Process evaluation for the Pharmacy Homeless Outreach Engagement Non-medical Independent prescribing Rx (PHOENIx) community pharmacy study

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

3D.6

Presenter:

Dr Shona Mackinnon

Co-authors:

Shona Mackinnon, Karen Wood, Yvonne Cunningham, Alessio Albanese, Richard Lowrie, Vibhu Paudyal, Andrea Williamson, Jane Moir, Andrew McPherson, Cian Lombard, Steven Ross, Adnan Araf, Helena Heath, Frances Mair

Author institutions:

University of Glasgow, University of Edinburgh, University of Birmingham, NHS Greater Glasgow & Clyde, Simon Community Scotland, Birmingham and Solihull Mental Health NHS Foundation Trust

Problem

People experiencing homelessness (PEH) have complex health and social care needs, with the average age of death for PEH being 45 years old. PEH frequently use community pharmacies; however, evaluation of the delivery of a structured, integrated, holistic health and social care intervention has not been previously undertaken in community pharmacies for PEH. This study aims to explore participant, healthcare professional and stakeholder perceptions of the intervention and acceptability of trial procedures.

Approach

PHOENIx is a randomised pilot trial. 100 PEH, aged ≥18 years were recruited from a total of five community pharmacies in Glasgow and Birmingham. PHOENIx intervention included structured assessment in both community pharmacy and other venues, of health, housing, benefits and activities, in addition to usual care, through weekly visits lasting up to six-months. The evaluation of the intervention included qualitative interviews conducted with intervention participants (n=19), health professionals/ study staff (n = 7) and stakeholders (n = 9). Semi-structured interviews explored the perceived issues in providing health care for PEH, acceptability of trial procedures, and perceived barriers and facilitators of any future implementation of the intervention. Interviews were audio-recorded and transcribed verbatim. Data were analysed thematically with Normalisation Process Theory used as an underpinning conceptual lens.

Findings

The overall perception of the PHOENIx intervention was positive, with a high level of support for the trial aims. Interviewees described the key issues in health care for PEH including services not being accessible, too complex to navigate and significant waiting times to access support. Optimal health care for PEH is described by participants as holistic, addressing physical, emotional and financial wellbeing. Intervention participants identified the perceived positive impacts of the intervention on their health and wellbeing including, changes to medication, a reduction or change to substance use, improved access to health care and an overall feeling of support for physical, emotional and financial wellbeing. Intervention participants indicated that they would likely be willing to take part in a larger scale trial, as well as recommend the intervention to other PEH.Health care professionals working with the intervention and other key stakeholders reflected on the role NHS pharmacists can play in the support of PEH, and their ability to work in partnership with other services. Participants identified some potential barriers to future implementation including the challenge of obtaining sustainable funding for the intervention and other services providing support to PEH.

Consequences

The PHOENIx intervention was deemed acceptable and perceived to have many perceived positive impacts. There is a high level of support for the PHOENIx intervention from both intervention participants and health care professionals/ stakeholders suggesting that if stop/go criteria for the pilot trial are met, including achieving the primary outcomes of the trial, then progression to a full-scale trial is merited.

Submitted by:

Hannah Scobie

Funding acknowledgement:

This research is funded by NIHR