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

Abstract

Background Accessing diabetes care, including screening for microvascular complications, requires effort and time. Social complexity, such as homelessness, often forces individuals to prioritize securing shelter and safety over medical appointments, particularly for the prevention of long-term complications. Methods We designed and conducted a non-randomized pilot study of a point-of-care screening program with expedited referral pathways within two inner-city community sites in Calgary, Canada which are accessed by individuals experiencing homelessness. Adults experiencing homelessness and diabetes were recruited through the host sites and invited to two separate visits. Microvascular screening (retinal fundoscopic images, albumin-to-creatinine ratio testing, and foot neurovascular assessment), glycemic monitoring, and footcare were performed at the first visit. The nurse shared the screening results and helped facilitate follow-up at the second visit. We compared the screening completion rates after visiting our program to historical screening over the past two years, based on chart review and patient reports. We also assessed the domains of reach and implementation as per the RE-AIM framework. Results Compared to the previous two years, participants (n = 40) experienced a 2.9-fold increase in peripheral neuropathy screening; a 1.7-fold increase in diabetic retinopathy screening; and a 90% increase in diabetic nephropathy screening. We also documented a 73% increase in glycemic monitoring. Most participants (83%) attended both clinic visits. Despite this unique model, challenges facilitating follow-up specialist visits remain, with fewer than half of referred patients attending follow-up visits. The cost of the pilot ($846/visit) illustrates this model requires modifications to yield optimal value. Conclusions Our findings show the SAFER model significantly increased screening rates for our sample, however, innovative approaches to healthcare are still needed for this population. Potential value-based adjustments include partnering with more community sites already servicing this population and expanding the scope of the care offered and the target population.