Blog Post 1: Conceptual Model of Cardiovascular Care for People Experiencing Homelessness
A study by Baggett et al in 2018: Cardiovascular disease (CVD) is a major cause of death among homeless adults, at rates that exceed those in nonhomeless individuals. A complex set of factors contributes to this disparity. In addition to a high prevalence of cigarette smoking and suboptimal control of traditional CVD risk factors such as hypertension and diabetes, a heavy burden of nontraditional psychosocial risk factors like chronic stress, depression, heavy alcohol use, and cocaine use may confer additional risk for adverse CVD outcomes beyond that predicted by conventional risk estimation methods. Poor health care access and logistical challenges to cardiac testing may lead to delays in presentation and diagnosis. The management of established CVD may be further challenged by barriers to medication adherence, communication, and timely follow-up. The authors present practical, patient-centered strategies for addressing these challenges, emphasizing the importance of multidisciplinary collaboration and partnership with homeless-tailored clinical programs to improve CVD outcomes in this population.
Blog Post 2: A Research Study in Toronto
A new study being beginning in 2022 in Toronto: Heart failure (HF) and homelessness represent two devastating epidemics in Canada. The homeless population has a heightened need for longitudinal and comprehensive HF management given their unstable living environment and challenges in accessing care. We must put HF management in the context of their larger competing priorities. This research aims to develop a new HF care pathway or program- perhaps using a remote telemonitoring application called Medly - to manage HF in people experiencing homelessness in Toronto that meets them where they are at. By working in partnership with community organizations, this work will integrate lived experience into the co-design of the care pathway. This research will use a mixed methods participatory-social justice design. First, the team will conduct a systematic scoping review to understand what is currently known in the literature about cardiovascular disease management for people experiencing homelessness. Second, they will conduct a multi-site qualitative study with semi-structured interviews and photovoice exercises at shelters and community health centres to explore the homeless population’s and care providers’ experiences with HF management, as well as perform a needs assessment. Third, they will co-design a new HF care pathway, and pilot it at two local community sites to undergo usability testing. This will be the first study of its kind in Toronto. If successful in the pilot phase, this intervention could be adopted at various urban sites, and adapted to other chronic illness management.