Prescribing in the homeless population

Last month, the research roundup provided you with an overview of articles looking at concerning deprescribing (Robertson, 2022). This month, we will review articles looking at prescribing in the homeless population. The first article looks at prescription data from specialist homelessness general practices. The second article looks at opioid replacement therapy in a homeless population, while the final paper reviews a pharmacist outreach and non-medical prescribing service for homeless people.

This article, published in the International Journal of Clinical Pharmacy aimed to investigate the prescribing of medicines to homeless persons who present to specialist homelessness primary care practices and compares the data with the general population (Khan et al, 2022). The research team collected information from prescribing datasets over 12 months between April 2019 and March 2020. The data of interest was the prescription of medications from 20 pre-selected British National Formulary paragraphs which related to the most commonly prescribed medications in England to the general population. The data from specialist homeless persons' general practices covered 15 practices across England from city areas. This was a broad spread across counties, but five were in London. The data extracted was then compared with the general population during the same time and also with the most deprived and least deprived populations in England. The main outcome measure reported was the number of medicines prescribed per 1000 people in key disease areas. These included drugs prescribed across a range of mental health conditions including substance dependence, drugs in gastrointestinal conditions, respiratory and cardiovascular conditions and diseases of the endocrine system. The analysis consisted of prescriptions for 20 572 people. The results revealed a significantly higher prescribing of drugs in opioid dependence compared to the general population with around 1297 items per 1000 people in the homeless practices and 15.7 in the general population. A marked increase was also seen in drugs for psychosis in the homeless population. This difference was even more marked when compared to the population from the least deprived areas of England. Conversely, prescribing for some other long-term conditions, especially of the cardiovascular system and thyroid hormones, was markedly lower in the homeless population. The authors conclude that most prescribing activities in the homeless population relate to mental health conditions and substance misuse. They acknowledge that other long-term conditions that overlap with homelessness may be underdiagnosed and under-managed. Finally, they suggest that the wide variations in data across practices need further investigation.