Diabetes Risk Assessment, A1C Measurement, and Goal Achievement of Standards of Care in Adults Experiencing Homelessness

Hadenfeldt, Cynthia; Knezevich, Emily; Black, Susannah

doi:10.1177/0145721719843680

Cited by 7 publications

(5 citation statements)

References 8 publications

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“…Few other studies have documented relatively high rates of inadequately managed diabetes among patients experiencing homelessness, including 32% (HbA1c > 8%) and 50% (A1c> 7·3%) compared with 20% among domiciled persons with diabetes, which were significant across ethnicity and race. 10 , 11 Considering the higher prevalence of other important risk factors for cardiovascular events such as inadequately managed hypertension, hyperlipidemia, and cigarette smoking among patients experiencing homelessness shown in our study and other literature, effective treatment and better diabetes management among patients experiencing homelessness gains even more importance. 19 , 20 …”

Section: Discussionmentioning

confidence: 60%

“… 5 , 6 , 7 , 8 , 9 Diabetes management in persons experiencing homelessness has not been well-studied. 10 , 11 Persons experiencing homelessness with diabetes have a higher rate of emergency room visits and hospital admissions for diabetes complications than domiciled adults. 12 Persons experiencing homelessness experience mental illness or substance misuse, encounter discrimination and stigma within the healthcare system, and face barriers to accessing primary care and achieving therapeutic lifestyle changes.…”

Section: Introductionmentioning

confidence: 99%

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Diabetes care and its predictors among persons experiencing homelessness compared with domiciled adults with diabetes in New York City; An observational study

2022

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Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Diabetes care and its predictors among persons experiencing homelessness compared with domiciled adults with diabetes in New York City; An observational study

2022

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“…PSH initiatives have helped secure and maintain stable housing and meet some of the residents' health care needs (Henwood et al, 2017;Rog et al, 2014). Yet research shows residents face ongoing challenges in trying to maintain healthy lifestyle habits to manage chronic conditions, leading to greater risk for increased complications (Hadenfeldt et al, 2019;Rog et al, 2014). A 2017 study of PSH adults in Los Angeles County found that 68% had two or more chronic physical health conditions, more than half experienced depression and about one third reported diagnoses of schizophrenia, bipolar disorder or post-traumatic stress disorder (Henwood et al, 2017).…”

Section: Yet Many Individuals In Psh (Residents Hereafter) Have Unmet Physicalmentioning

confidence: 99%

Views on health activation and support services among formerly homeless adults living in Permanent Supportive Housing in the United States

Jolles

Rivera

Jacobs

et al. 2021

Health Soc Care Community

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Individuals who have experienced chronic homelessness often have unmet physical and mental health needs and experiences of trauma and stigma. This study aimed to measure, for the first time, health activation (self-advocacy and empowerment) levels among formerly homeless adults living in Permanent Supportive Housing or PSH (referred to hereafter as residents). In addition, residents' experiences accessing health services, and their sense of health activation and efforts to manage their health within PSH settings, were explored. A mixed-methods study was conducted in Southern California (October 2018-June 2019) using a validated survey and interviews with a randomly selected group of residents (n = 61) from three PSH agencies.Activation levels were measured using the Patient Activation Measure. Descriptive and univariate survey analyses were conducted. Interview data was analysed using NVivo. Two coders coded all transcripts, and team meetings were held to reach consensus. Results showed most residents were female (64%), racial and ethnic minorities (66%), on average 54-year-olds, with 37 months of PSH residency, and 43% were taking some action to manage their health (intermediate activation level). Challenges accessing care were due to breakdowns in care, unpleasant experiences with providers, low health literacy and feeling overwhelmed by co-occurring chronic conditions. Health activation related to knowing when to take care of their health on their own and when to seek care. Unique challenges emerged related to PSH, such as lack of resident control within the housing setting and limited personnel responding to health emergencies. These challenges were magnified because residents live alone, per PSH requirements.

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“…Yet, nurse participants noted that physical health concerns were important to residents and were difficult to treat in a timely manner. Research has shown that residents are challenged to maintain their health and properly manage their chronic conditions, and are at higher risk for developing complications (Hadenfeldt et al, 2019;Rog et al, 2014). One study of residents' health outcomes after 2 ½ years in PSH found that mental health improved but physical health remained unchanged (Hunter et al, 2017).…”

Section: Authenticity In Communication and Healthcare Planningmentioning

confidence: 99%

Nurse and case manager views on improving access and use of healthcare for adults living in permanent supportive housing

Schneiderman

Nedjat-Haiem

Rivera

et al. 2021

Research in Nursing & Health

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Housing is one of the social determinants of health, and homelessness is associated with health inequalities including increased morbidity and decreased life expectancy.Services to improve access to and use of primary healthcare are provided to formerly homeless individuals (hereafter residents) who live in permanent supportive housing (PSH). Residents do not always utilize services, nor receive adequate healthcare, and often have poor health outcomes. The study aims were to explore nurse and case manager (hereafter participants) views on the challenges of providing healthcare to residents, and strategies to address challenges. This descriptive, qualitative study used thematic analysis. Five nurses and eight case managers working with residents of PSH agencies were interviewed using semistructured interviews. Five main themes emerged. The first theme of context of healthcare use included how the residents' history of homelessness, trauma, and survival affected using services. The second theme was how aspects of relationships (communication issues and mistrust)were barriers to care. The third theme was how residents' health issues (physical chronic diseases, mental health, and substance dependency) affected care. Community level barriers (insurance, financial hardship, and transportation) was the fourth theme. The final theme highlighted recommendations to improve access and use of healthcare by building rapport, addressing mistrust, and using effective communication techniques. Participants noted that barriers to healthcare use were often influenced by residents' previous homeless experience. Nurses noted that chronic physical health issues were problematic for residents. Participants expressed the need to take time to form an authentic relationship to increase trust with residents.

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Diabetes Risk Assessment, A1C Measurement, and Goal Achievement of Standards of Care in Adults Experiencing Homelessness

Abstract: The purpose of this study was to explore diabetes in adults experiencing homelessness by evaluating diabetes risk, A1C measurement, and achievement of the goals of the American Diabetes Association (ADA) Standards of Medical Care in Diabetes.

Cited by 7 publications

References 8 publications

Diabetes care and its predictors among persons experiencing homelessness compared with domiciled adults with diabetes in New York City; An observational study

Diabetes care and its predictors among persons experiencing homelessness compared with domiciled adults with diabetes in New York City; An observational study

Views on health activation and support services among formerly homeless adults living in Permanent Supportive Housing in the United States

Nurse and case manager views on improving access and use of healthcare for adults living in permanent supportive housing

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