Abstract
Objectives
Persons with lived experience of homelessness face many challenges in managing their
diabetes, including purchasing and storing medications, procuring healthy food and
accessing health-care services. Not only do these individuals have challenges in accessing
primary care, they are also seen by diabetes specialists (endocrinologists, diabetes
educators, foot- and eye-care specialists) less frequently.
Methods
We conducted a qualitative descriptive study using open-ended interviews of 96 health
and social care providers across 5 Canadian cities (Calgary, Edmonton, Ottawa, Vancouver,
Toronto). We used NVivo qualitative software to facilitate thematic analysis of the
data, focussing on homelessness-related patient barriers to diabetes specialty care.
Results
Barriers identified included patients’ competing priorities and previous negative
experiences with specialists, long wait times from referral to appointment, difficulty
in contacting patients, and location of the clinics. Primary care providers were confident
in managing diabetes in most patients and believed that patients were best served
under their care. Other barriers included specialists’ limited understanding of patients’
complex social situations and medication coverage as well as out-of-pocket costs associated
with some specialist care. Recommendations for improving access to diabetes specialty
care for these medically and socially complex patients included holding diabetes specialty
clinics at community health centres, providing physician-to-physician direct referrals,
and selecting specialists with an interest in health of the homeless population.
Conclusions
Barriers to diabetes specialty care for persons with lived experience of homelessness
are due largely to the physical and social environment of the clinics. Innovative
solutions may be implemented to address these challenges and improve access for this
population.
Résumé
Objectifs
Les personnes qui ont une expérience concrète de l’itinérance sont confrontées à plusieurs
difficultés dans la prise en charge de leur diabète, notamment en ce qui concerne
l’achat et la conservation des médicaments, l’approvisionnement en aliments sains
et l’accès aux services de soins de santé. En particulier, ils sont moins fréquemment
vus par les spécialistes du diabète (endocrinologues, éducateurs spécialisés en diabète,
spécialistes des pieds et des yeux).
Méthodes
Nous avons réalisé une étude descriptive qualitative par des entretiens non directifs
auprès de 96 prestataires de soins en santé et de services sociaux de 5 villes canadiennes
(Calgary, Edmonton, Ottawa, Vancouver, Toronto). Nous avons utilisé le logiciel d’analyse
qualitative NVivo pour faciliter l’analyse thématique des données, qui porte sur les
obstacles liés à l’itinérance auxquels sont confrontés les patients pour accéder aux
soins spécialisés en diabète.
Résultats
Les obstacles relevés s’articulaient autour des priorités concurrentes des patients
et des expériences négatives antérieures avec les spécialistes, les longs délais d’attente
entre l’aiguillage et le rendez-vous, la difficulté d’entrer en contact avec les patients
et l’emplacement des cliniques. Les prestataires de soins primaires avaient confiance
dans la prise en charge de la plupart des patients avec diabète qui, selon eux, étaient
mieux servis sous leur aile. Parmi les autres obstacles figurent la compréhension
limitée qu’ont les spécialistes sur les situations sociales complexes des patients,
la couverture des médicaments et les frais non remboursés de certains soins spécialisés.
Les recommandations sur l’amélioration de l’accès aux soins spécialisés en diabète
de ces patients aux besoins médicaux et sociaux complexes étaient les suivantes :
la tenue de cliniques spécialisées en diabète dans des centres de santé communautaire,
l’offre d’aiguillage d’un médecin à un autre médecin et la sélection des spécialistes
qui montrent un intérêt en matière de santé de la population en situation d’itinérance.
Conclusions
Les obstacles aux soins spécialisés en diabète des personnes en situation d’itinérance
sont dus en grande partie à l’environnement physique et social des cliniques. Des
solutions novatrices peuvent être mises en œuvre pour surmonter ces difficultés et
améliorer l’accès aux soins de cette population.
Keywords
Mots clés
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Article Info
Publication History
Published online: May 24, 2022
Accepted:
May 19,
2022
Received in revised form:
April 25,
2022
Received:
November 15,
2021
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Canadian Diabetes Association.
