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

Richard Lowrie; Andrew McPherson; Frances S Mair; Kate Stock; Donogh Maguire; Vibhu Paudyal; Clare Duncan; Rebecca Blair; Cian Lombard; Steven Ross; Fiona Hughes; Jane Moir; Ailsa Scott; Frank Reilly; Laura Sills; Jennifer Hislop; Stephen Wishart; David Brannan; James Roy Robertson; Rebekah Ramage; Alison Boyle; Nicola Greenlaw; Andrea E Williamson

doi:10.1136/bmjph-2023-000219

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

Richard Lowrie, Andrew McPherson, Frances S Mair, Kate Stock, Donogh Maguire, Vibhu Paudyal, Clare Duncan, Rebecca Blair, Cian Lombard, Steven Ross, Fiona Hughes, Jane Moir, Ailsa Scott, Frank Reilly, Laura Sills, Jennifer Hislop, Stephen Wishart, David Brannan, James Roy Robertson, Rebekah RamageAlison Boyle, Nicola Greenlaw, Andrea E Williamson

Social Work

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Trial registration number ISRCTN10585019.

Original language	English
Article number	000219
Number of pages	14
Journal	BMJ Public Health
Volume	2
Issue number	1
DOIs	https://doi.org/10.1136/bmjph-2023-000219
Publication status	Published - 13 Mar 2024

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

non-fatal overdose
homelessness
pharmacists
mental health

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Lowrie, R., McPherson, A., Mair, F. S., Stock, K., Maguire, D., Paudyal, V., Duncan, C., Blair, R., Lombard, C., Ross, S., Hughes, F., Moir, J., Scott, A., Reilly, F., Sills, L., Hislop, J., Wishart, S., Brannan, D., Robertson, J. R., ... Williamson, A. E. (2024). 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. BMJ Public Health, 2(1), Article 000219. https://doi.org/10.1136/bmjph-2023-000219

Lowrie, Richard ; McPherson, Andrew ; Mair, Frances S et al. / 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. In: BMJ Public Health. 2024 ; Vol. 2, No. 1.

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title = "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",

abstract = "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. Trial registration number ISRCTN10585019.",

keywords = "non-fatal overdose, homelessness, pharmacists, mental health",

author = "Richard Lowrie and Andrew McPherson and Mair, \{Frances S\} and Kate Stock and Donogh Maguire and Vibhu Paudyal and Clare Duncan and Rebecca Blair and Cian Lombard and Steven Ross and Fiona Hughes and Jane Moir and Ailsa Scott and Frank Reilly and Laura Sills and Jennifer Hislop and Stephen Wishart and David Brannan and Robertson, \{James Roy\} and Rebekah Ramage and Alison Boyle and Nicola Greenlaw and Williamson, \{Andrea E\}",

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Lowrie, R, McPherson, A, Mair, FS, Stock, K, Maguire, D, Paudyal, V, Duncan, C, Blair, R, Lombard, C, Ross, S, Hughes, F, Moir, J, Scott, A, Reilly, F, Sills, L, Hislop, J, Wishart, S, Brannan, D, Robertson, JR, Ramage, R, Boyle, A, Greenlaw, N & Williamson, AE 2024, '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', BMJ Public Health, vol. 2, no. 1, 000219. https://doi.org/10.1136/bmjph-2023-000219

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. / Lowrie, Richard; McPherson, Andrew; Mair, Frances S et al.
In: BMJ Public Health, Vol. 2, No. 1, 000219, 13.03.2024.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Holistic health and social care outreach for people experiencing homelessness with recent non-fatal overdose in Glasgow, Scotland

T2 - the Pharmacist and third sector Homeless charity worker Outreach Engagement Non-medical Independent prescriber Rx (PHOENIx) pilot randomised controlled trial

AU - Lowrie, Richard

AU - McPherson, Andrew

AU - Mair, Frances S

AU - Stock, Kate

AU - Maguire, Donogh

AU - Paudyal, Vibhu

AU - Duncan, Clare

AU - Blair, Rebecca

AU - Lombard, Cian

AU - Ross, Steven

AU - Hughes, Fiona

AU - Moir, Jane

AU - Scott, Ailsa

AU - Reilly, Frank

AU - Sills, Laura

AU - Hislop, Jennifer

AU - Wishart, Stephen

AU - Brannan, David

AU - Robertson, James Roy

AU - Ramage, Rebekah

AU - Boyle, Alison

AU - Greenlaw, Nicola

AU - Williamson, Andrea E

PY - 2024/3/13

Y1 - 2024/3/13

N2 - 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. Trial registration number ISRCTN10585019.

AB - 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. Trial registration number ISRCTN10585019.

KW - non-fatal overdose

KW - homelessness

KW - pharmacists

KW - mental health

U2 - 10.1136/bmjph-2023-000219

DO - 10.1136/bmjph-2023-000219

M3 - Article

SN - 2753-4294

VL - 2

JO - BMJ Public Health

JF - BMJ Public Health

IS - 1

M1 - 000219

ER -

Lowrie R, McPherson A, Mair FS, Stock K, Maguire D, Paudyal V et al. 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. BMJ Public Health. 2024 Mar 13;2(1):000219. doi: 10.1136/bmjph-2023-000219