Qualitative Evaluation of Clinical Pharmacist Prescribing Input into the Care of People Experiencing Homelessness
The links between homelessness and poor health are well recognised, and the difficulties healthcare providers encounter in meeting the needs of the most vulnerable homeless people – some of whom are branded ‘service resistant' – have been well documented.
Practitioners are increasingly looking to develop innovative interventions to improve the accessibility and effectiveness of healthcare for this group. Dedicated clinical pharmacy input represents one such innovation. This has been provided in Glasgow for three years, where it is delivered via consultations in the Homeless Health Service (HHS), in hostels, and (much more recently) via street outreach.
Service users’ and non-users’ perceptions and experiences of this service have not, to date, been evaluated. Nor have key stakeholders’ views of the strengths and weaknesses of the service been assessed. This qualitative study will examine these issues so as to inform the future development of pharmacist services for this client group. It will also seek participants’ input regarding the design of a future Randomised Control Trial (RCT) which will assess the influence of the pharmacists’ intervention on a range of outcome measures including, amongst others, hospitalisations, clinic attendance (GP and hospital), prescribing, and disease markers.
The proposed qualitative study has three main aims, these being to:
- assess homeless people’s perceptions and (where relevant) personal experiences of dedicated clinical (prescribing) pharmacist input into their clinical care;
- seek staff and stakeholder views on the strengths and weaknesses of the intervention, and
- consult homeless participants on the design of the proposed RCT
The study will investigate the following specific research questions:
- what do homeless people think of the current dedicated pharmacist intervention (including the screening phases)?
- what might be done to maximise homeless peoples’ uptake of a GP based pharmacy service?
- what do staff and other stakeholders consider to be the strengths and weaknesses of the intervention?
- what do homeless people think should be measured in the context of the planned study?
- what would encourage homeless people to participate in the planned study?
- what would encourage homeless people to remain in the planned study until the end (2-3 years)?
Study findings will thus be used to shape the delivery of the pharmacy service itself (i.e. to maximise user uptake and service effectiveness) and inform the design of the proposed RCT (i.e. to maximise study relevance, recruitment and retention).
Greater Glasgow and Clyde NHS Health Board
Key contact: Professor Sarah Johnsen, Heriot Watt University
Dr Fiona Cuthill, Lecturer in Nursing Studies, University of Edinburgh