How can pharmacists help the homeless?

A study has looked at how pharmacists can provide support to homeless people for their medication and health needs

UK researchers have looked at a new service where pharmacists conducted pop-up, drop-in health clinics – no appointment needed – to various homeless support venues in Glasgow City Centre.

Interventions were provided by pharmacist independent prescribers over the 9-month period of the study, at venues including hostels, day centres, soup kitchens and charities, according to a study published in the International Journal of Pharmacy Practice.

Clinics last around two hours and were run by a single pharmacist who provided health assessments, which would cover cardiovascular health, respiratory health, nutrition, mental health, substance misuse, alcohol consumption, blood borne viruses, sexual health, foot care, female health, and medication reviews.

An assessment could consist of a full health check, including blood pressure monitoring or blood borne viruses screening, or could be a consultation about a specific patient concern.

Prescriptions could be issued at these clinics, but no OTC products were carried or handed out. Prescription cost budgets were linked to the homeless GP practice.

The pharmacy team consisted of three pharmacists, all providing solo clinics at various locations, rotating at weekly intervals.

The number of patients in the sample was 52, with the majority of these being male (82.7%).

Duration of homelessness ranged from one month to 17 years, with a mean duration of five years and eight months.

Blood pressure measurement was the most common near patient testing, with 79% of the sample receiving this.

The least common test was venepuncture for various conditions (23% received this).

Pharmacists identified new clinical issues in 69% from the sample. The most common issue was infection (dental, wounds, abscesses and rashes).

Sixty-two per cent of patients had their presenting symptoms managed solely by a pharmacist. Sixty-eight referrals were made to other healthcare professionals (such as secondary care, GPs, podiatry).

There were also 17 referrals to non-medical organisations, for example to a charity for housing and financial support; to soup kitchens; and to free charitable football training sessions.

“The pharmacists’ interventions provide a complimentary approach to health care for this patient group, who are challenging to engage with, at a time of GP shortage and strain,” said the authors.

Medication was prescribed by the pharmacist for 32 unique patients (62% of total sample).

Of these 32, a total of 22 patients (69%) were prescribed new items; 21 (66%) were prescribed repeat medication or re-started on medication they had previously had; and in five patients (16%), the pharmacists made changes to existing medication.

Examples of medications prescribed were wound dressings, hypertension medications, diabetic medications, analgesics, inhalers, antidepressants and nutritional supplements.

“Results from the project describe pharmacists delivering services traditionally carried out by GP services such as physical examination; diagnosis; prescribing; onward referral; and clinical follow-up,” say the authors.

“The pharmacists’ interventions provide a complimentary approach to health care for this patient group, who are challenging to engage with, at a time of GP shortage and strain. This improves ease of access to health services for this patient group.”

Previous research in their local area showed that on average each homeless patient suffered from 2.8 long-term health conditions, with 60% suffering from both a long-term physical and mental health condition.

Health conditions included depression, anxiety, chronic obstructive pulmonary disease, diabetes, hepatitis C, HIV, substance misuse and alcohol abuse.

The article was published in the International Journal of Pharmacy Practice (login required)

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