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The Effect of Place of Service on Diabetic Screening Adherence in the Homeless Population.

Authors
  • Wainwright, Mary Katherine1
  • Earle, Melinda2
  • Kosog, Kari3
  • Gilbert, Mary Kay4
  • Nolan, Christopher5
  • Stellon, Ed4
  • Vitolo, Olivia6
  • Canar, William Jeffrey7
  • 1 Rush University Medical Center, 1750 W Harrison, Suite 603, Chicago, IL, 60612, USA.
  • 2 College of Nursing and College of Health Sciences, Rush University Medical Center, 600 South Paulina St, Suite 1080, Chicago, IL, 60612, USA.
  • 3 , 39W110 Preston Circle, Geneva, IL, 60134, USA.
  • 4 Heartland Alliance Health, 4750 North Sheridan Road, Suite 449, Chicago, IL, 60616, USA.
  • 5 Rush University Medical Center, 710 South Paulina, Suite 316G, Chicago, IL, 60612, USA.
  • 6 Heartland Alliance Health, 4750 N. Sheridan Road, Chicago, IL, 60640, USA.
  • 7 Department of Health Systems Management (126 TOB), Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL, 60612, USA. [email protected]
Type
Published Article
Journal
Journal of community health
Publication Date
Feb 01, 2020
Volume
45
Issue
1
Pages
73–80
Identifiers
DOI: 10.1007/s10900-019-00718-6
PMID: 31396826
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

This study examined the association between place of service and adherence to select diabetes screening measures in a homeless population. At a Midwestern metropolitan federally qualified health center (FQHC), 508 participants with diabetes and also experiencing homelessness were studied throughout calendar year 2018. Diabetes measures included controlled blood pressure, diabetic foot exam and hemoglobin A1C screening. Patients were seen at one of three locations: FQHC only, shelter only and both shelter and FQHC. After controlling for primary insurance, insurance status, homeless status, age group, ethnicity, primary language, race, sex and poverty level, a stepwise binary logistic regression demonstrated significant model improvement in A1c screening (p ≤ 0.001) and controlled blood pressure (p = 0.009) when place of service was added as a predictor. Specifically, results showed significant negative associations in screening adherence for shelter as compared to FQHC for both controlled blood pressure (OR = 0.40; 95% CI = 0.20-0.79; p = 0.009) and A1c screening (OR = 0.06; 95% CI = 0.03-0.16; p ≤ 0.001). Our results support the hypothesis that FQHC care results in higher rates of adherence than shelter only or FQHC and shelter combined care. The study addresses the gap in literature surrounding place of service and patient adherence. Recommendations for future research are included.

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