Clinical Pharmacy Intervention for Persons Experiencing Homelessness: Evaluation of Patient Perspectives in Service Design and Development
Abstract
:1. Background
2. Method
- Why do you come to the specialist healthcare centre/use the services of the outreach team?
- Who would you expect to see/what types of staff—clinical/social care/support services?
- Have you faced problems in accessing health services before?
- Have you come across a pharmacist before?
- How do you think a pharmacist coming to you in the street as part of the outreach team or at the specialist healthcare centre can help you?
- Do you think having a pharmacist at the specialist healthcare centre /outreach team is a good idea?
- How do you feel about pharmacist doing health MOT for persons experiencing homelessness?E.g., screen for chronic health conditions each such as cardiovascular, respiratory, mental illness, anxiety and depression, alcohol and substance misuse, diet, podiatry, teeth
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- Medication review, adherence, starting/stopping medicines, monitoring
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- Signposting to other services [Prompt: how should they be doing it, where should they be doing it?]
- What issues do you face in getting and keeping the medicines you require?
- Do you often get enough time to discuss your medicines with your doctors, nurses?
- How do you feel about receiving support about your medicines from the pharmacist at the Health Exchange/outreach team? [prompt: optimising medicines, adding or reducing the number of medicines based on the checks, advice on storing medicines, getting your medicines, pharmacist liaising with the community pharmacist for you to get medicines on time, etc.]
- What differences (outcomes) do you think a pharmacist can make to a person experiencing homelessness?
3. Results
3.1. Acquaintance with Pharmacy Services
‘There wasn’t the opportunity to talk to the pharmacist … they don’t say, they just say a ten minute wait, that’s the only conversation you’re going to have.’M 49
‘My experience is, it’s not good. You’re in a queue … And also, I put a prescription in on a Saturday, couldn’t get it till Monday so, I’d missed a couple of tablets anyway …’M 56
3.2. Perceived Feasibility and Benefits of a Clinical Pharmacy Service
‘I’ve got to walk on my heel sometimes, very painful, and if there was a pharmacist down there that’d save me a trip.’M 50a
‘Yeah, I’ve missed medication cause I, I couldn’t get, cause I suffer with arthritis so, certain days I, it’s a no go even walking, I can’t walk…’F 55
‘I’ve recently started a new medication cause I was already diagnosed, dual diagnosis, when I was in prison I had an addition diagnosis, I started a new medication but, I’ve not had a chance to speak to anybody about the medication or potential side effects, whatever, whereas if there was a pharmacist there at the time, that would’ve helped a lot … and maybe if the doctor’s being awkward with you or you think that the doctors being unfair, if you’ve got a pharmacist to talk to, they can either back up what the doctor says or back up what you’re saying and then maybe they can go to the doctor. That would be good.’M 50b
‘When they put me on the medication in jail that was an anti-psychotic as well. So, I mean, and if you’re not the right person for that medication it can have really adverse effects. Luckily, I was the right person for it but…’M 50b
‘I went to hospital once, cause I had an operation, it was stent, stent, yeah, got some but my doctor didn’t know about it until I look a letter to my doctor. He hadn’t had a copy so, he didn’t know what to prescribe me, he wasn’t even aware of the operation …‘. ‘I started heroin in jail cause they stopped my co-codamol. So, I pay for this, and my codeine.’M 50a
‘… it helps them see if people are abusing their meds, know what I mean, they might see them taking too many straight away or selling on, stuff like that.’M 50b
‘Sometimes pharmacists are better at diagnosis than doctors, in my eyes.’M (age not known)
‘I have one doctor saying I’ve got osteoarthritis, but my pharmacist said no, no, it’s rheumatoid, it is the other one, yeah … and the doctor said, no, it’s rheumatoid arthritis, you know, cause I worked in water, I was a plasterer by trade, so work in water over the years, hands shrank.’M 50a
‘Most people sleeping rough have got multiple problems going on but just don’t (have access to services). They seem to be the sort of people that don’t go to doctor’s appointments, don’t go and see doctors, don’t go and get it taken care of. Cause they’re living their day to day routine on the streets, whatever it is they have to do…they’re developing multiple physical or mental problems, but they (also) never search for any help so, a pharmacist going out to them, they’d be getting the care and attention that they should be getting but, they’re choosing not to for whatever reason. They probably get, they’d probably benefit more from it than anyone.’M 50b
3.3. Prospect of Outreach Visits by Pharmacists
‘They (persons experiencing homelessness) don’t go to a doctor … so, if you went out to them … they would probably open up to you.’F 55
3.4. Peer Support and Social Influences in Engaging with Services
‘And when one person hears from another that they, they sent the wellbeing bus or whatever and it helps them, and they move on or they got better. Word of mouth alone is going to build trust amongst these people.’M 50b
‘Suggesting recruiting people like us, who are already on the street, some of us, going to know certain people, and I’m just getting nowhere, here mate, I’ll signpost you to them. I mean what is it really, are you going to go out yourself or you’re going…’M 50a
3.5. Addressing Challenges in Following up Homeless Persons
4. Discussion
4.1. Strengths and Limitations
4.2. Future Plans
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Jagpal, P.; Barnes, N.; Lowrie, R.; Banerjee, A.; Paudyal, V. Clinical Pharmacy Intervention for Persons Experiencing Homelessness: Evaluation of Patient Perspectives in Service Design and Development. Pharmacy 2019, 7, 153. https://doi.org/10.3390/pharmacy7040153
Jagpal P, Barnes N, Lowrie R, Banerjee A, Paudyal V. Clinical Pharmacy Intervention for Persons Experiencing Homelessness: Evaluation of Patient Perspectives in Service Design and Development. Pharmacy. 2019; 7(4):153. https://doi.org/10.3390/pharmacy7040153
Chicago/Turabian StyleJagpal, Parbir, Nigel Barnes, Richard Lowrie, Amitava Banerjee, and Vibhu Paudyal. 2019. "Clinical Pharmacy Intervention for Persons Experiencing Homelessness: Evaluation of Patient Perspectives in Service Design and Development" Pharmacy 7, no. 4: 153. https://doi.org/10.3390/pharmacy7040153