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Oliveras C, Bruguera P, Cordero Torres I, Millán Hernández A, Pons MT, Guzmán Cortez PR, Gómez-Ramiro M, Vázquez Vallejo M, Salgado E, Asenjo Romero M, Vieta E, Gual A, López-Pelayo H, Balcells-Oliveró M. Another Round: Influence of Alcohol-Related Conditions and Other Drug Use-Related Disorders in Emergency Department Frequent Use - A Single-Site Matched Case-Control Study in Spain. Eur Addict Res 2024:1-13. [PMID: 39068928 DOI: 10.1159/000538987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 04/11/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Patients who make 5 or more visits per year to hospital emergency departments (EDs) are usually considered ED frequent users (FUs). This study aims to better characterize the influence of alcohol and other drug use-related disorders in this phenomenon in a European Mediterranean country with public, universal, tax-financed healthcare system. METHODS Matched case-control study. Cases were adults between 18 and 65 years old who consulted 5 or more times the ED of a tertiary hospital in Spain between December 2018 and November 2019. Each case was assigned a control of the same age and gender, who appeared to the ED on the same day, but who made 4 visits or less to the service during the study period. The electronic record of the first ED visit during this period was used to extract the variables of interest: emergency care received, clinical and social characteristics. Predictors of frequent ED use were identified with conditional logistic regression. RESULTS 609 case-control pairs (total n = 1,218) were selected. History of alcohol-related conditions (adjusted odds ratio [AOR] = 1.82 [95% CI: 1.26-2.64] p = 0.001) and also other drug use-related disorders (AOR = 1.50 [95% CI: 1.11-2.03] p = 0.009) significantly increased the probability of frequent use of emergency services. DISCUSSION/CONCLUSION Alcohol-related conditions and other drug use-related disorders must be evaluated in all ED FUs. Specific action protocols to concurrently address repeated attendance and addictions in the emergency room could be a good tool to reduce frequent ED use.
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Affiliation(s)
- Clara Oliveras
- Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| | - Pol Bruguera
- Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| | | | - Andrea Millán Hernández
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| | - Maria Teresa Pons
- Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| | - Pablo Rodrigo Guzmán Cortez
- Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| | - Marta Gómez-Ramiro
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Hospital Clínic de Barcelona, Emergency Department, Barcelona, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
- Psychiatry Service, Complejo Hospitalario Universitario de Vigo, SERGAS, Spain, Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IISGS), Barcelona, Spain
| | - Mireia Vázquez Vallejo
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Hospital Clínic de Barcelona, Emergency Department, Barcelona, Spain
| | - Emilio Salgado
- Hospital Clínic de Barcelona, Emergency Department, Barcelona, Spain
- Clinical Toxicology Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Eduard Vieta
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Antoni Gual
- Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| | - Hugo López-Pelayo
- Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
| | - Mercè Balcells-Oliveró
- Addictions Unit, Psychiatry and Psychology Service, ICN, Hospital Clinic Barcelona, Barcelona, Spain
- Department of Psychiatry and Clinical Psychology, Hospital Clínic de Barcelona, Barcelona, Spain
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Red de Investigación en Atención Primaria de Adicciones, RIAPAd (RICORS), Barcelona, Spain
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Hodwitz K, Ginocchio GF, Fedorovsky T, Girdler H, Bossin B, Juando-Prats C, Dell E, Somers A, Hulme J. Healthcare workers' perspectives on a prescription phone program to meet the health equity needs of patients in the emergency department: a qualitative study. CAN J EMERG MED 2024:10.1007/s43678-024-00735-y. [PMID: 38951473 DOI: 10.1007/s43678-024-00735-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/30/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES People experiencing homelessness and marginalization face considerable barriers to accessing healthcare services. Increased reliance on technology within healthcare has exacerbated these inequities. We evaluated a hospital-based prescription phone program aimed to reduce digital health inequities and improve access to services among marginalized patients in Emergency Departments. We examined the perceived outcomes of the program and the contextual barriers and facilitators affecting outcomes. METHODS We conducted a constructivist qualitative program evaluation at two urban, academic hospitals in Toronto, Ontario. We interviewed 12 healthcare workers about their perspectives on program implementation and outcomes and analyzed the interview data using reflexive thematic analysis. RESULTS Our analyses generated five interrelated program outcomes: building trust with patients, facilitating independence in healthcare, bridging sectors of care, enabling equitable care for marginalized populations, and mitigating moral distress among healthcare workers. Participants expressed that phone provision is critical for adequately serving patients who face barriers to accessing health and social services, and for supporting healthcare workers who often lack resources to adequately serve these patients. We identified key contextual enablers and challenges that may influence program outcomes and future implementation efforts. CONCLUSIONS Our findings suggest that providing phones to marginalized patient populations may address digital and social health inequities; however, building trusting relationships with patients, understanding the unique needs of these populations, and operating within a biopsychosocial model of health are key to program success.
