News Release

Health of the homeless

Peer-Reviewed Publication

Canadian Medical Association Journal

Barriers to appropriate diabetes management among homeless people in Toronto -- S.W. Hwang, A.L. Bugeja
Homelessness: reducing health disparities -- J.D. Plumb
Physician payment for the care of homeless people -- S. Hwang et al

In the first of three articles on the health care system and homeless people, Drs. Stephen Hwang and Ann Bugeja interviewed 50 homeless people with diabetes in Toronto shelters and found that 72% had difficulties managing their disease. The authors report that, by at least some measures, the access to health care was relatively good since most were regularly seeing a physician for diabetes care.

Forty (40) percent of respondents reported a history of mental illness and 38% showed signs of alcohol abuse, but the most commonly cited barriers to their diabetes care were related to the quality of the diet in shelters and to the logistics of scheduling and administering medication. The authors recommend that shelters establish secure areas for diabetic patients to self-administer insulin, as well as the provision of safe storage areas for the medication. The authors also recommend that an objective assessment of shelter meals be carried out to determine whether subjective reports of dietary problems are justified.

In a related commentary, Dr. James Plumb cites a Philadelphia example of how the use of restaurant school students to staff the kitchens of homeless shelters can result in healthier food choices. He adds, however, that care management, shelter modification and other strategies are all well and good, but effective disease prevention or treatment of homeless people also requires effective prevention of homelessness.

A second article by Dr. Hwang and colleagues examined the billing records of 3 physicians providing medical care at 3 separate homeless shelters and found that physicians only received payment for 54% of treatment encounters. The authors state that even though care for the homeless can be professionally and personally fulfilling for physicians, special arrangements may need to be considered if health care outreach programs for the homeless are to be sustained.

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