Results of a Peer Navigator Program to Address Chronic Illness Among Persons Experiencing Homelessness.

People who are homeless disproportionately experience the burdens of chronic disease, have limited access to preventive care, and may be less trusting of healthcare agencies. The Collective Impact Project created and evaluated an innovative model designed to increase chronic disease screening and referral to healthcare and public health services. Trained Peer Navigators (PNs), who were paid staff with lived experiences similar to the clients served, were embedded in five agencies serving people experiencing homelessness or at risk for homelessness. Over two years, PNs engaged 1071 individuals. Of those, 823 were screened for chronic diseases and 429 were referred to healthcare services. Alongside screening and referrals, the project demonstrated the value of convening a coalition of community stakeholders, experts, and resources to identify service gaps and how PN functions might complement existing staffing roles. Project findings add to a growing literature documenting unique PN roles that potentially reduce health inequities.

Comparison between success rates for smokers re-treated by a smokers' clinic and success rates for smokers treated for the first time.

AIMS: To compare success rates and characteristics of smokers treated a second time by a smokers' clinic with success rates of their first treatment. DESIGN: Retrospective cohort study. SETTING: Tobacco Dependence Treatment clinic in Prague, Czech Republic, between 2005 and 2017. PARTICIPANTS: A total of 5225 smokers treated either once (n = 5006, single treatment sample, SS) or also second time (n = 219, re-treated sample, RS), on average 4.47 years after the first visit. INTERVENTION: Smokers received intensive treatment of tobacco dependence with pharmacotherapy options. Outcomes were evaluated after 1 year. In case of failure or relapse, participants could undergo re-treatment in the same setting at least 1 year after the start of the first treatment. MEASUREMENTS: Twelve-month self-reported continuous abstinence; CO-validated (≤ 6 parts per million); number of visits; type of pharmacotherapy; mental health history; Fagerström Test for Cigarette Dependence; time between first and second treatment. RESULTS: The abstinence rate in the SS was 34.8% [95% confidence interval (CI) = 33.4%, 36.1%] and in the RS was 37% (95% CI = 30.6%, 43.8%) and 39.7% (95% CI = 33.2%, 45.5%) for their first and second treatments, respectively. The samples were comparable on smoking and socio-demographic characteristics and pharmacotherapy used, but the RS in the second treatment had a higher prevalence of diagnosed mental health disorder at 39.3% (95% CI = 32.8%; 46.1%) compared with 23.7% (95% CI = 22.5%; 24.9%) in the SS. Participants who initiated their second quit attempt 1 to 2 years after the first one were less successful than those who initiated their second quit attempt later (25 versus 43%; P < 0.05). The results of the first treatment cycle were not found to be a reliable predictor for outcomes of the second cycle of treatment in univariate or multivariate logistic regression (odds ratio = 1.35, 95% CI = 0.70-2.63, P = 0.373). CONCLUSION: In Prague, Czech Republic, smokers re-attending stop-smoking treatment more than 2 years after their previous quit attempt appear to achieve similar success rates to those being treated for the first time.