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BMC Health Services Research
Published in: BMC Health Services Research 1/2021

Open Access 01-12-2021 | Research article

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

Authors: Sarah Johnsen, Fiona Cuthill, Janice Blenkinsopp

Published in: BMC Health Services Research | Issue 1/2021

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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.
Appendix
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Footnotes
1
Questions were carefully selected in these latter instances so as to ensure that interviewees were not asked and/or did not feel compelled to disclose personal or sensitive information when confidentiality could not be guaranteed.
 
2
A sample of transcriptions was quality checked by interviewers. Whilst any requests from participants to check or comment on the transcription from their interview would have been respected, interviewees were not specifically asked to do so on ethical and data protection grounds, especially the imperatives to minimise burden on participants and mitigate against breaches of confidentiality. Resource restrictions and the challenges involved in re-contacting homeless people meant that the research team was unable to invite feedback on preliminary findings in any systematic way. A report of findings was however made available to all agencies supporting the study that provided services to interviewees with experience of homelessness.
 
3
A small minority of people with experience of homelessness who were invited to contribute declined to do so. The number of refusals and reasons for declining were not recorded.
 
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Metadata
Title
Outreach-based clinical pharmacist prescribing input into the healthcare of people experiencing homelessness: a qualitative investigation
Authors
Sarah Johnsen
Fiona Cuthill
Janice Blenkinsopp
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2021
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-020-06013-8

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