What is the treatment burden for people experiencing homelessness with a recent non-fatal overdose?

Abstract

Background: People experiencing homelessness (PEH) who also have problem drug use, have complex medical/social needs, with barriers to accessing services and treatments. Their treatment burden ( workload of self-management and impact on well-being) remains unexplored. Aim: This study uses a validated questionnaire, the Patient Experience with Treatment and Self-management (PETS), to investigate treatment burden in PEH with a recent non-fatal overdose. Design and Setting: PETS questionnaire collected as part of a pilot Randomised Control Trial (RCT) undertaken in Glasgow, Scotland, the main outcome is whether this pilot RCT should progress to a definitive RCT. Methods: An adapted 52-item, 12-domain PETS used to measure treatment burden of treatment. Greater treatment burden indicated by higher PETS scores. Results: Of 128 participants, 123 completed PETS; mean age=42.1 (SD=8.6); 71.5 % male, and 99.2% white ethnicity. Most (91.2%) had >5 chronic conditions with an average of 8.5 conditions. Mean PETS scores were highest in domains focusing on the impact of self-management on well-being: physical/mental exhaustion (Mean=79.5, SD=3.2); and role-social activity limitations (Mean=64, SD=3.4). Scores were higher than those observed in studies of non-homeless patients. Conclusions: In a socially marginalised patient group at high risk of drug overdose, the PETS showed a very high level of treatment burden and highlights the profound impact of self-management work on well-being and daily activities. Treatment burden is an important person-centered outcome to help compare the effectiveness of interventions in PEH and merits inclusion in future trials as an outcome measure.