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Affiliation(s)
- Kathryn Hodwitz
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Galo F Ginocchio
- Einstein Lab, Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Tali Fedorovsky
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hannah Girdler
- Centre for Global Equity in Emergency Medicine, University Health Network, Toronto, ON, Canada
| | - Brielle Bossin
- Emergency Department, St. Michael's Hospital, Toronto, ON, Canada
| | - Clara Juando-Prats
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Evelyn Dell
- Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Andrea Somers
- University Health Network, Toronto, ON, Canada
- Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer Hulme
- University Health Network, Toronto General Hospital, Toronto, ON, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
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Shah JK, Liu F, Cevallos P, Amakiri UO, Johnstone T, Nazerali R, Sheckter CC. A national analysis of burn injuries among homeless persons presenting to emergency departments. Burns 2024; 50:1091-1100. [PMID: 38492979 DOI: 10.1016/j.burns.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/31/2024] [Accepted: 02/27/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Burn injuries among the homeless are increasing as record numbers of people are unsheltered and resort to unsafe heating practices. This study characterizes burns in homeless encounters presenting to US emergency departments (EDs). METHODS Burn encounters in the 2019 Nationwide Emergency Department Sample (NEDS) were queried. ICD-10 and CPT codes identified homelessness, injury regions, depths, total body surface area (TBSA %), and treatment plans. Demographics, comorbidities, and charges were analyzed. Discharge weights generated national estimates. Statistical analysis included univariate testing and multivariate modeling. RESULTS Of 316,344 weighted ED visits meeting criteria, 1919 (0.6%) were homeless. Homeless encounters were older (mean age 44.83 vs. 32.39 years), male-predominant (71% vs. 52%), and had more comorbidities, and were more often White or Black race (p < 0.001). They more commonly presented to EDs in the West and were covered by Medicaid (51% vs. 33%) (p < 0.001). 12% and 5% of homeless burn injuries were related to self-harm and assault, respectively (p < 0.001). Homeless encounters experienced more third-degree burns (13% vs. 4%; p < 0.001), though TBSA % deciles were not significantly different (34% vs. 33% had TBSA % of ten or lower; p = 0.516). Homeless encounters were more often admitted (49% vs. 7%; p < 0.001), and homelessness increased odds of admission (OR 4.779; p < 0.001). Odds of transfer were significantly lower (OR 0.405; p = 0.021). CONCLUSION Homeless burn ED encounters were more likely due to assault and self-inflicted injuries, and more severe. ED practitioners should be aware of these patients' unique presentation and triage to burn centers accordingly.
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Affiliation(s)
- Jennifer K Shah
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Farrah Liu
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | - Rahim Nazerali
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Clifford C Sheckter
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA; Regional Burn Center, Santa Clara Valley Medical Center, USA.
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Ball MAZ, Sack DE, Druffner SA, Jones I, Wrenn JO, Sexton MM, Shinn M, Hess JJ. Characteristics and Health Care Utilization of Patients With Housing Insecurity in the ED. JAMA Netw Open 2024; 7:e248565. [PMID: 38669017 PMCID: PMC11053378 DOI: 10.1001/jamanetworkopen.2024.8565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/28/2024] [Indexed: 04/29/2024] Open
Abstract
Importance Unstable housing and homelessness can exacerbate adverse health outcomes leading to increased risk of chronic disease, injury, and disability. However, emergency departments (EDs) have no universal method to identify those at risk of or currently experiencing homelessness. Objective To describe the extent of housing insecurity among patients who seek care in an urban ED, including chief concerns, demographics, and patterns of health care utilization. Design, Setting, and Participants This cross-sectional study included all adult patients presenting to the ED at Vanderbilt University Medical Center (VUMC), an urban tertiary care, level I trauma center in the Southeast US, from January 5 to May 16, 2023. Main Outcomes and Measures The primary outcome was the proportion of ED visits at which patients screened positive for housing insecurity. Secondary outcomes included prevalence of insecurity by chief concerns, demographics, and patterns of health care utilization. Results Of all 23 795 VUMC ED visits with screenings for housing insecurity (12 465 visits among women [52%]; median age, 47 years [IQR, 32-48 years]), in 1185 (5%), patients screened positive for current homelessness or housing insecurity (660 unique patients); at 22 610 visits (95%), the screening result was negative. Of visits with positive results, the median age of patients was 46 years (IQR, 36-55 years) and 829 (70%) were among male patients. Suicide and intoxication were more common chief concerns among visits at which patients screened positive (132 [11%] and 118 [10%], respectively) than among those at which patients screened negative (220 [1%] and 335 [2%], respectively). Visits with positive results were more likely to be among patients who were uninsured (395 [33%] vs 2272 [10%]) and had multiple visits during the study period. A higher proportion of positive screening results occurred between 8 pm and 6 am. The social work team assessed patients at 919 visits (78%) with positive screening results. Conclusions and Relevance In this cross-sectional study of 23 795 ED visits, at 5% of visits, patients screened positive for housing insecurity and were more likely to present with a chief concern of suicide, to be uninsured, and to have multiple visits during the study period. This analysis provides a call for other institutions to introduce screening and create tailored care plans for patients experiencing housing insecurity to achieve equitable health care.
