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

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.

Keywords: access to care; accès aux soins; aiguillage; complications liées au diabète; diabetes complications; dépistage; homelessness; itinérance; referrals; screening; soins spécialisés; specialty care.