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Accessing Diabetes Specialty Care for Persons With Lived Experience of Homelessness in Canada: Challenges and Opportunities

  • Breanna McSweeney
    Affiliations
    Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • Rachel B. Campbell
    Affiliations
    Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • Eshleen K. Grewal
    Affiliations
    Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • Gillian L. Booth
    Affiliations
    Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
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  • Hamna Tariq
    Affiliations
    Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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  • David J.T. Campbell
    Correspondence
    Address for correspondence: David J.T. Campbell MD, PhD, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, CWPH Building 3E33, Calgary, Alberta T2N 4N1, Canada.
    Affiliations
    Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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      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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