Pharmacist and Homeless Outreach Engagement and Non-medical Independent prescribing Rx (PHOENIx) Trial - Process Evaluation

Context: People experiencing homelessness (PEH) have complex health and social care needs and most die in their early 40s. PEH frequently use community pharmacies; however, evaluation of the delivery of a structured, integrated, holistic health and social care intervention has not been previously undertaken in community pharmacies for PEH. PHOENIx (Pharmacy Homeless Outreach Engagement Non-medical Independent prescribing Rx) has been delivered and tested in Glasgow, Scotland and Birmingham, England, by NHS pharmacist independent prescribers and third sector homelessness support workers as a pilot randomised controlled trial.

Objectives: To explore acceptability and future implementation potential of the PHOENIx intervention.

Study Design and Analysis: Qualitative process evaluation involving semi-structured interviews with three participant groups: intervention (N=13), control (N=7), and key stakeholders (N=10). Normalisation Process Theory (NPT) is used as the conceptual lens through which to analyse the data.

Outcome measures: Acceptability and barriers and facilitators to future implementation.

Results: Participants discussed the importance of receiving healthcare support. Key Stakeholders perceived the intervention as reducing non-fatal overdose, admission to the emergency room, and helping participants to liaise with addiction services and were positive about the potential benefits of the PHOENIx approach to tackle the issues that PEH are faced with, particularly their complex, unmet needs. Financial resource constraints were perceived as a potential barrier to wider implementation. Both PEH (those receiving the intervention and controls) and stakeholders thought the intervention acceptable. PEH, who were receiving the intervention, liked the ease with which they could now access a health professional. Trial participants described the benefits of having one single point of contact (i.e. community hub) where they can assess support related to homelessness, housing and social care. Some PEH mentioned mental health as an unmet need, and several interviewees were open to accessing such services if available.

Conclusions: Overall, the PHOENIx intervention was viewed positively by both PEH and key stakeholders and our findings would support progression to a full scale, randomised controlled trial.