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Affiliation(s)
| | - Daniel E. Sack
- Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Medicine, University of Pennsylvania, Philadelphia
| | | | - Ian Jones
- Department of Emergency Medicine and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jesse O. Wrenn
- Department of Emergency Medicine and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mitchell M. Sexton
- Department of Emergency Medicine and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marybeth Shinn
- Vanderbilt University Peabody College, Nashville, Tennessee
| | - Jennifer J. Hess
- Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Garcia C, Doran K, Kushel M. Homelessness And Health: Factors, Evidence, Innovations That Work, And Policy Recommendations. Health Aff (Millwood) 2024; 43:164-171. [PMID: 38315930 DOI: 10.1377/hlthaff.2023.01049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
On a single night in 2023, more than 653,000 people experienced homelessness in the United States. In this overview, we highlight structural and individual risk factors that can lead to homelessness, explore evidence on the relationship between homelessness and health, discuss programmatic and policy innovations, and provide policy recommendations. Health system efforts to address homelessness and improve the health of homeless populations have included interventions such as screening for social needs and medical respite programs. Initiatives using the Housing First approach to permanent supportive housing have a strong track record of success. Health care financing innovations using Medicaid Section 1115 waivers offer promising new approaches to improving health and housing for people experiencing homelessness. To substantially reduce homelessness and its many adverse health impacts, changes are needed to increase the supply of affordable housing for households with very low incomes. Health care providers and systems should leverage their political power to advocate for policies that scale durable, evidence-based solutions to reduce homelessness, including increased funding to expand housing choice vouchers and greater investment in the creation and preservation of affordable housing.
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Affiliation(s)
- Cheyenne Garcia
- Cheyenne Garcia, University of California San Francisco, San Francisco, California
| | - Kelly Doran
- Kelly Doran, New York University, New York, New York
| | - Margot Kushel
- Margot Kushel , University of California San Francisco
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Juarez PD. Economic Determinants of Health Disparities and the Role of the Primary Care Provider. Prim Care 2023; 50:561-577. [PMID: 37866831 DOI: 10.1016/j.pop.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
The economic determinants of adverse personal health outcomes and population level disparities pose a daunting challenge for primary care providers in promoting health for persons experiencing poverty and neighborhood deprivation. Until they are addressed, however, the health and economic well-being of persons experiencing neighborhood deprivation is not likely to be improved. There is growing evidence of effective interventions that primary care providers can adopt to address social and economic determinants of health. Primary care providers can participate in clinic and community-based approaches that target individual, neighborhood and social level drives of health and disparities.
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Affiliation(s)
- Paul D Juarez
- Department of Family & Community Medicine, Meharry Medical College, 1005 Dr. DB Todd Jr. Boulevard, Nashville, TN 37208, USA.
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Shao X, Bai J, Ji A, Sun W. Retrospective analysis of medical emergencies in an oral emergency department. Med Oral Patol Oral Cir Bucal 2023; 28:e539-e544. [PMID: 37099708 PMCID: PMC10635636 DOI: 10.4317/medoral.25947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/22/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND To retrospectively analyze the rescue of medical emergencies and critical patients in the oral emergency department in a hospital during the past 14 years; analyze the general condition of patients, their diagnosis, etiological factors, and outcomes of the disease, so as to improve the ability of oral medical staff to deal with emergencies; and optimize the emergency procedures and resource allocation in such departments. MATERIAL AND METHODS Data and related information of critical patient emergency rescue from the Emergency Department of the Hospital of Stomatology, Peking University from January 2006 to December 2019, were analyzed. RESULTS A total of 53 critical patients were rescued in the oral emergency department in the past 14 years, which is an average of four cases per year, with an incidence rate of 0.00506%. The main type of emergency included hemorrhagic shock and active hemorrhage, with the highest incidence being in the age group of 19-40 years old. Among these cases, 67.92% (36/53) developed emergency and critical diseases before visiting the oral emergency department and 41.51% (22/53) had systemic diseases. After rescue, a total of 48 patients (90.57%) had stable vital signs and 5 (9.43%) died. CONCLUSIONS Oral doctors and other medical staff should be able to rapidly identify medical emergencies in oral emergency departments and commence emergency treatment. The department should be equipped with relevant first-aid drugs and devices, and medical staff should be regularly trained in practical first-aid skills. Patients with oral and maxillofacial trauma, massive hemorrhage and systemic diseases should be evaluated and treated according to their conditions and systemic organ function to prevent and reduce medical emergencies.
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Affiliation(s)
- X Shao
- 22 Zhongguancun Nandajie, Haidian District Beijing, 100089, China
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Richards-Jones L, Patel P, Jagpal PK, Lowrie R, Saunders K, Burwood S, Shrestha S, Paudyal V. Provision of drug and alcohol services amidst COVID-19 pandemic: a qualitative evaluation on the experiences of service providers. Int J Clin Pharm 2023; 45:1098-1106. [PMID: 36971897 PMCID: PMC10042098 DOI: 10.1007/s11096-023-01557-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/14/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The impact of COVID-19 pandemic on the provision of drug and alcohol (D&A) services and associated outcomes have been under-researched. AIM This study aimed to understand the experiences of service providers in relation to how drug and alcohol (D&A) services were affected during COVID-19 pandemic, including the adaptations made and lessons learnt for the future. METHOD Focus groups and semi-structured interviews were conducted with participants from various D&A service organisations across the UK. Data were audio recorded, followed by transcription and thematic analysis. RESULTS A total of 46 participants representing various service providers were recruited between October and January 2022. The thematic analysis identified ten themes. COVID-19 required significant changes to how the treatment was provided and prioritised. Expansion of telehealth and digital services were described, which reduced service wait times and increased opportunities for peer network. However, they described missed opportunities for disease screening, and some users risked facing digital exclusion. Participants who provided opiate substitution therapy service spoke of improving service provider/user trust following the shift from daily supervised treatment consumption to weekly dispensing. At the same time, they feared fatal overdoses and non-adherence to treatment. CONCLUSION This study demonstrates the multifaceted impact of the COVID-19 pandemic on UK-based D&A service provisions. The long-term impact of reduced supervision on Substance Use Disorder treatment and outcomes and any effect of virtual communications on service efficiency, patient-provider relationships and treatment retention and successes are unknown, suggesting the need for further study to assess their utility.
