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Journal of Community Health

, Volume 45, Issue 1, pp 73–80 | Cite as

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

  • Mary Katherine Wainwright
  • Melinda Earle
  • Kari Kosog
  • Mary Kay Gilbert
  • Christopher Nolan
  • Ed Stellon
  • Olivia Vitolo
  • William Jeffrey CanarEmail author
Original Paper
  • 77 Downloads

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.

Keywords

Homelessness FQHC Diabetes Adherence 

Notes

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Rush University Medical CenterChicagoUSA
  2. 2.College of Nursing and College of Health SciencesRush University Medical CenterChicagoUSA
  3. 3.GenevaUSA
  4. 4.Heartland Alliance HealthChicagoUSA
  5. 5.Rush University Medical CenterChicagoUSA
  6. 6.Heartland Alliance HealthChicagoUSA
  7. 7.Department of Health Systems Management (126 TOB)Rush University Medical CenterChicagoUSA

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