Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Can J Diabetes. 2020 Oct;44(7):643-650. doi: 10.1016/j.jcjd.2020.01.011. Epub 2020 Feb 14.
For a variety of reasons, homelessness creates major challenges for the management of diabetes, resulting in excess morbidity and mortality in this population. The objective of this study was to document innovations in providing diabetes care for individuals experiencing homelessness.
Using directed snowball sampling, we recruited a sample of service providers (family physicians, nurses, social workers, endocrinologists, diabetes educators, shelter workers) in 5 Canadian cities (Vancouver, Calgary, Edmonton, Toronto, Ottawa). Data were collected using detailed, open-ended interviews. Transcripts and field notes were analyzed using thematic analysis.
We interviewed 96 program managers and providers representing 38 organizations. Although many of the same challenges were faced by care providers in different jurisdictions, there was little communication or sharing of experiences across providers and organizations. However, we identified 5 unique and innovative approaches to providing diabetes care to individuals experiencing homelessness. These include: 1) provision of in-shelter care, 2) peer outreach/support workers, 3) diabetes specialty outreach clinics, 4) diabetes group care specific for this population and 5) community-based pharmacy interventions.
Providers and organizations in different cities face similar challenges in providing diabetes care to individuals who are experiencing homelessness, yet they tend to address these difficulties in isolation. Despite this, numerous organizations have created innovative solutions to improve diabetes care. Sharing experiences across organizations and jurisdictions can facilitate development and implementation of successful program models.
由于种种原因，无家可归给糖尿病的管理带来了重大挑战，导致该人群的发病率和死亡率过高。本研究的目的是记录为无家可归者提供糖尿病护理的创新方法。
我们使用有针对性的滚雪球抽样，在加拿大的 5 个城市（温哥华、卡尔加里、埃德蒙顿、多伦多、渥太华）招募了一批服务提供者（家庭医生、护士、社会工作者、内分泌学家、糖尿病教育者、收容所工作人员）作为样本。数据收集采用详细的开放式访谈。使用主题分析对转录本和实地笔记进行分析。
我们采访了 96 名来自 38 个组织的项目经理和服务提供者。尽管不同司法管辖区的护理提供者面临着许多相同的挑战，但提供者和组织之间几乎没有沟通或经验分享。然而，我们确定了 5 种为无家可归者提供糖尿病护理的独特而创新的方法。这些方法包括：1）在收容所提供护理，2）同伴外展/支持工作者，3）糖尿病专科外展诊所，4）针对该人群的糖尿病团体护理，以及 5）社区药店干预措施。
不同城市的提供者和组织在为无家可归者提供糖尿病护理方面面临着类似的挑战，但他们往往孤立地解决这些困难。尽管如此，许多组织还是创造了创新的解决方案来改善糖尿病护理。在组织和司法管辖区之间分享经验可以促进成功项目模式的开发和实施。
