PHOENIx

Pharmacy Homeless Outreach Engagement Non medical Independent prescribing (PHOENIx): community pharmacy based multicentre pilot randomised controlled trial with parallel process and economic evaluation.

Homelessness confers a higher risk for all causes of premature death and hospitalisation. Facing severe and multiple disadvantages, people experiencing homelessness have as many long-term health conditions as an 85 year old might, despite being 43 years old on average. Lower levels of access to care, treatment uptake, and medicines adherence all contribute to poor outcomes. Most deaths are due to street drug overdose.  

Evidence is lacking for holistic interventions to improve health outcomes. Thus, community pharmacy based holistic health and social care interventions, such as this project (PHOENIx), have the potential to improve access and care. PHOENIx intervention is delivered by NHS employee independent-prescribing pharmacists or nurses, working with third sector staff. Together they offer weekly consultations in the patient’s choice of venue for 6 months. Pharmacists/nurses clinically assess, treat, prescribe and refer, in full collaboration with existing health and social care teams and with full remote access to NHS acute and primary care clinical information systems. 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.  

Our multicentre pilot randomised controlled trial (RCT) of PHOENIx in Glasgow and Birmingham is evaluating participant recruitment; data collection; retention; intervention fidelity; and a range of outcomes in preparation for a definitive RCT. An embedded qualitative evaluation examines the acceptability of PHOENIx to participants and stakeholders, and an economic evaluation describes the costs of the intervention. 

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). UC is existing primary and secondary care, social and third sector care. 

Six months post-randomisation follow up visits by researchers assess achievement of progression criteria (recruitment, retention, data collection, intervention fidelity) and scheduled/unscheduled healthcare utilisation, costs, prescribing, quality of life, housing tenure, criminal justice contacts.  

Conditional on a signal of improved outcomes at follow up and a favourable process evaluation, findings from the PHOENIx pilot RCT will inform a subsequent definitive randomised controlled trial. 

Funded by NIHR. Working in collaboration with Simon Community Scotland, Trident REACH (Birmingham), NHS Greater Glasgow and Clyde, NHS Birmingham and Solihull, University of Birmingham.