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
Homeless Health, Pharmacy Services, Clarkston Court, NHS Greater Glasgow & Clyde, 56 Busby Road, Clarkston, Glasgow, G76 7AT, UK.
Simon Community Scotland, Glasgow, UK.
Int J Equity Health. 2021 Jan 7;20(1):19. doi: 10.1186/s12939-020-01337-7.
Homelessness 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).
Non-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.
Twenty 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.
Feasibility testing of the PHOENIx intervention suggests merit in a subsequent pilot RCT.
无家可归现象以及与之相关的死亡率和多种疾病并发率正在上升。系统评价表明，缺乏能减少非计划急诊医疗服务使用或增加预约护理的复杂干预措施。需要更好的证据来为政策应对提供依据。我们研究了一种复杂干预措施（PHOENIx：由药剂师主导的无家可归者外展参与非医疗独立处方（Rx））的可行性，以便为后续的试点随机对照试验（RCT）提供信息。
在苏格兰大格拉斯哥和克莱德健康委员会进行的一项设有常规护理（UC）对照组的非随机试验。参与者为格拉斯哥市中心一家医院的成年无家可归住院患者，于2018年3月19日至2019年4月6日出院时被转介至PHOENIx团队。每位患者的随访期从首次就诊（干预组）或首次被转介（UC组）之日开始，直至2019年8月24日，即所有患者的审查日期。所有患者均被提供并同意接受与PHOENIx团队（与苏格兰西蒙社区（第三部门无家可归者慈善工作者）合作的NHS药剂师开方者）的系列咨询。PHOENIx团队无法联系到的患者被分配到UC组。PHOENIx干预措施包括对身体/心理健康、成瘾情况、住房、福利和社会活动进行评估，随后由药剂师开方，并在必要时转介至其他健康服务专科。所有参与者均接受初级（包括基于无家可归者健康服务专科的全科医生护理、心理健康和成瘾服务）和二级护理。主要结局指标包括：招募率；留存率；干预措施的接受率；以及从招募到审查日期收集数据的完整性。
24名患者被提供并同意参与；12名患者被联系到并按计划接受了干预，每位患者的咨询次数中位数为7.5次（四分位间距3.0 - 14.2）。药剂师为每位患者开出的新处方中位数为2张（四分位间距0.3 - 3.8），重复处方中位数为2张（1.3 - 7.0）；10名（83%）患者获得了福利、住房或维权方面的支持。12名患者出院后尽管同意参与，但随后无法联系到，被分配到UC组。UC组有2名患者在随访期间死于药物/酒精过量；干预组无患者死亡。所有24名患者均留在干预组或UC组直至死亡或审查日期，且所有患者记录在随访时均可获取：两组均有11名（92%）患者就诊于急诊科，干预组有11名（92%）患者住院，UC组有9名（75%）患者住院。干预组8名（67%）患者和UC组3名（25%）患者参加了预约门诊。
PHOENIx干预措施的可行性测试表明，后续的试点随机对照试验具有价值。
