Evaluation of a pilot outreach program to support point-of-care screening for individuals with diabetes who are experiencing homelessness in Alberta, Canada: results of a mixed methods study.

Background: Accessing diabetes care requires effort and time. Homelessness often forces individuals to prioritize securing shelter and safety over medical appointments, particularly for the screening and prevention of long-term diabetes complications. We evaluated the effectiveness and costs associated with a point-of-care screening program with expedited referral pathways within two inner-city community sites in Calgary, Canada serving individuals experiencing homelessness.

Methods: We conducted a non-randomized concurrent-convergent mixed methods pilot study of the program. Adults experiencing homelessness and diabetes were recruited through the host sites and attended two separate visits. At the initial visit, screening for microvascular complications, glycemic monitoring (glycated hemoglobin testing), and footcare were offered. At the follow-up visit, the nurse shared the screening results and arranged specialist referrals. The quantitative strand of the study was comprised of a pre-post assessment, comparing screening completion rates after our program to historical screening over the past two years, based on chart review and patient reports. We used a qualitative descriptive approach to report on patient reflections of the program.

Results: Nearly all participants (n = 40) completed the screening tests offered: foot/peripheral neuropathy (n = 39), retinopathy (n = 30), and diabetic kidney disease (n = 38). This is compared to the previous two years, where only n = 10, n = 11, and n = 20 completed these tests, respectively. While n = 23 had their glycated hemoglobin measured in the past year, n = 40 completed it with our program. Most participants (83%) attended both clinic visits. Despite this unique and well received model, getting participants to see specialists remained challenging, with fewer than half of referred patients attending follow-up visits. The cost of the pilot ($846/visit) illustrates this model requires modifications to provide even better value. Four main themes emerged from the participant interviews regarding the program that include: improved accessibility to services, positive experiences, ideal locations of service, and willingness to return.

Conclusions: This point-of-care screening model significantly increased screening rates from the pre-period and participants indicated interest in and support for the program. However, innovative approaches to enhance the program are required. Potential adjustments include partnering with more community sites servicing this population and expanding the scope of care offered as well as reaching a broader population.