Holistic health and social care outreach for people experiencing homelessness with recent non-fatal overdose in Glasgow, Scotland: the Pharmacist and third sector Homeless charity worker Outreach Engagement Non-medical Independent prescriber Rx (PHOENIx) pilot randomised controlled trial

Objectives: To examine randomised controlled trial (RCT) progression criteria including emergency department (ED) attendance and non-fatal overdose, from a holistic, integrated health and social care outreach intervention (PHOENIx), for people experiencing homelessness with recent non-fatal street drug overdose. Design: Pilot RCT. 1:1 randomisation to PHOENIx plus usual care (UC) or UC. Setting: Glasgow, Scotland. Participants: 128 adults experiencing homelessness with at least one non-fatal street drug overdose in the preceding 6 months. Interventions: Pharmacists from the National Health Service and third sector homelessness workers offered weekly outreach. PHOENIx teams develop therapeutic relationships to address health (physical health, mental health and problem drug use) and social care (housing, welfare benefits and social prescribing) in addition to UC. UC comprised building-based primary and secondary health, social and third sector services. Outcomes: Primary: progression criteria: recruitment (≥100 participants in 4 months); ≥80% of participants with data collected at baseline, 6 and 9 months; ≥60% of participants retained in the trial at each follow-up period (6 and 9 months); ≥60% of participants receiving the intervention weekly; any reduction in the rate of presentation to ED and overdoses, at 6- or 9-month follow-up. Secondary: participants with, and time to: hospitalisations; health-related quality of life (QoL); treatment uptake for physical and mental health conditions, and problematic drug use. Results: Progression criteria were exceeded. In PHOENIx compared with UC, there appeared to be a delay in the median time to ED visit, overdose and hospitalisation but no improvement in number of participants with ED visits, overdoses or hospitalisations. QoL and treatment uptake appeared to be higher in PHOENIx versus UC at 6 and 9 months. Conclusions: A definitive RCT is merited, to assess the impact of PHOENIx on people with multiple, severe disadvantages

Patient navigation for perinatal substance use disorder treatment: a systematic review protocol

Substance use during the perinatal period (broadly defined as pregnancy and the first year postpartum) can pose significant health risks to the mother and child. However, treatments exist to reduce these risks and present a unique opportunity to streamline health services when individuals present for care. Patient navigators identify barriers to care, along with patients, in order to improve understanding of and access to health care systems. This model has been shown to increase coordination of care in chronic diseases (e.g., cancer, diabetes, cardiovascular diseases, kidney diseases, smoking, and HIV/AIDS) for under-resourced populations for whom geography, employment, transportation, income, language, education, and other socioeconomic factors deter health care access. This is a needed gap for patients seeking care in the fragmented substance use disorders treatment landscape (cite evidence on this fragmentation). [Evidence of substance use and patient navigators, generally). Further, it is especially relevant for those navigating the increased health care utilization during the perinatal period. Despite this promising application of this practice to perinatal substance use treatment, little remains known about its efficacy across different treatment settings

Study protocol for the Pharmacist and Homeless Outreach worker Engagement, Non-medical Independent prescribing Rx (PHOENIx) pilot randomised controlled trial

Introduction: The number of people experiencing homelessness (PEH) is increasing worldwide. Systematic reviews show high levels of multimorbidity and mortality. Integrated health and social care outreach interventions may improve outcomes. No previous studies have targeted PEH with recent drug overdose despite high levels of drug-related deaths and few data describe their health/social care problems. Feasibility work suggests a collaborative health and social care intervention (Pharmacist and Homeless Outreach Engagement and Non-medical Independent prescribing Rx, PHOENIx) is potentially beneficial. We describe the methods of a pilot randomised controlled trial (RCT) with parallel process and economic evaluation of PEH with recent overdose. Methods and analysis: Detailed health and social care information will be collected before randomisation to care-as-usual plus visits from a pharmacist and a homeless outreach worker (PHOENIx) for 6–9 months or to care-as-usual. The outcomes are the rates of presentations to emergency department for overdose or other causes and whether to progress to a definitive RCT: recruitment of ≥100 participants within 4 months, ≥60% of patients remaining in the study at 6 and 9 months, ≥60% of patients receiving the intervention, and ≥80% of patients with data collected. The secondary outcomes include health-related quality of life, hospitalisations, treatment uptake and patient-reported measures. Semistructured interviews will explore the future implementation of PHOENIx, the reasons for overdose and protective factors. We will assess the feasibility of conducting a cost-effectiveness analysis. Ethics and dissemination: The study was approved by South East Scotland National Health Service Research Ethics Committee 01. Results will be made available to PEH, the study funders and other researchers