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Affiliation(s)
- Levi Richards-Jones
- School of Pharmacy, College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Priya Patel
- School of Pharmacy, College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Parbir Kaur Jagpal
- School of Pharmacy, College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Richard Lowrie
- Pharmacy and Prescribing Support Unit, NHS Glasgow and Clyde, Glasgow, G76 7AT, UK
| | | | | | - Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia
| | - Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Chan V, Estrella MJ, Hanafy S, Colclough Z, Joyce JM, Babineau J, Colantonio A. Equity considerations in clinical practice guidelines for traumatic brain injury and homelessness: a systematic review. EClinicalMedicine 2023; 63:102152. [PMID: 37662521 PMCID: PMC10474365 DOI: 10.1016/j.eclinm.2023.102152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 09/05/2023] Open
Abstract
Background Clinical practice guidelines (CPGs) predominantly prioritise treatment and cost-effectiveness, which encourages a universal approach that may not address the circumstances of disadvantaged groups. We aimed to advance equity and quality of care for individuals experiencing homelessness and traumatic brain injury (TBI) by assessing the extent to which homelessness and TBI are integrated in CPGs for TBI and CPGs for homelessness, respectively, and the extent to which equity, including consideration of disadvantaged populations and the PROGRESS-Plus framework, is considered in these CPGs. Methods For this systematic review, CPGs for TBI or homelessness were identified from electronic databases (MEDLINE, Embase, CINAHL, PsycINFO), targeted websites, Google Search, and reference lists of eligible CPGs on November 16, 2021 and March 16, 2023. The proportion of CPGs that integrated evidence regarding TBI and homelessness was identified and qualitative content analysis was conducted to understand how homelessness is integrated in CPGs for TBI and vice versa. Equity assessment tools were utilised to understand the extent to which equity was considered in these CPGs. This review is registered with PROSPERO (CRD42021287696). Findings Fifty-eight CPGs for TBI and two CPGs for homelessness met inclusion criteria. Only three CPGs for TBI integrated evidence regarding homelessness by recognizing the prevalence of TBI in individuals experiencing homelessness and identifying housing as a consideration in the assessment and management of TBI. The two CPGs for homelessness acknowledged TBI as prevalent and recognised individuals experiencing TBI and homelessness as a disadvantaged population that should be prioritised in guideline development. Equity was rarely considered in the content and development of CPGs for TBI. Interpretation Considerations for equity in CPGs for homelessness and TBI are lacking. To ensure that CPGs reflect and address the needs of individuals experiencing homelessness and TBI, we have identified several guideline development priorities. Namely, there is a need to integrate evidence regarding homelessness and TBI in CPGs for TBI and CPGs for homelessness, respectively and engage disadvantaged populations in all stages of guideline development. Further, this review highlights an urgent need to conduct research focused on and with disadvantaged populations. Funding Canada Research Chairs Program (2019-00019) and the Ontario Ministry of Health and Long-Term Care (Grant #725A).
