Towards Equitable Health Care Access: Community Participatory Research Exploring Unmet Health Care Needs of Homeless Individuals.

Community and health services often overlook health care needs of persons experiencing homelessness, which leads to deterioration in health and increased utilization of emergency services. Since homeless people are underrepresented in health service research, little is known about their unmet health care needs, particularly in smaller cities where resources are limited. This community-based participatory research explored the experiences of small-city homeless service users (HSUs) with unmet health care needs and community service providers (CSPs) who work with them to determine barriers to health care access affecting them. Structured interviews were conducted with 65 HSUs and 15 CSPs in interior British Columbia, Canada. These interviews were audio-recorded, and the retrieved data were analyzed thematically. The three themes uncovered included: a lack of access to health care and risk of stigma, a lack of trust and fear of discrimination, and a need for community navigation and social support. The findings indicate that HSUs do not receive equitable care and face challenges in accessing appropriate and timely foot care, which contributes to increased foot-related emergency visits, loss of trust in the health care system, and disabilities due to worsening foot conditions. Various social determinants of health also impact HSUs, such as low socioeconomic status, lack of housing, decreased social support, unhealthy behaviors, and inequitable access to health services. By collaborating with HSUs, community and health services need to develop innovative outreach programs that provide better community resources as the first step toward equitable access to health care.

Peri-procedural outcome of saphenous vein graft intervention.

BACKGROUND: Patients who develop recurrent myocardial ischemia after coronary artery bypass graft (CABG) surgery are often referred for percutaneous coronary intervention. The objective of this study was to evaluate the clinical characteristics and peri-procedural outcomes in patients with prior CABG referred for percutaneous coronary intervention (PCI) over a 3 year period. METHODS: Data were collected on patients who underwent coronary interventional procedures following CABG surgery. We evaluated angiographic procedural success and immediate outcome among patients who had undergone such procedures from Nov 2006 to Oct 2009 (n = 113). RESULTS: Patients in the 2006-2009 cohort had mean age 58.2 years, more patients were male (109 vs 4) and were more likely to have hypertension (57.5%), hyperlipidaemia (72.6%) and family history of ischemic heart disease (IHD) (65.5%), but less likely to have smoking (42.5%). Acute closure of stent leading to procedural failure was seen in 1 (0.9%) patient, sub-acute thrombosis of stent was seen in 1 (0.9%) patient, dissection or perforation of target vessel was seen in 3 (2.7%) and 1 (0.9%) patients respectively. Slow flow phenomenon was seen in 13 (11.5%) and post-procedural cardiac enzymes were raised in 6 (5.3%) patients. CONCLUSION: Success rates of saphenous vein graft (SVG) intervention and survival rate have improved with time as a result of improvements in technique and greater use of stents, filter devices and adjunctive medications.

Carotid disease in diabetic patients undergoing coronary artery bypass grafting.

OBJECTIVE: To compare the severity of carotid artery disease in diabetic and non-diabetic patients undergoing coronary artery bypass grafting. METHODS: From January to June 2008, 379 patients undergoing elective coronary artery bypass surgery were preoperatively evaluated for the presence of carotid stenoses by duplex scanning. Patients were divided into two groups, Group I, 156 (41.2%) diabetic patients and Group II, 223 (58.8%) non-diabetic patients. RESULTS: There were 314 (82.8%) males and 65 (17.2%) females with a mean age of 57.2 +/- 9.1 years. In diabetic group there were 125 (80.1%) males and 31 (19.9%) females with a mean age of 56.3 +/- 8.9 years. Left main stem stenosis was present in 59 (37.8%) diabetics and 45 (20.2%) non-diabetics (p<0.0001). Diffuse disease in left anterior descending (LAD) artery was observed in more diabetic patients 72 (46.2%) as compared to non-diabetics 83 (37.2%) (p<0.295). Single tight stenosis in LAD was observed in more non-diabetics. Significant carotid artery stenosis was observed in 50 (13.2%) patients. Carotid artery stenosis was observed in 30 (19.2%) diabetics as compared to 20 (9%) non-diabetics (p<0.004). Analysis of percentage stenosis of carotid artery disease in the study population revealed that >70% stenosis was present in 20 (5.3%) with 13 (8.3%) diabetics and 7 (3.1%) non-diabetics (p<0.025). Stenosis of 50-70% was observed in 30 (7.9%) of which 17 (10.9%) were diabetics and 13 (5.8%) were non-diabetics. CONCLUSION: Presence of diabetes mellitus is associated with diffuse coronary artery disease and significant carotid artery disease in patients undergoing coronary artery bypass grafting.