Principles of better care for homeless identified
Homeless people face many barriers to health care and in order to help overcome these barriers, some principles of best practice are described in this week's Journal of the Royal Society of Medicine.
The main health issue among homeless people is drug dependence, say Nat
Wright, centre for research in primary care, Nuffield Institute, Leeds,
and colleagues. The aim of harm reduction treatment should be to stabilise
health and social functioning of drug users. One way to achieve this
is through a substitute prescription. However, it is important to avoid
concomitant use of opioids and benzodiazepines, which can lead to an
increase in drug-related deaths, and to avoid prescribing methadone in
tablet or injectable form in primary care.
Two roles for pharmacists are identified. First, supervision of the consumption
of methadone and of buprenorphine tablets, which should be crushed before
consumption, the authors suggest. In addition, hospital pharmacists should
work with community pharmacists to ensure that drug misusers receive
sufficient substitute medication to last until the next appointment with
their GP.
Alcohol dependence is also common among homeless people. The drug of
choice to manage withdrawal is chlordiazepoxide, not clomethiazole (Heminevrin)
which is more toxic in overdose and has a greater potential for addiction,
the authors say. A course of substitute vitamins is also needed.
Practical suggestions for health promotion to the homeless population
include offering hepatitis B immunisation to drug injectors, encouraging
use of needle exchange programmes and being aware of heroin-related overdose.
This includes giving advice on loss of tolerance after abstinence.
The authors say that there has been much debate over whether primary
care services for homeless people are better delivered through specialised
or mainstream practices. They conclude that specialised practices are
only feasible in large urban areas and that a resettlement worker is
needed to reintroduce the person into a mainstream practice once they
have been stabilised (2004;97:170).
A specialised practice approach has been taken in Glasgow where, this
week, a new health and social care centre for homeless people was launched.
The Hunter Street centre is staffed by 62 health and social work professionals
but no pharmacists. |
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