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Affiliation(s)
- Vincy Chan
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Maria Jennifer Estrella
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Sara Hanafy
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Zoe Colclough
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Julie Michele Joyce
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jessica Babineau
- Library and Information Services, University Health Network, Toronto, ON, Canada
- The Institute for Education Research, University Health Network, Toronto, ON, Canada
| | - Angela Colantonio
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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Paudyal V, Vohra N, Price M, Jalal Z, Saunders K. Key causes and long-term trends related to emergency department and inpatient hospital admissions of homeless persons in England. Int J Emerg Med 2023; 16:48. [PMID: 37550625 PMCID: PMC10405435 DOI: 10.1186/s12245-023-00526-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/24/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND It is estimated that approximately 300,000 people are experiencing homelessness in England. The aim of this study was to evaluate key causes and long-term trends of emergency departments (EDs) and in hospital inpatient admissions of persons experiencing homelessness in England. METHODS ED and hospital inpatient admissions data were obtained from Hospital Episode Statistics (HES) covering all National Health Service (NHS) England hospitals. Anyone identified or declared to be experiencing homelessness during the service usage are recorded in HES datasets. Data were extracted for the 10-year study period and compared to the general population, which includes all patients attending the ED or admitted to inpatient care in England. RESULTS Drug- and alcohol-related causes contribute to the most frequent reasons for attendance and admissions of persons experiencing homelessness in the ED and inpatient respectively. A total of 30,406 ED attendances were recorded for persons experiencing homelessness in the year 2018/2019 (+ 44.9% rise vs 2009/10) of which injuries and poisoning respectively represented 21.8% and 17.9% of all persons experiencing homelessness presentations to the ED. Poisoning (including drug overdose) represented only 1.9% of all attendances by the general population during the same study year (rate ratio vs general populations 9.2 95% CI 9.0-9.4). High mortality rates were observed in relation to presentations attributed to drug- and alcohol-related causes. A total of 14,858 persons experiencing homelessness inpatient admissions were recorded in 2018/2019 (+ 68.6% vs 2009/2010). Psychoactive substance use constituted 12.7% of all admissions in 2018/2019 compared to 0.4% of in the general populations (rate ratio: 33.3, 95% CI: 31.9-34.7). There was a 44.3% rise in the number of admissions related to poisoning in the study period amongst persons experiencing homelessness in England (vs 14.2% in general population). CONCLUSION Marked disparities around primary causes of ED and inpatient admissions were identified between persons experiencing homelessness and the general population. There is a continued need for prevention measures to reduce the prevalence of drug and alcohol, injury and poisoning-related admissions to the ED, enhanced service provision at the community level, and multisector collaborations. These initiatives should maximise opportunities for early interventions and improve outcomes for persons experiencing homelessness, including increased accessibility of healthcare and mental health services, particularly in areas that demonstrate increasing ED and inpatient attendance rates over time.
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Affiliation(s)
- Vibhu Paudyal
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Neha Vohra
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Malcolm Price
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham, Birmingham, UK
| | - Zahraa Jalal
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
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11
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Clapp J, Calvo-Friedman A, Davis N. Addressing Health-Related Social Needs-Costs and Optimism. JAMA Intern Med 2023; 183:774-775. [PMID: 37252719 DOI: 10.1001/jamainternmed.2023.1972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Jenifer Clapp
- Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, New York
| | - Alessandra Calvo-Friedman
- Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, New York
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Nichola Davis
- Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
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12
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Richard L, Golding H, Saskin R, Jenkinson JIR, Francombe Pridham K, Gogosis E, Snider C, Hwang SW. Cold-related injuries among patients experiencing homelessness in Toronto: a descriptive analysis of emergency department visits. CAN J EMERG MED 2023; 25:695-703. [PMID: 37405616 DOI: 10.1007/s43678-023-00546-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/16/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE Homelessness increases the risk of cold-related injuries. We examined emergency department visits for cold-related injuries in Toronto over a 4-year period, comparing visits for patients identified as homeless to visits for patients not identified as homeless. METHODS This descriptive analysis of visits to emergency departments in Toronto between July 2018 and June 2022 used linked health administrative data. We measured emergency department visits with cold-related injury diagnoses among patients experiencing homelessness and those not identified as homeless. Rates were expressed as a number of visits for cold-related injury per 100,000 visits overall. Rate ratios were used to compare rates between homeless vs. not homeless groups. RESULTS We identified 333 visits for cold-related injuries among patients experiencing homelessness and 1126 visits among non-homeless patients. In each of the 4 years of observation, rate ratios ranged between 13.6 and 17.6 for cold-related injuries overall, 13.7 and 17.8 for hypothermia, and 10.3 and 18.3 for frostbite. Rates per 100,000 visits in the fourth year (July 2021 to June 2022) were significantly higher than in the pre-pandemic period. Male patients had higher rates, regardless of homelessness status; female patients experiencing homelessness had higher rate ratios than male patients experiencing homelessness. CONCLUSION Patients experiencing homelessness visiting the emergency department are much more likely to be seen for cold-related injuries than non-homeless patients. Additional efforts are needed to prevent cold-related exposure and consequent injury among people experiencing homelessness.
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Affiliation(s)
- Lucie Richard
- MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond St., Toronto, ON, Canada.
| | | | | | - Jesse I R Jenkinson
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | | | - Evie Gogosis
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | | | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
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13
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Borton D, Ryding R, Scales MJ, Fraser K. Demographics of the Population Experiencing Homelessness and Receiving Publicly Funded Substance Use and Mental Health Treatment Services in Delaware. Dela J Public Health 2023; 9:14-17. [PMID: 37622147 PMCID: PMC10445603 DOI: 10.32481/djph.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
Objective To determine the prevalence of clients experiencing homelessness in publicly funded substance use and mental health services in Delaware and uncover basic patterns in the demographics and service access of said clients. Methods We analyzed Consumer Reporting Form data for clients admitted to publicly funded substance use and mental health treatment. All clients who were admitted to services from a publicly-funded provider and completed the CRF between 2019 and 2021 were included in this analysis (n=29,495). Results 5,717 clients (19%) reported experiencing homelessness. 20% of men reported homelessness, compared to 18% of women, and 22% of Black clients reported homelessness, compared to 19% of White clients. 48% of admissions were to substance use treatment, 29% were to mental health treatment, and 23% were to treatment for both. Conclusions Nearly one-fifth of clients who received publicly funded treatment between 2019 and 2021 reported experiencing homelessness, a vast overrepresentation when compared against the less than 1% of the population who was counted as homeless through the annual PIT count in Delaware. Policy Implications Homelessness can be experienced across the lifespan and impacts individuals and families of all demographic makeups. Individuals are often unable to access primary care, insurance supported services, and chronic disease management teams resulting in a disproportionately high use of emergency services and departments for acute needs.
