Identifying Challenges and Solutions to Providing Diabetes Care for Those Experiencing Homelessness

Abstract

Introduction: Health care providers face a multitude of challenges in providing care to patients with diabetes who are experiencing homelessness. Considering the unique circumstance faced by this population, mainstream services must be adapted and tailored to meet patients’ needs. The objective of this study was to explore both the barriers faced by providers and programs in offering comprehensive diabetes care to these patients, and their suggested areas for improvement. Methods: We conducted semi-structured interviews with providers who care for patients who have diabetes and/or who experience homelessness. Participants included primary care providers, specialist physicians, dietitians, shelter staff, outreach workers, and diabetes educators in five Canadian centres (n=96). Responses were analyzed using qualitative thematic analysis. Results: Barriers most frequently cited by providers were a lack of resources for staff. Other challenges included policy barriers (restrictions on billing codes, care professionals’ scope of practice, and the structure of financial support for this population), duplication of services, and alternative priorities of care. Participants identified several strategies to improve care, which targeted the following spheres: location of service provision and coordination of care, policy changes, and extending funding and resources for staff, such as augmented funding to hire allied health professionals in outpatient settings and increasing outreach capabilities. Conclusion: Programs that strive to address the unique needs of clients experiencing homelessness face numerous challenges. Unique potential solutions to these barriers, such as service provision in a convenient location involving social and health services, incorporating allied health care providers in care to a greater extent, and updating policies to reflect the social complexity of the population can improve diabetes care.

Homeless but not hopeless: overcoming the challenges of managing diabetes in people with lived experience of homelessness

“…Consider outreach clinics to minimise travel for PWLEH or even the possibility of providing in-shelter care. 29,31,32 In the UK, there are currently 123 specialist primary care services for PWLEH, ranging from services delivered within a GP practice to outreach clinics at hostels or day centres. 33 Point-of-care screening tools in primary care reduce the travel burden of accessing diabetes care.…”

Outcomes of a Pilot Outreach Program to Support Point-of-Care Screening in Individuals with Diabetes who are Experiencing Homelessness in Alberta, Canada

“…(2,3) Higher mortality rates and poorer diabetes-related outcomes in this population, compared to those who are securely housed, have been well documented in the literature. (4)(5)(6)(7)(8)(9)(10)(11) One of the contributors to these disparities is the fact that those who experience homelessness are known to be one of the groups with the least access to comprehensive primary and specialty care. (5,(11)(12)(13) The lack of outpatient care leads many to delay seeking care until chronic complications become symptomatic or severe which is not only costly to healthcare systems, but also results in permanent, irreversible organ damage that might have been averted if care was provided earlier in the disease course.…”