Nurse practitioner

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  • nurse practitioner who works with individuals experiencing homelessness, or are street involved
  • primarily works from a pop-up, on-site, temporary clinic
    • program created to help people unable to access traditional forms of healthcare
    • close to where patients were so it was a familiar and comfortable setting
  • providing care similar to an urgent care centre
    • wounds, infections, pneumonia
  • clinics ran evenings and weekends on a predictable schedule
    • weekends and evenings so that patients don't lose their bed or spot at the shelter
  • provide a non-judgmental space and reduce barriers to primary care
  • patients can be existing patients or newcomers - a mixed bag

Pre-existing barriers for patients

  • Difficulty in making appointments
  • Feeling stigmitized or unwelcome in healthcare settings
  • Unable to get to places to get healthcare, or specialist appointments
  • Time and place is a big barrier
  • Food security, no place to sleep, unsafe environment - personal health becomes a lower priority and difficult to manage

Effect of COVID-19

  • clinic was not available for 1.5 months as the pandemic / shutdown happened
  • during this time, noticed a decline in health of patients
    • many patients did not have access to phone and internet
      • prescription refills weren't done
      • health conditions not cared for
  • encampments have increased as a result of the pandemic, although access use of the shelter ("congregate housing") system
  • change to the way the program ran may have caused a drop-off in usage
    • highlights importance of trust and predictability

Effect of Shift to Virtual Healthcare

  • Many patients lack phones or internet access (hence phone numbers and email addresses)
    • keeping track of passwords or login information would be a barrier
  • Shift to virtual care has caused a lot of problems
  • Virtual care can work for the population of interest, just needs more creativity in how it's implemented
  • Home clinic has two virtual healthcare rooms for appointments
    • this can be a barrier as some do not want to be in a formal clinic setting
    • requires a nurse / worker /staff to help patient set up the VH appointment
  • Very few shelters have facilities for virtual healthcare visits
    • knows of only 2
  • Virtual health could work, but would take time to build trust
    • computer literacy may be another issue
  • Combination of virtual healthcare and onsite service could work, but only if it isn't a burden
    • might be a good way to offer other services such as counselling or therapy – this is all currently virtual and is inaccessible to patients
  • For the practitioner, the shift to VH has been an issue
    • newness of technology
    • technology literacy and familiarity
    • privacy concerns
    • workflow issues (lack of a predictable appointment process - more ad-hoc)
    • preference for in-person practice
  • People in home clinic seem okay providing VH services and the outcomes seem to be good

Providing Healthcare

  • people come to the pop-up clinic without prior appointments
    • mostly acute episodic visits, occasionally some are scheduled
    • support workers onsite to help - help with relationship building and harm reduction
  • rarely opportunity to provide follow-up as many patients don't have phones (although some do have phones)
    • only way to follow-up is if they come to a clinic again on another occasion.
  • more major issues are sometimes surfaced during more minor meetings
    • unsupported / undiagnosed conditions can come out during conversation
  • many patients have other conditions such as substance abuse, mental health
    • shift toward harm reduction such as providing clean kits, naloxone
    • hoping to have opiate agonists and safe supplies in the new year
  • access to specialists is currently only available through virtual and in the home clinic
    • the person also needs to be willing to come to the home clinic (and not everyone is comfortable with that)
  • clinic sites are predictable and accessible
    • given out using flyers - same stop every week
    • With COVID, this has been more difficult as people have moved around
    • location can be set up outside a shelter so it provides an easy opportunity for people to drop in
  • Not all patients have health cards or ID, may use an alias
    • have funding to help provide some small diagnostics and tests for patients without health cards
  • Replacing health cards that are lost or stolen is part of the case worker's role

Health Literacy

  • health literacy is all over the map
  • try to capture the same people over time to improve chances of health information is understood


  • partner with other organizations who have case managers - help people get appointments, phones, housing, etc.
  • less formal partnerships with shelters and drop-ins


  • Pamphlets, community boards, signs are good ways to get information out
  • Connect with case managers at organizations who know the individuals better
    • trust is an issue - best to go through an org.
  • offering something back would be a good way to encourage people to get involved
    • gift certificates for groceries and food
    • supplies and clothes