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Affiliation(s)
- David Borton
- Center for Drug and Health Studies, University of Delaware
| | - Rachel Ryding
- Center for Drug and Health Studies, University of Delaware
| | | | - Kris Fraser
- Division of Substance Abuse and Mental Health, Delaware Department of Health and Social Services
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14
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Ingram C, Buggy C, Elabbasy D, Perrotta C. Homelessness and health-related outcomes in the Republic of Ireland: a systematic review, meta-analysis and evidence map. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023:1-22. [PMID: 37361314 PMCID: PMC10233198 DOI: 10.1007/s10389-023-01934-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/03/2023] [Indexed: 06/28/2023]
Abstract
Aim To map existing research on homelessness and health in the Republic of Ireland, and to synthesize the evidence on housing-related disparities in health. Methods Peer-reviewed articles and conference abstracts published in English between 2012-2022 were retrieved from 11 bibliographic databases if they contained empirical data on homelessness and health in Ireland, and - in a subsequent screening stage - at least one measure of health disparity between the homeless and general populations. Reviewers extracted relative risks (RR), 95% confidence intervals (CI), and calculated pooled RR of comparable health disparities using pairwise random-effects meta-analyses. Results One hundred four articles contained empirical data on the health of homeless individuals residing in Ireland, addressing primarily substance use, addiction and mental health. Homelessness was associated with increased risk of illicit drug use (RR 7.33 [95% CI 4.2, 12.9]), reduced access to a general practitioner (GP) (RR 0.73 [CI 95% 0.71, 0.75]), frequent emergency department (ED) presentation (pooled RR 27.8 [95% CI 4.1, 189.8]), repeat presentation for self-harm (pooled RR 1.6 [95% CI 1.2, 2.0]) and premature departure from hospital (pooled RR 2.65 [95% CI 1.27, 5.53]). Conclusions Homelessness in Ireland is associated with reduced access to primary care and overreliance on acute care. Chronic conditions amongst homeless individuals are understudied. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-023-01934-0.
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Affiliation(s)
- Carolyn Ingram
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Conor Buggy
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
- Centre for Safety and Health at Work, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Darin Elabbasy
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Carla Perrotta
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
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15
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Yohannes K, Målqvist M, Bradby H, Berhane Y, Herzig van Wees S. Addressing the needs of Ethiopia's street homeless women of reproductive age in the health and social protection policy: a qualitative study. Int J Equity Health 2023; 22:80. [PMID: 37143037 PMCID: PMC10159225 DOI: 10.1186/s12939-023-01874-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/24/2023] [Indexed: 05/06/2023] Open
Abstract
INTRODUCTION Globally, homelessness is a growing concern, and homeless women of reproductive age are particularly vulnerable to adverse physical, mental, and reproductive health conditions, including violence. Although Ethiopia has many homeless individuals, the topic has received little attention in the policy arena. Therefore, we aimed to understand the reason for the lack of attention, with particular emphasis on women of reproductive age. METHODS This is a qualitative study; 34 participants from governmental and non-governmental organisations responsible for addressing homeless individuals' needs participated in in-depth interviews. A deductive analysis of the interview materials was applied using Shiffman and Smith's political prioritisation framework. RESULTS Several factors contributed to the underrepresentation of homeless women's health and well-being needs in the policy context. Although many governmental and non-governmental organisations contributed to the homeless-focused programme, there was little collaboration and no unifying leadership. Moreover, there was insufficient advocacy and mobilisation to pressure national leaders. Concerning ideas, there was no consensus regarding the definition of and solution to homeless women's health and social protection issues. Regarding political contexts and issue characteristics, a lack of a well-established structure, a paucity of information on the number of homeless women and the severity of their health situations relative to other problems, and the lack of clear indicators prevented this issue from gaining political priority. CONCLUSIONS To prioritise the health and well-being of homeless women, the government should form a unifying collaboration and a governance structure that addresses the unmet needs of these women. It is imperative to divide responsibilities and explicitly include homeless people and services targeted for them in the national health and social protection implementation documents. Further, generating consensus on framing the problems and solutions and establishing indicators for assessing the situation is vital.
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Affiliation(s)
- Kalkidan Yohannes
- SWEDESD- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
- WOMHER- Women's Mental Health During the Reproductive Lifespan, Interdisciplinary Research Center, Uppsala University, Uppsala, Sweden.
