Evaluation of a pilot outreach program to support point-of-care screening for individuals with diabetes who are experiencing homelessness in Alberta, Canada: results of a mixed methods study
Notice bibliographique
Résumé
BACKGROUND: Accessing diabetes care requires effort and time. Homelessness often forces individuals to prioritize securing shelter and safety over medical appointments, particularly for the screening and prevention of long-term diabetes complications. We evaluated the effectiveness and costs associated with a point-of-care screening program with expedited referral pathways within two inner-city community sites in Calgary, Canada serving individuals experiencing homelessness. METHODS: We conducted a non-randomized concurrent-convergent mixed methods pilot study of the program. Adults experiencing homelessness and diabetes were recruited through the host sites and attended two separate visits. At the initial visit, screening for microvascular complications, glycemic monitoring (glycated hemoglobin testing), and footcare were offered. At the follow-up visit, the nurse shared the screening results and arranged specialist referrals. The quantitative strand of the study was comprised of a pre-post assessment, comparing screening completion rates after our program to historical screening over the past two years, based on chart review and patient reports. We used a qualitative descriptive approach to report on patient reflections of the program. RESULTS: Nearly all participants (n = 40) completed the screening tests offered: foot/peripheral neuropathy (n = 39), retinopathy (n = 30), and diabetic kidney disease (n = 38). This is compared to the previous two years, where only n = 10, n = 11, and n = 20 completed these tests, respectively. While n = 23 had their glycated hemoglobin measured in the past year, n = 40 completed it with our program. Most participants (83%) attended both clinic visits. Despite this unique and well received model, getting participants to see specialists remained challenging, with fewer than half of referred patients attending follow-up visits. The cost of the pilot ($846/visit) illustrates this model requires modifications to provide even better value. Four main themes emerged from the participant interviews regarding the program that include: improved accessibility to services, positive experiences, ideal locations of service, and willingness to return. CONCLUSIONS: This point-of-care screening model significantly increased screening rates from the pre-period and participants indicated interest in and support for the program. However, innovative approaches to enhance the program are required. Potential adjustments include partnering with more community sites servicing this population and expanding the scope of care offered as well as reaching a broader population.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,014 | 0,010 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,007 | 0,002 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,004 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».