Barriers to Care in Homeless Patients with Diabetes Mellitus

Abstract

Research Question: Between access to medication, access to diabetic-friendly food, and access to healthcare services, what are the primary barriers affecting diabetes management for patients experiencing homelessness in Fort Worth?

Background, Significance, and Rationale: There are few studies assessing specific barriers to care for homeless patients with diagnosed diabetes, despite evidence that homeless patients suffer from diabetes at about the same rate as the general public. Homeless patients often face a particular set of challenges, including unstable housing, limited food choices, mental health problems, lack of access to stable care, lack of access to transportation, and chronic stress, that are different than the barriers that housed patients with diabetes face. We have developed a survey that will focus on barriers to care that are unique for homeless patients managing chronic conditions, specifically diabetes. Having data on patients’ barriers to care will allow the True Worth Clinic to more effectively address the unique barriers that their patients face.

Materials and Methods: This is a cross-sectional survey of adult patients experiencing homelessness and diagnosed with diabetes at the JPS True Worth Clinic. Statistics were performed using SAS® 9.4 (SAS Institute, Cary, NC).

Results: There were multiple barriers that a majority of respondents, expressed in the management of diabetes while experiencing homelessness. Patients reported difficulty taking their prescribed diabetes medication, transportation to a pharmacy and forgetting to take their medication were the most common barriers. Additionally, among the patients who stated someone talked to them about food to eat for optimal diabetes control, only approximately half (54%) felt they had access to those types of foods.

Conclusions: Being able to describe barriers to diabetes care that are specific to patients experiencing homelessness is the first step in being able to address those barriers. We hope that with the results of this survey interventions can be more targeted at things that patients specifically pointed out as issues, such as transportation to and from the pharmacy, storage for medication, and expanding access to foods that help control blood sugar.