- Department of Psychiatry, College of Health and Medical Science, Dilla University, Dilla, Ethiopia.
| | - Mats Målqvist
- SWEDESD- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Hannah Bradby
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Sibylle Herzig van Wees
- SWEDESD- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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16
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Paudyal V, Lowrie R, Mair FS, Middleton L, Cheed V, Hislop J, Williamson A, Barnes N, Jolly C, Saunders K, Allen N, Jagpal P, Provan G, Ross S, Hunter C, Tearne S, McPherson A, Heath H, Lombard C, Araf A, Dixon E, Hatch A, Moir J, Akhtar S. Protocol for a pilot randomised controlled trial to evaluate integrated support from pharmacist independent prescriber and third sector worker for people experiencing homelessness: the PHOENIx community pharmacy study. Pilot Feasibility Stud 2023; 9:29. [PMID: 36814302 PMCID: PMC9946705 DOI: 10.1186/s40814-023-01261-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND People experiencing homelessness (PEH) have complex health and social care needs and most die in their early 40 s. PEH frequently use community pharmacies; however, evaluation of the delivery of structured, integrated, holistic health and social care intervention has not been previously undertaken in community pharmacies for PEH. PHOENIx (Pharmacy Homeless Outreach Engagement Non-medical Independent prescribing Rx) has been delivered and tested in Glasgow, Scotland, by NHS pharmacist independent prescribers and third sector homelessness support workers offering health and social care intervention in low threshold homeless drop-in venues, emergency accommodation and emergency departments, to PEH. Building on this work, this study aims to test recruitment, retention, intervention adherence and fidelity of community pharmacy-based PHOENIx intervention. METHODS Randomised, multi-centre, open, parallel-group external pilot trial. A total of 100 PEH aged 18 years and over will be recruited from community pharmacies in Glasgow and Birmingham. PHOENIx intervention includes structured assessment in the community pharmacy of health, housing, benefits and activities, in addition to usual care, through weekly visits lasting up to six months. A primary outcome is whether to proceed to a definitive trial based on pre-specified progression criteria. Secondary outcomes include drug/alcohol treatment uptake and treatment retention; overdose rates; mortality and time to death; prison/criminal justice encounters; healthcare utilisation; housing tenure; patient-reported measures and intervention acceptability. Analysis will include descriptive statistics of recruitment and retention rates. Process evaluation will be conducted using Normalisation Process Theory. Health, social care and personal resource use data will be identified, measured and valued. DISCUSSION If the findings of this pilot study suggest progression to a definitive trial, and if the definitive trial offers positive outcomes, it is intended that PHOENIx will be a publicly funded free-to-access service in community pharmacy for PEH. The study results will be shared with wider stakeholders and patients in addition to dissemination through medical journals and scientific conferences. TRIAL REGISTRATION International Clinical Trial Registration ISRCTN88146807. Approved protocol version 2.0 dated July 19, 2022.
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Affiliation(s)
- Vibhu Paudyal
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | - Richard Lowrie
- Pharmacy Services, NHS Greater Glasgow and Clyde, Scotland, UK. .,Homeless Health / Research and Development, NHS Greater Glasgow and Clyde, Glasgow, G76 7AT, Scotland, UK.
| | - Frances S. Mair
- grid.8756.c0000 0001 2193 314XGeneral Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Lee Middleton
- grid.6572.60000 0004 1936 7486Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Versha Cheed
- grid.6572.60000 0004 1936 7486Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Jennifer Hislop
- grid.482042.80000 0000 8610 2323Healthcare Improvement Scotland, Edinburgh, UK
| | - Andrea Williamson
- grid.8756.c0000 0001 2193 314XUndergraduate Medical School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Nigel Barnes
- NHS Birmingham and Solihull Mental Health Foundations Trust, Birmingham, UK
| | - Catherine Jolly
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Karen Saunders
- Office for Health Improvement and Disparities, Department of Health and Social Care, Birmingham, UK
| | | | - Parbir Jagpal
- grid.413301.40000 0001 0523 9342Pharmacy Services, NHS Greater Glasgow and Clyde, Scotland, UK
| | | | | | - Carole Hunter
- Glasgow City HSCP, Alcohol and Drug Recovery Services, Glasgow, UK
| | - Sarah Tearne
- grid.6572.60000 0004 1936 7486Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Andrew McPherson
- grid.413301.40000 0001 0523 9342Pharmacy Services, NHS Greater Glasgow and Clyde, Scotland, UK
| | - Helena Heath
- NHS Birmingham and Solihull Mental Health Foundations Trust, Birmingham, UK
| | - Cian Lombard
- grid.413301.40000 0001 0523 9342Pharmacy Services, NHS Greater Glasgow and Clyde, Scotland, UK
| | - Adnan Araf
- NHS Birmingham and Solihull Mental Health Foundations Trust, Birmingham, UK
| | - Emily Dixon
- grid.6572.60000 0004 1936 7486Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Amy Hatch
- grid.6572.60000 0004 1936 7486Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Jane Moir
- grid.413301.40000 0001 0523 9342Pharmacy Services, NHS Greater Glasgow and Clyde, Scotland, UK
| | - Shabana Akhtar
- NHS Birmingham and Solihull Mental Health Foundations Trust, Birmingham, UK
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Currie J, Stafford A, Hutton J, Wood L. Optimising Access to Healthcare for Patients Experiencing Homelessness in Hospital Emergency Departments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2424. [PMID: 36767794 PMCID: PMC9916150 DOI: 10.3390/ijerph20032424] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
The ED is often the first and sometimes the only place where people experiencing homelessness seek medical assistance. While access to primary healthcare is a preferable and more cost-effective alternative to ED, for many reasons, people experiencing homelessness are much less likely to have a regular General Practitioner compared to those living in stable accommodation. Drawing on a growing body of emergency care and homelessness literature and practice, we have synthesised four potential interventions to optimise access to care when people experiencing homelessness present to an ED. Although EDs are in no way responsible for resolving the complex health and social issues of their local homeless population, they are a common contact point and therefore present an opportunity to improve access to healthcare.
