Objective: Boston Health Care for the Homeless Program (BHCHP) provides episodic and primary care to more than 7000 persons each year in 45 sites, ranging from hospital- based clinics to respite care services to the provision of direct clinical care in shelters and on the streets. The care and management of diabetes presents particular challenges to those struggling with the uncertainties of life without stable housing. Methods. A random sample of 52 diabetic patients who met specified criteria was selected, and the BHCHP electronic medical records reviewed for adherence to 11 standards of care taken from the American Diabetes Association guidelines. Among the standards were: glycosylated hemoglobin every four months; annual cholesterol and HDL levels, annual eye and foot examinations, annual urinalysis for protein, influenza vaccination each fall, and a Pneumovax every 5 years. Results: 80% of the charts reviewed met between six and nine of the eleven standards of care. Conclusion: Managing diabetes among homeless persons presents complex challenges. Diet, weight loss, and exercise are the pillars of chronic diabetes management, but virtually impossible for persons struggling to survive amidst the vicissitudes of life on the streets. Insulin and syringes are difficult to manage in shelters. Shelters and soup kitchens generally provide meals high in both fat and protein. While this review demonstrated high levels of adherence to accepted guidelines, the national standards of quality care need to recognize the special needs of homeless persons with diabetes and their providers.
Learning Objectives: 1. Describe the unique challenges that homelessness presents to the care and management of diabetes. 2. Evaluate quality standards of diabetes care that recognize the unique challenges faced by homeless persons and their primary care providers. 3. Assess the quality of care provided to a cohort of chronically homeless persons
Keywords: Diabetes, Homeless Health Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.