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    Integration of Harm Reduction and General Practice in Out-Reach Settings. Lessons Learned After 6 Years

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    Henrik Thiesen
    This document summarizes lessons learned from six years of integrating harm reduction and general practice in outreach settings for homeless populations in Copenhagen. Key points include: - Homeless patients have high rates of psychiatric comorbidities, chronic diseases, and acute health issues but are often only treated for immediate needs. - A health team was created to provide care wherever patients are, including shelters, hospitals, and on the street. - Ongoing research looks at access to healthcare, substance abuse and harm reduction, health at admission, and more. - Initiatives include alcohol and hepatitis screening, a walk-in inner-city clinic, and developing harm reduction tools like naloxone vaporizers and crack smoking kits.

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    Integration of Harm Reduction and General Practice in Out-Reach Settings. Lessons Learned After 6 Years

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    Henrik Thiesen
    36 views42 pages
    This document summarizes lessons learned from six years of integrating harm reduction and general practice in outreach settings for homeless populations in Copenhagen. Key points include: - Homeless patients have high rates of psychiatric comorbidities, chronic diseases, and acute health issues but are often only treated for immediate needs. - A health team was created to provide care wherever patients are, including shelters, hospitals, and on the street. - Ongoing research looks at access to healthcare, substance abuse and harm reduction, health at admission, and more. - Initiatives include alcohol and hepatitis screening, a walk-in inner-city clinic, and developing harm reduction tools like naloxone vaporizers and crack smoking kits.

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    Description of implementation and results in Health-outreach for vulnerable persons in Copenhagen

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    This document summarizes lessons learned from six years of integrating harm reduction and general practice in outreach settings for homeless populations in Copenhagen. Key points include: - Homeless patients have high rates of psychiatric comorbidities, chronic diseases, and acute health issues but are often only treated for immediate needs. - A health team was created to provide care wherever patients are, including shelters, hospitals, and on the street. - Ongoing research looks at access to healthcare, substance abuse and harm reduction, health at admission, and more. - Initiatives include alcohol and hepatitis screening, a walk-in inner-city clinic, and developing harm reduction tools like naloxone vaporizers and crack smoking kits.

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    Download as PPSX or read online from Scribd
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    36 views42 pages

    Integration of Harm Reduction and General Practice in Out-Reach Settings. Lessons Learned After 6 Years

    Uploaded by

    Henrik Thiesen
    This document summarizes lessons learned from six years of integrating harm reduction and general practice in outreach settings for homeless populations in Copenhagen. Key points include: - Homeless patients have high rates of psychiatric comorbidities, chronic diseases, and acute health issues but are often only treated for immediate needs. - A health team was created to provide care wherever patients are, including shelters, hospitals, and on the street. - Ongoing research looks at access to healthcare, substance abuse and harm reduction, health at admission, and more. - Initiatives include alcohol and hepatitis screening, a walk-in inner-city clinic, and developing harm reduction tools like naloxone vaporizers and crack smoking kits.

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    of 42

    Integration of

    Harm Reduction and General Practice inOutReach Settings


    - lessons learned after 6 years.

    17th Nordic Congress of General Practice Troms, 14- 17. June 2011 Henrik Thiesen

    Copenhagen & the resundsregion


    > 500.000 inh. in central Copenhagen > 1 million incl. suburbs resund-region 3-4 million

    Helsing Helsingbo r rg Hillerd Kbenhav Lund n Malm

    Roskild e

    Conclusion from outreach project 2000-2004ofled to Very high number opening ofdiseases Chronic somatic HealtTeam Addiction in may 2005

    Psychiatric comobidity and chronic diseases

    Patients mostly treated for acute diseases in health-system

    HealthTeam
    where they are

    caring for people


    Specialist Rehabilitation Hospital ward

    Patient

    Re-visit Problem

    GP m-

    Proble solving

    Physiotherapist Hospital ward Another specialist

    HealthTeam
    where they are

    caring for people

    Specialist Homeless patient

    GP

    Rehabilitation Emergency ward Emergency ward

    HealthTeam
    where they are

    caring for people

    Proble Patient Out-reach msolving !

