A BC Centre for Excellence in HIV/AIDS (BC-CfE) research team is working to evaluate how a new primary care clinic can keep clients engaged in health care among residents of Vancouver’s Downtown East Side (DTES).
The “Hope to Health Engagement and Retention Evaluation (HERE) Study” is being conducted from the Hope to Health (H2H) Research and Innovation Centre located on Powell Street. Opened in late 2019, the Research and Innovation Centre was developed with an integrated, team-based approach to primary health care, based on the best evidence for service design in engaging under-served and marginalized urban core populations.
The DTES is one of the lowest income neighbourhoods in Canada with median household incomes of approximately $23,000 and is characterized by high levels of homelessness and unstable housing. The population of the DTES is heavily overrepresented by people living with mental illnesses and substance use disorders, as well as pervasive trauma and structural violence. Other chronic medical conditions, including HIV and HCV infection, are hyper-endemic with prevalence estimates of 30% and 70% respectively. DTES residents have also been greatly impacted by the opioid crisis, with the highest rate of death due to illicit drug overdoses in BC, at over 100 deaths/100,000 population. There is a striking 15-year disparity in life expectancy between residents of the DTES and residents of neighbouring areas of Vancouver.
DTES residents often rely on DTES community health centres (CHCs), or clinics outside of the neighbourhood in order to access primary healthcare services, as there are very few family-practice or walk-in clinics in the area. However, CHCs face tremendous challenges in engaging and retaining clients with complex medical and psychiatric needs, a challenge made even more difficult by limited capacity to enroll new clients. As such, many DTES residents predominantly access health care through emergency services at one of the three hospitals in central Vancouver.
Following hospital care, many patients discharged do not have an identified primary healthcare provider, which leads to limited outpatient follow-up and frequent re-admission. Recent estimates from Vancouver Coastal Health (VCH), suggest that about 7,500 residents of the DTES are unattached or poorly attached to clinical services.
The relatively recent establishment of the BC-CfE’s H2H Primary Care Clinic and the HERE Study represents an extraordinary opportunity to address these pervasive health systems gaps affecting DTES residents.
Dr. David Moore, the Principal Investigator of the study and a clinician at H2H noted, “This H2H Primary Care Clinic provides an ideal environment for clinicians, researchers and members of the community to study ways to better engage DTES residents in effective primary health care.”
The HERE Study will be using the WelTel mobile health intervention platform. WelTel is designed to be patient-centered, empowering people to manage their own health needs and take part in their healthcare decisions via a two-way automated check-in text messaging system.
BC-CfE clinicians and researchers with the HERE Study will adapt the WelTel platform and experience, capitalizing on substantial in-kind donations of 1,400 refurbished mobile phones and data plans through Telus’ Mobility for Good program for the specific needs of the DTES population.
The HERE study represents a critical opportunity to gather the detailed data required to evaluate interventions specific to this unique client population, and allows researchers to share lessons learned with providers serving similar clients in urban settings across Canada.