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Affiliation(s)
- Jane Currie
- School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane, QLD 4059, Australia
| | | | - Jennie Hutton
- Emergency Department, St Vincent’s Hospital Melbourne, Melbourne, VIC 3065, Australia
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Lisa Wood
- Institute for Health Research, University of Notre Dame, Fremantle, WA 6061, Australia
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18
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Chopra E, Choudhary T, Hazen A, Shrestha S, Dehele I, Paudyal V. Clinical pharmacists in primary care general practices: evaluation of current workforce and their distribution. J Pharm Policy Pract 2022; 15:101. [PMID: 36494761 PMCID: PMC9733025 DOI: 10.1186/s40545-022-00483-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/03/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND General practices in primary care across England are increasingly employing clinical pharmacists to help tackle the workforce crisis and alleviate pressure. Clinical pharmacists can provide administrative and clinical duties, including non-medical prescribing, advice on polypharmacy and medicines optimisation. The aim of this study was to investigate the distribution of clinical pharmacists in general practice across England, and explore the relationship between the distribution and regional demography. METHODS This study used publicly available government database from various sources pertaining to primary care general practice workforce and population demographics of England. The number and distribution of pharmacists working within general practices in England were analysed and compared across practices considering general practitioner (GP), nurse and patient population in the practices, patients age ≥ 65 years and over and the Index of Multiple Deprivation (IMD) scores. RESULTS Twenty two percentage (1469 of 6674) of practices in England were found to have access to a clinical pharmacist, equating to 1358 full-time equivalent (FTE) pharmacists and a mean pharmacist FTE of 10.07 (95% CI 8.40, 11.75, SD = 9.84) per Clinical Commissioning Group (CCG). A significant relationship between pharmacist FTE and the number of patients 65 years and older [r (132) = 0.75, P < 0.001)] was observed; however, the distribution was not related to population deprivation scores. CONCLUSIONS Approximately one in five general practices in England have access to a clinical pharmacist. Further research is needed to ensure wider and equitable distribution based on workforce needs and practice population demography.
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Affiliation(s)
- Elisha Chopra
- grid.6572.60000 0004 1936 7486School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Tanvi Choudhary
- grid.6572.60000 0004 1936 7486School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ankie Hazen
- grid.7692.a0000000090126352Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sunil Shrestha
- grid.440425.30000 0004 1798 0746School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Malaysia
| | - Inderpal Dehele
- grid.6572.60000 0004 1936 7486School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Vibhu Paudyal
- grid.6572.60000 0004 1936 7486School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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19
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Currie J, Grech E, Yee J, Aitkenhead A, Jones L. Multistage Psychometric Testing of the Homeless Health Access to Care Tool. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15928. [PMID: 36498002 PMCID: PMC9738957 DOI: 10.3390/ijerph192315928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/17/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
People experiencing homelessness find it challenging to access the healthcare they so desperately need. To address this, we have developed the Homeless Health Access to Care Tool, which assesses health related vulnerability (burden of injury and/or illness and ability to access healthcare) and can be used to prioritize people for access to healthcare. Here, we report the initial psychometrics of the Homeless Health Access to Care Tool. To assess interrater reliability, clinician participants were invited to instinctually rate the health-related vulnerability of 18-fictional case studies and then apply the Homeless Health Access to Care Tool to these same case studies. To assess convergent validity, the Homeless Health Access to Care Tool and the tool it was adapted from, the Australian Vulnerability Index Service Prioritization Decision Assistance Tool were administered to people experiencing homelessness. Feedback was sought from the participants receiving these two tools and from those administering them. The Homeless Health Access to Care Tool demonstrated a high interrater reliability and internal consistency. Participants using and receiving the Homeless Health Access to Care Tool reported it as straightforward, unintrusive and clear. Median time of administration was 7 min 29 s (SD 118.03 s). Convergent validity was established for the Homeless Health Access to Care Tool with a moderate correlation (r = 0.567) with the total score of the Australian Vulnerability Index Service Prioritization Decision Assistance Tool. Findings suggest that the Homeless Health Access to Care Tool is feasible and reliable. Larger samples are required to report construct validity.
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Affiliation(s)
- Jane Currie
- School of Nursing, Queensland University of Technology, Brisbane, QLD 4000, Australia
- Homeless Health Service, St Vincent’s Hospital Sydney, Sydney, NSW 2010, Australia
| | - Elizabeth Grech
- Homeless Health Service, St Vincent’s Hospital Sydney, Sydney, NSW 2010, Australia
| | - Jasmine Yee
- Homeless Health Service, St Vincent’s Hospital Sydney, Sydney, NSW 2010, Australia
| | - Amy Aitkenhead
- Homeless Health Service, St Vincent’s Hospital Sydney, Sydney, NSW 2010, Australia
| | - Lee Jones
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4000, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, QLD 4000, Australia
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