(DCP054) MIXED METHODS EVALUATION OF A DIABETES COMPLICATION SCREENING PROGRAM IN OUTREACH SETTINGS FOR PEOPLE WITH LIVED EXPERIENCE OF HOMELESSNESS AND DIABETES

Background: Diabetes management is complicated and time-consuming for various reasons, including the need to undergo ongoing screening for complications. It requires regular screening for microvascular complications such as retinopathy, nephropathy, and neuropathy and wounds of the feet, in addition to blood tests (i.e., glycated hemoglobin) for assessment of glycemia. While it is challenging for all individuals living with diabetes to complete these tests, it is especially challenging for people experiencing homelessness (PEH) given the barriers they face in accessing care. We aimed to improve screening for diabetes complications among PEH by offering a point-of-care screening clinic at an emergency shelter and an inner-city clinic in Calgary, AB. The primary objective was to determine the incremental increase in the completion of: retinal assessment, neuropathy screening, albuminuria testing, as well as glycemia testing (A1c) due to the program.

METHODS AND RESULTS: The incremental increase in screening was determined through a chart review of medical records and interviews with clients in the program to understand when they last completed screening tests. Additionally, interviews were conducted with the clients and the staff involved in the planning and implementation of the program to identify barriers faced by PEH in completing screening, and their views on whether the program was an accessible, lower-barrier option for this population.

A total of 40 clients were seen in the program, furthermore, 9 providers participated in interviews. Overall, there was an increase in the rate of completion for each type of screening; there was a 73% increase in the completion of A1c testing, a 2.9-fold increase in foot/neuropathy screening, a 1.7-fold increase in retinal screening, and a 62% increase in albuminuria testing. Clients indicated willingness to return to the outreach screening clinic if it continued to be offered, and although providers saw the value in it, they expressed concerns regarding the practicality of adopting it as a permanent fixture in their clinics. Moreover, they felt it would be difficult to operate without additional resources like equipment and trained personnel, and it may be difficult to acquire those as the program does not entirely align with the agencies’ organizational priorities.

Conclusion: Although a preventative outreach program like ours can increase screening for microvascular complications among PEH who have diabetes, and there is an interest in having such programs in accessible locations such as shelters and inner-city clinics, it may not be feasible for all organizations to adopt such a model given the episodic care they provide.