-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
1/42
Integration ofHarm Reduction andGeneral Practice in Out-Reach
Settings- lessons learned after 6 years.
17th Nordic Congress of General Practice
Troms, 14- 17. June 2011
Henrik Thiesen
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
2/42
Copenhagen & theresundsregion
> 500.000 inh. in central Copenhagen
> 1 million incl. suburbs
resund-region 3-4 million
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
3/42
Hillerd
Helsing
r
Helsingbo
rg
Malm
LundKbenhavnRoskild
e
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
4/42
Conclusion from
outreach project2000-2004 led to
opening of HealtTeamin may 2005
Very high number of Chronic somatic diseases Addiction
Psychiatric comobidity and chronic diseases
Patients mostly treated for acute diseasesin health-system
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
5/42
Patient GP
Specialist
Physiotherapist
Rehabilitation
Hospital ward
Hospital ward
Another specialist
ProblemRe-visit
Proble
m-solving
HealthTeam caring for peoplewhere they are
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
6/42
Homelesspatient
GP
Specialist
Rehabilitation
Emergencyward
Emergencyward
HealthTeam caring for peoplewhere they are
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
7/42
Patient
HealthTeamOut-reach
Social out-reach
Housing
Special needs
Welfare
AOD
treatment
Specialist
Rehabilitatio
n
Hospital ward
Out-patient clini
Problem-solving
!
HealthTeam caring for peoplewhere they are
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
8/42
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
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
9/42
Age-distribution
01
234567
89
10
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
10/42
43 differentnationalities
0
1
2
3
4
5
6
7
8
9
10
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
11/42
91% from Denmarkand surroundingcountries
01
2
3
4
5
6
7
8
9
10
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
12/42
Risk of being Greenlandic andhomeless in need of
healthservice in Copenhagen2005- nov. 2010
Nationality No.% of totalpopulation
Danish 360 0,0069
Greenlandic 126 0,2520
Greenlanders living as
homeless in Copenhagenare 36 times more
common than Danes in
proportion to populationsize !!..
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
13/42
The network-based GP
HealthTeam
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
14/42
Classification ofhomelessnessStreet homelessNight shelter
Room in shelter
Couch-surfers
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
15/42
Disease-groups at
admission
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
16/42
On-going research in
homeless-healthAccess to health-services
Quality management in out-reach work
Substance abuse & harm-reduction
Health at admission
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
17/42
Harmreduction
directed at severealcohol-misuse among
homeless men
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
18/42
Alcohol-screen and
biomarkers
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
19/42
Alcohol screen and
biomarkers(-GT and CDT (Carbohydrate DeficientFerritin)
Addict Behav. 2010 Mar;35(3):260-2. Epub 2009 Oct30.
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
20/42
Access to healthcareand definitions ofhomelessness
omeless in Europe, 2011 ; vol1.,
7-10,p://www.feantsa.org/files/freshstart/Communications/Homeless%20in%20Europe%20EN/PDF_2011/Homeless_in_Europe_Spring_2011.pdf
i f
http://www.feantsa.org/files/freshstart/Communications/Homeless%20in%20Europe%20EN/PDF_2011/Homeless_in_Europe_Spring_2011.pdfhttp://www.feantsa.org/files/freshstart/Communications/Homeless%20in%20Europe%20EN/PDF_2011/Homeless_in_Europe_Spring_2011.pdf
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
21/42
Screening forbiomarkers336 of 832 screened
Hematology
Hepatology
Diabetes (HbA1c)
Vitamin D
i k
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
22/42
Biomarkers Vitamin D in 214homelesspreliminary results
0
1
2
3
4
5
6
7
8
9
10
85% below 50 nmol/l =insufficiency
60% below 25 nmol/l = deficiency
28% below 12 nmol/l = severe
deficiency
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
23/42
Biomarkers Vitamin D in 230socially vulnerable screened for
hepatitis
in september 2011preliminary results
01
2
3
4
5
6
7
8
9
10
70% below 50 nmol/l =
insufficiency44% below 25 nmol/l = deficiency
9% below 12 nmol/l = severedeficiency
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
24/42
Hepatitis C among 345
testedNegative 81%
Positive 19% General population 0.0046%
Among hepatitis C positiveAdmits injecting 30%
Denies injecting 54% (!)
Do not remember 16%
ADHD
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
25/42
ADHD - surveyamong homeless in
Copenhagenin collaboration with Centre for Alcoholand Drug
Research
P li i d t f
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
26/42
June 2011
67 patients tested at admission Evaluated by nurse
Screened with the Adult Self Report Scale
(ASRS) v. 1.1
Preliminary data fromthe survey
P li i d t f
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
27/42
Preliminary data fromthe survey
Imprisonment and ADHD
No.% of all
ASRS pos.% of all
ASRS neg.
Positive ASRSand been toprison 16 53
Negative ASRSand been toprison 10 27
( li i )
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
28/42
(preliminary)Conclusions
Imprisonment is occuring twice as often amongADHD patients
Of those who has been imprisoned the averagescore on general
function in prison compared tooutside is
3= better functioning inside prison.(5 point scale)
27% indicates much betterfunctioning insideprison
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
29/42
Inner-city clinicwalk in GP-practice- in close relation toopen
drug scene
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
30/42
Inner-city clinic
Opened january 2009 as part of nationalproject
30-40 daily consultations
120 individual patients per week
>600 longer courses of treatment
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
31/42
Inner-city clinic
5 nurses
1 GP (part-time, on call full time)
1 foot therapist
1 social case-manager
I it li i
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
32/42
Inner-city clinicMost seen problems
Addiction related problems including alldrugs and alcohol
Organic psychoses and personalitydisturbances
Schizophrenic spectrum disorders / chronicpsychotic
disorders
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
33/42
Harm Reduction
User-involvement in
overdose preventionfrom inner city
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
34/42
Naloxone in vaporizer
U t i i
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
35/42
User-training
N b f d
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
36/42
Number of overdose-deaths prevented per
user in 6 sitesProject Number of overdose-deathsprevented per
userBerlin 0,08 / person / month
ersey 0,003 / person / monthChicago Uvist
36000 doses delivered.319 persons saved
Los Angeles 0,03 / person / month
Boston 0,013 / person / month
Copenhagen 0,019 / person / month
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
37/42
Development ofcrack-smoking kit
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
38/42
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
39/42
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
40/42
Report in
Danish:http://www.hjemlosesundhed.dk/downloads/Crackkokain_fuld.pdf
In the pipeline
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
41/42
In the pipeline.
Use of health-services among 500 homeless2004-2011
Use of health services before and afteradmission to nursing home
for active alcoholmisusers
Analysis of database of biomarkers
-
8/6/2019 Integration of Harm Reduction and General Practice in
Out-Reach Settings. Lessons Learned After 6 Years
42/42
Thank you!
Henrik Thiesen
Mail: [email protected]
Web: www.hjemlosesundhed.dk
mailto:[email protected]://www.hjemlosesundhed.dk/http://www.hjemlosesundhed.dk/mailto:[email protected]
