. There is nevertheless an apparent need for greater clarity regarding the responsibilities of, and the governance relationships between, healthcare providers supporting this patient group.
• Most patient and many stakeholder interviewees did not fully comprehend the parameters of the pharmacists’ specialist expertise and prescription capabilities (commonly confusing them with other healthcare professionals). In their view, the service’s distinctiveness, and greatest value, lies in its informal and flexible engagement approach.