Setting
multimorbidity, overdose, cancer, overdosed, deaths
CANCER, SECONDARY
The study setting is Glasgow, Scotland (drug deaths account for 33.7 per 100,000 population and over half of all deaths in people experiencing homelessness (59%, 151 deaths)) [Due to the risks associated with co-prescribing OST, diazepam and gabapentinoids together, specialist alcohol and drug recovery teams take responsibility for combination prescribing in people experiencing homelessness in Glasgow. Patients receiving these combinations tend to have their medicines dispensed daily, with consumption supervised in community pharmacies. For these reasons, overdose with prescribed medicines is less likely. The study therefore targeted people experiencing homelessness who had overdosed with non-prescribed (street) drugs.
In the UK, facilities for people experiencing homelessness who also have problem drug use, include residential rehabilitation units. These provide in-house short to medium term detoxification or stabilisation for people who have needs that cannot be met, although there are a shortage of rehabilitation beds. This level of respite care requires specialist addiction team input, and Glasgow is no different in this respect. Because of the level of specialist care needed to oversee stabilisation or detoxification, these units have qualified medical and nursing staff in-house. Clinical information relating to episodes of patient care in rehabilitation units include treatments is shared with the patient’s NHS primary and secondary care providers, to enable continuity of care after patients leave rehabilitation units. There are no barriers to information sharing with NHS practitioners including NHS employee PHOENIx Pharmacists. The PHOENIx team often refer patients into these residential rehabilitation units because their care needs cannot be met elsewhere.In Glasgow, the care of problem drug or alcohol use in people experiencing homelessness with problem drug use is provided by specialist Alcohol and Drug Recovery Services (ADRS). Mental health services are provided by specialist homeless mental health teams, specialist community mental health teams or via ADRS. Mainstream General Practices, or the Specialist Homeless Health Service General Practitioner led service provide generalist care for physical and mental health needs, referring patients for specialist ADRS, mental health services and specialist hospital care as required. Community pharmacies dispense medicines but have no access to patients’ clinical information. Instead, community pharmacy staff retain their own records and share information about patients with ADRS staff as and when required. All health care (including medicines) is available free of charge in NHS Scotland. Social care and third sector charity services records are not routinely shared with other services. Prescribing for problem substance use is undertaken by ADRS; Glasgow also has Scotland’s first Heroin-Assisted Treatment Unit, with capacity for approximately 20 patients. Acute and long-term prescribing of most other medicines except antiretrovirals and some other specialised medication such as cancer chemotherapy is undertaken by General Practitioners and specialists in secondary care. Mental health teams (specifically psychiatrists) take responsibility for initiating antipsychotic medication. To have their health care needs met, patients with multimorbidity (two or more long-term conditions) [The PHOENIx intervention is described below, using the TIDieR checklist [