What is the treatment burden for people experiencing homelessness with a recent non-fatal overdose?

Problem

Homelessness and drug deaths are increasing in Scotland year on year, and Scotland has the highest drug related death rate in Europe. People experiencing homelessness (PEH) who also have problem drug use, have complex medical and social needs, with undisputed barriers to accessing services and treatments but their treatment burden (the workload of self-management and its impact on well-being) has not been described previously. Understanding treatment burden might enable shaping of appropriate interventions to support this severely disadvantaged, multiply excluded group.

Approach

The aim of this sub study is to use a validated questionnaire, the Patient Experience with Treatment and Self-management (PETS), to investigate perceived treatment burden in people experiencing homelessness in Glasgow.The Pharmacist Homeless Outreach Engagement Non Medical Independent prescribing team (PHOENIx) trial is an ongoing pilot randomised control trial investigating whether an intensive pharmacist and third sector intervention merits progression to a definitive trial. The target group are PEH with recent non-fatal drug overdoses in Glasgow. Patients who were homeless and had a non-fatal drug overdose in the preceding 6 months were recruited to the PHOENIx trial. All patients had extensive baseline data collected including the PETS. The PETS assess multiple domains of treatment burden with scale scores ranging from 0 (no burden) to 100 (high burden). This study is the first to describe treatment burden in a homeless population.

Findings

We collected data on 128 participants, the mean age of participants was 42.8 (SD 8.4), 71.1 % were male, 99.2% were of white ethnicity. The average number of long term conditions (including health conditions, mental health conditions and drug problems ) was 8.5 (SD3) per participant. Mean PETS scores were highest in the domains indicating the impact of self-management on well-being, namely, physical/mental exhaustion (Mean=79.54, SD=3.26) and role-social activity limitations (Mean=64, SD=3.48). Respondents also reported experiencing challenges in doing exercise or physical therapy for their health (Mean=61.38, SD=15.81), difficulties with healthcare services, i.e., lack of care coordination (Mean=57.9, SD=16.9), and bother due to stressful interpersonal relationships with others (Mean=53.24, SD=15.42). Scores were generally higher than those observed in other studies of non-homeless patient samples.

Consequences

In a socially-vulnerable group of patients at high risk of overdose, the PETS can be used to measure treatment burden. This study identified a profound impact of self-management on well-being and daily activities in a population at high risk with few resources. The PHOENIx intervention seeks to help patients identify and address interpersonal challenges with others and obstacles interacting with healthcare services and systems, and the current PHOENIx after overdose pilot RCT may generate a signal of improvement in self management on wellbeing and daily activities.