Interim findings from a multicentre pilot randomised controlled trial (RCT): Community Pharmacy Homeless Outreach Engagement Non-medical Independent prescribing Rx (Community Pharmacy PHOENIx)

Conference: 
SAPC ASM 2023 - Brighton
Talk Code: 
2B.7
Presenter: 
Richard Lowrie
Co-authors: 
Vibhu Paudyal (joint lead author), Andrew McPherson, Jane Moir, Helena Heath, Versha Cheed, Shabana Akhtar, Sarah Tearne, Adnan Araf, Steven Ross, Cian Lombard, Frances Mair, Lee Middleton, Frank Reilly, Andrea Williamson.
Author institutions: 
University of Birmingham, General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow; NHS Greater Glasgow and Clyde; Simon Community Scotland, Birmingham and Solihull Mental Health NHS Foundation Trust.

Problem

Homelessness confers a higher risk for all cause premature death and hospitalisation. Lower levels of: access to care; treatment uptake; medicines adherence; and fragmented primary health and social care systems contribute to poor outcomes. Evidence is lacking for holistic interventions to improve health outcomes in this patient population. Thus, community pharmacy based holistic health and social care intervention has the potential to improve access and care but remains untested.

Approach

Multicentre pilot RCT of PHOENIx in Glasgow and Birmingham with parallel qualitative and economic evaluation testing: patient recruitment; data collection; retention; intervention fidelity; and a range of outcomes in preparation for a definitive RCT. Participants are homeless adults recruited from community pharmacies by independent researchers who collect comprehensive baseline data (physical, mental, drug use, medicines, healthcare utilisation, housing, benefits, quality of life) then randomise (1:1) to PHOENIx plus Usual Care (UC) or UC.

PHOENIx intervention delivered by NHS employee independent prescribing pharmacists working in pairs with third sector homelessness outreach street workers, offering weekly consultations in the patient’s choice of venue, for 6 months. Pharmacists clinically assess, prescribe, refer, embedded in existing clinical teams and with full remote access to NHS clinical information systems in primary and acute care. Third sector workers offer social prescribing, welfare benefits assessment and application, housing options and all round advocacy, collaborating with wider street outreach networks. PHOENIx let patients prioritise which, if any, problems they want to address while building strong therapeutic relationships. UC is existing primary and secondary care driven by patient demand and presentation including routine health and social care worker input.

3 and 6 month follow up visits by researchers assess achievement of a-priori progression criteria (recruitment, retention, data collection) and scheduled/unscheduled healthcare utilisation, costs, prescribing, quality of life, housing tenure, criminal justice contacts.

Findings

Recruitment from community pharmacies is ongoing; 86 from a target 100 participants recruited from Nov 22-Feb 23. Full baseline data collected for all participants; 43 randomised to PHOENIx; 43 UC. Intervention delivery underway in Glasgow (ends June 2023) and Birmingham (ends Sep 2023). 3 month follow up in progress. Full baseline characteristics will be available for presentation at conference.

Consequences

Baseline characteristics provide comprehensive contemporary health and social care phenotyping of a sample of the UK’s most destitute citizens while describing their unmet health needs. If recruitment and other a-priori progression criteria are achieved alongside signal of improved outcomes, and favourable process evaluation, PHOENIx intervention merits testing in a definitive RCT.

Submitted by: 
Richard Lowrie
Funding acknowledgement: 
NIHR; NHS Greater Glasgow and Clyde.