(P152) CARDIOVASCULAR CARE EXPERIENCES OF PEOPLE EXPERIENCING HOMELESSNESS AND THE FUTURE CO-DESIGN OF A CARE PROGRAM: A COMMUNITY-BASED STUDY IN TORONTO

Background: Minimal consideration has been given to understanding the challenges of managing cardiovascular disease (CVD) and accessing mainstream cardiac care while homeless from the perspective of people with lived experience (PWLE). This community-based research aims to explore and understand the care experiences and needs of people experiencing homelessness and CVD to inform the co-design of a future care program in Toronto.

METHODS AND RESULTS: By partnering with various community organizations (e.g., shelters, community health centres (CHCs), outreach programs, hospitals) and four peer researchers with lived experience, we are conducting a critical ethnographic needs assessment. This includes observational fieldwork, demographic surveys, one-on-one interviews, community resource mapping, and photovoice exercises (where participants take photos to reflect on their experiences) with PWLE with CVD (e.g., heart failure, coronary artery disease, endocarditis, arrhythmia), as well as their multi-disciplinary care providers (e.g., primary care providers, cardiologists, nurses, social workers, shelter staff, among others). Transcripts are coded for themes and analyzed using Interpretive Description. This abstract presents interim results. Full study results will be completed by September 2022. We have interviewed 17 PWLE and CVD – including 7 photovoice exercises – and 24 multi-disciplinary providers (see Table 1; target of N=30 of each group). To date, we have found that PWLE have various challenges managing CVD, including competing priorities of housing/food security, severe mental illness/addiction, stolen medications/cell phones, low health literacy, fragmented primary care, past trauma in the healthcare system, high-salt shelter meals, among others. These challenges lead to crisis-oriented cardiac care in the emergency department. Common recommendations/solutions include: 1) Reform hospital-based cardiac clinics to be more trauma-informed and anti-racist, including psychiatric training, 2) Bring cardiac specialist care to shelters/CHCs where PWLE feel safer, 3) Have cardiac specialists join already-established medical outreach teams, 4) Include the essential role of case management in cardiac clinics, and 5) Set-up communal shelter-based remote tele-monitoring stations (e.g., UHNs Medly), where patients can input daily measurements/symptoms and cardiac clinics can monitor/intervene. A tension exists on the use of technology in healthcare delivery for the homeless population; patients are enthusiastic/determined while providers are hesitant of its feasibility.

Conclusion: A trauma-informed approach, peer researchers on the study team, and community partnerships are essential to gain trust in the homeless community. We will translate these findings of lived experience perspectives and recommendations of new care program elements to the community. We aim to co-design a new CVD program that meets folks where they are at.