Student-led interprofessional health checks for the homeless-a pilot service evaluation

Abstract

General and oral health are key indicators of wellbeing and can be compromised in hard-to-reach patient groups such as the homeless. This results in poorer health outcomes, widening inequalities and leads to raised social and economic costs. Student-led health checks have been shown to be welcomed by hard-toreach patients and to provide more accessible environments 1. An interprofessional student-led health check service was piloted in Portsmouth, South of England, providing general and oral health checks to the homeless community, with support from the local council. The aim of this study was to evaluate the pilot service, including its facilitation of ongoing access to healthcare, and to explore the experiences of the service users. Ten final year pharmacy students from the University of Portsmouth and ten final year dental students from King's College, London, collaboratively provided health checks over five days at various locations in Portsmouth, supervised by at least one pharmacy and one dental educator who were suitably registered professionals. Locations included two centres providing services for the homeless and an outreach vehicle located in a city centre car park and a church grounds. Health checks included a dental screen and cardiovascular risk assessment (QRISK2), and involved referral and lifestyle advice where appropriate. Each check was led by one pharmacy and one dental student. Service users self-referred to the service, which was advertised by local organisations providing support to the homeless community. All service users were invited to share their experiences of the health checks during interviews after the event; the interview transcripts were then subjected to thematic analysis. The study received NHS HRA approval and ethical approval from the University of Portsmouth Science Faculty Ethics Committee. Twenty patients aged 19-59 (median 39.5 years) participated in the health checks. Cardiovascular risk assessment identified 75% (n = 15) at low risk of a cardiovascular event in the next 10 years. Dental screening identified all as requiring at least routine preventative dental care, with 35% (n = 7) requiring urgent treatment. All service users were provided with lifestyle advice and referred for a dental appointment, 3 were registered with a general practitioner (GP), and 9 were referred for follow-up assessment or treatment with their existing GP. Interview data analysis identified two main themes: drivers for maintaining health, which included wanting to participate in health maintaining activities such as exercise and visiting the dentist, and drivers for the health check service which included being seen as a good thing, cost free and supporting students in their learning. Indicators of oral and general health examined within the checks suggested a picture in line with the general population. Drivers for maintaining health were important to the participants, who perceived themselves as healthy, and included wanting to maintain their health. The inter-professional student-led checks were viewed as a good service that was valuable for being free of charge and providing an educational opportunity, as well as facilitating ongoing access to healthcare. This study has shown that student-led health checks are welcomed and beneficial to hard-to-reach patients.