Background

People experiencing homelessness (PEH) live with a high burden of chronic illness, functional and cognitive impairments, and serious mental illness. Many PEH are prescribed complex medication regimens to manage symptoms and improve health and functioning. However, medication use within the context of homelessness is complicated, and adherence is often suboptimal.

Objective

To document medication use within the context of homelessness and explore experiences of medication use among people experiencing homelessness (PEH).

Methods

This study used mixed methods including photo-elicitation interviews. Participants were given a digital camera and asked to take pictures of people, places, things, and situations that represented every day medication use. Participants were also asked to write down reasons for taking the pictures. After two weeks, participants returned the camera and notes. At a subsequent interview, the photographs and notes were reviewed and discussed. Demographic and health-related information was also collected for each participant. An interpretive description approach was used for qualitative data analysis. Quantitative data were analyzed using descriptive statistics in order to describe the sample.

Results

Seven PEH completed this study. Mean age was 45 years (SD = 11.3) and length of homelessness was 6.1 years (SD = 11.3). All reported multiple chronic conditions (≥2) and reported taking 6.6 (SD = 2.6) medications. Participants reported medication adherence barriers with mean score of 37 (SD = 5.5) on the ASK-12, a 12-item scale with a range of 12–60 (higher scores indicate more barriers). Qualitative analysis identified four categories: medication-related burdens, medication-related beliefs, connectedness, and stigmatizing encounters.

Conclusions

Medication use among PEH is complex and cannot be considered separately from daily life or from struggles to meet basic needs. Multi-level interventions are needed to optimize medication use among PEH, and healthcare professionals including community pharmacists should reinforce beliefs that medication-related benefits outweigh the burdens and then tailor services to the context of homelessness.

中文翻译：

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“没有我的药物，我就是一个残骸”：照片启发探索无家可归者的药物使用情况

背景

无家可归者 (PEH) 承受着沉重的慢性疾病、功能和认知障碍以及严重精神疾病的负担。许多 PEH 都被规定了复杂的药物治疗方案，以控制症状并改善健康和功能。然而，在无家可归的情况下使用药物很复杂，而且依从性通常不是最理想的。

客观的

记录无家可归者的药物使用情况，并探索无家可归者 (PEH) 的药物使用经验。

方法

本研究采用混合方法，包括照片启发式访谈。参与者被给予一台数码相机，并被要求拍摄代表每天药物使用的人、地点、事物和情况的照片。参与者还被要求写下拍照的原因。两周后，参与者归还了相机和笔记。在随后的采访中，对照片和笔记进行了审查和讨论。还为每个参与者收集了人口统计和健康相关信息。解释性描述方法用于定性数据分析。使用描述性统计分析定量数据以描述样本。

结果

七个 PEH 完成了这项研究。平均年龄为 45 岁（SD = 11.3），无家可归的时间为 6.1 岁（SD = 11.3）。所有人都报告了多种慢性病 (≥2) 并报告服用 6.6 (SD = 2.6) 种药物。参与者报告了药物依从性障碍，ASK-12 的平均得分为 37（SD = 5.5），这是一个 12 项量表，范围为 12-60（得分越高表示障碍越多）。定性分析确定了四类：与药物相关的负担、与药物相关的信念、关联性和污名化遭遇。

结论

PEH 中的药物使用很复杂，不能与日常生活或满足基本需求的斗争分开考虑。需要多层次的干预来优化 PEH 中的药物使用，包括社区药剂师在内的医疗保健专业人员应强化药物相关益处大于负担的信念，然后根据无家可归者的情况定制服务。