Pharmacist and Homeless Outreach Engagement and Non-medical Independent prescribing Rx (PHOENIx): a study protocol for a pilot randomised controlled trial

Richard Lowrie*, Andrew McPherson*, Frances Mair*, Donogh Maguire*, Dr Vibhu Paudyal*, Becky Blair*, David Brannan*, Jane Moir*, Fiona Hughes *, Clare Duncan *, Kate Stock*, Natalia Farmer*, Rebekah Ramage *, Cian Lombard *, Steven Ross*, Ailsa Scott*, George Provan *, Laura Sills *, Jenni Hislop*, Frank Reilly*Andrea E. Williamson

*Corresponding author for this work

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Abstract

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.
Original languageEnglish
Article numbere064792
JournalBMJ Open
Volume12
Issue number12
DOIs
Publication statusPublished - 16 Dec 2022

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