    Health Team Social outreach

    Rehabilitatio Welfare n Specialist Housing Hospitalneeds Special ward

    AOD Out-patient clinic treatment

    Demographics
    832 patients since october 2005 + 370 in vaccination and hepatitis programme 300-350 individual patients treatet in a year ~150 new patients per year ~150-200 from earlier years

    Age-distribution

    10 9 8 7 6 5 4 3 2 1 0

    43 different nationalities
    10 9 8 7 6 5 4 3 2 1 0

    91% from Denmark and surrounding countries


    10 9 8 7 6 5 4 3 2 1 0

    Risk of being Greenlandic and homeless in need of healthservice in Copenhagen 2005- nov. 2010
    % of as Greenlanders livingtotal Nationality No. population homeless in Copenhagen are 36 times more Danish 360 0,0069 common than Danes in proportion to population Greenlandic size !!.. 0,2520 126

    The network-based GP

    Health Team

    Classification of Street homeless homelessness


    Night shelter Couch-surfers

    Room in shelter

    Disease-groups at admission

    On-going research in homeless-health


    Access to health-services Quality management in out-reach work Substance abuse & harm-reduction Health at admission

    Harmreduction directed at severe alcohol-misuse among homeless men

    Alcohol-screen and biomarkers

    Alcohol screen and biomarkers


    (-GT and CDT (Carbohydrate Deficient Ferritin)

    Addict Behav. 2010 Mar;35(3):260-2. Epub 2009 Oct 30.

    Access to healthcare and definitions of homelessness

    Homeless in Europe, 2011 ; vol1., 7-10,

    tp://www.feantsa.org/files/freshstart/Communications/Homeless%20in%20Europe%20EN/PDF_2011/Homeless_in_Europe_Spring_2011.pdf

    Screening for biomarkers


    336 of 832 screened

    Hematology

    Hepatology

    Diabetes (HbA1c)

    Vitamin D

    Biomarkers

    Vitamin D in 214

    homeless preliminary results 85% below 50 nmol/l =


    insufficiency 60% below 25 nmol/l = deficiency 28% below 12 nmol/l = severe deficiency
    10 9 8 7 6 5 4 3 2 1 0

    Biomarkers

    Vitamin D in 230 socially vulnerable 50 nmol/l = for hepatitis screened 70% below in september 2011 preliminary results insufficiency
    44% below 25 nmol/l = deficiency 9% below 12 nmol/l = severe deficiency

    10 9 8 7 6 5 4 3 2 1 0

    Hepatitis C among 345 tested


    Negative Positive

    81% 19%

    General population 0.0046%

    Among hepatitis C positive Admits injecting 30% Denies injecting 54% (!) Do not remember 16%

    ADHD - survey among homeless in Copenhagen


    in collaboration with Centre for Alcohol and Drug Research

    Preliminary data from the survey


    June 2011 67 patients tested at admission

    Evaluated by nurse Screened with the Adult Self Report Scale (ASRS) v. 1.1

    Preliminary data from the survey


    Imprisonment and ADHD

    No. Positive ASRS and been to prison Negative ASRS and been to prison

    % of all ASRS pos.

    % of all ASRS neg.

    16 10

    53 27

    (preliminary) Conclusions
    Imprisonment is occuring twice as often among ADHD patients Of those who has been imprisoned the average score on general function in prison compared to outside is 3 = better functioning inside prison.
    (5 point scale)

    27% indicates much better functioning inside


    prison

    Inner-city clinic
    walk in GP-practice - in close relation to open drug scene

    Inner-city clinic
    Opened january 2009 as part of national project 30-40 daily consultations 120 individual patients per week >600 longer courses of treatment

    Inner-city clinic
    5 nurses 1 GP (part-time, on call full time) 1 foot therapist 1 social case-manager

    Inner-city clinic
    Most seen problems Addiction related problems including all drugs and alcohol Organic psychoses and personality disturbances Schizophrenic spectrum disorders / chronic psychotic disorders

    Harm Reduction User-involvement in overdose prevention from inner city

    Naloxone in vaporizer

    User-training

    Number of overdosedeaths prevented per Number of overdose-deaths Project user in 6 prevented per user sites
    Berlin Jersey Chicago 0,08 / person / month 0,003 / person / month Uvist 36000 doses delivered. 319 persons saved 0,03 / person / month 0,013 / person / month

    Los Angeles Boston

    Copenhagen

    0,019 / person / month

    Development of crack-smoking kit

    Report in Danish: http://www.hjemlosesundhed.dk/downloads/Crackkokain_fuld.pdf

    In the pipeline.
    Use of health-services among 500 homeless 2004-2011 Use of health services before and after admission to nursing home for active alcohol misusers Analysis of database of biomarkers

    Thank you!

    Henrik Thiesen Mail: alkodoktor@dadlnet.dk Web: www.hjemlosesundhed.dk

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