Engaging People Who Use Drugs in Tayside Into Care to Decrease Risk of Drug-Related Mortality and Improve Health Outcomes; The ‘Cocoon’ Service Evaluation Project

Author: Farsana Ahmad John Dillon Jenna Qumsieh Christian Sharkey Brian Stephens

Theme: Clinical Research Year: 2022

Scotland has one of the highest drug-related mortality rates in Europe. NHS Tayside has an estimated 2,800 people who use drugs (PWUD), with the second-highest drug related mortality rate in Scotland, having increased by 22%, from 2017-2019. Appreciating PWUD in Scotland are an ageing cohort with multiple co-morbidities, particularly cardio-respiratory illness, the Scottish government was keen to support efforts addressing unmet needs.
Cocoon is a ‘one-stop’ holistic care bundle, facilitated by nurses at a community level, to engage with the high risk injecting population, offering three visits, over a 12 month period, incorporating electro-cardiogram (ECG), liver fibroscan and micro-spirometry, respectively. Venous bloods; BBV screening and fib-4 score are obtained, whilst sexual-health screening is offered. Whilst awaiting results of a HCV PCR processed via ‘point of care’, staff can suitably deliver harm reduction initiatives; such as supply of naloxone, provide wound review and offer uptake of covid vaccination. Baseline measurements for pulse-oximetry and blood pressure are also recorded, as is body mass index (BMI). An ‘assessment of injecting risk’ (AIR) questionnaire tool is obtained to determine illicit trends and injecting habits.
In the initial eight months, 134 participants were recruited; 97 male (72.4%). The project identified a prevalence of 105, (78%) participants HCV antibody positive, with 12 (8.9%) returned bearing active HCV infections, of which 11 patients successfully commenced HCV treatment. Six participants have died since engaged on the project. The project facilitated screening of self-reported mental wellbeing utilizing the Warwick/ Edinburgh Mental Wellbeing Scale, (WEMWEBS), where 75 (56%) individuals identified bearing low mood, were advised to seek review from their general practitioner and were prescribed antidepressants.
The key goal of the Cocoon project is to understand what this new care package achieves with respect to reducing drug related deaths, (DRD) and improving health outcomes for PWUD locally.
Disclosure of Interest Statement:
FA, JQ, CS, declare no conflict of interest.
BPS, has honoraria for lectures from Janssen-Cilag, Merck Sharp & Dohme and Gilead Sciences.
JFD has honoraria for lectures and research grants from Janssen-Cilag, Roche, Merck Sharp &
Dohme, AbbVie, Bristol-Myers Squibb, & Gilead.

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