Background
With an
ever increasing number of individuals living with chronic and terminal
illnesses, palliative care as an emerging field is poised for unprecedented
expansion. Today’s rising recognition of its key role in patients’ illnesses
has led to increased interest in access to palliative care. It is known that
homelessness as a social determinant of health has been associated with
decreased access to health resources in spite of poorer health outcomes and
some would argue, higher need. This article aims to discuss the current state
of affairs with regards to accessing palliative care for the homeless in
Canada.
Discussion
Recent
review of the literature reveals differential access to palliative care
services and outcomes with differing socio-economic status (SES). Notably,
individuals of lower SES and in particular, those who are homeless have poorer
health outcomes in addition to poor access to quality palliative care. Current
palliative care services are ill equipped to care for this vulnerable
population and most programs are built upon an infrastructure that is
prohibitive for the homeless to access its services. A preliminary review of
existing Canadian programs in place to address this gap in access identified a
paucity of sporadic palliative care programs across the country with a focus on
homeless and vulnerably-housed individuals. It is apparent that there is no
unified national strategy to address this gap in access.
Summary
The changing
landscape of the Canadian population calls for an expansion of palliative care
as a field and as many have put it, as a right. The right to access quality
palliative and end of life care should not be confined to particular population
groups. This article calls for the development of a unified national strategy
to address this glaring gap in our healthcare provision and advocates for
attention to and adoption of policy and processes that would support the
homeless populations’ right to quality palliative care.
Below: Modelled vs. observed: (a) HIV prevalence, (b) cervical cancer incidence, (c) cervical cancer mortality. Sources: HIV prevalence [57]; cervical cancer incidence [58], cervical cancer mortality [59]. CC, cervical cancer; HIV, human immunodeficiency virus; HIV+
Below: One-way price sensitivity analysis: (a) base case analysis, (b) scenario analysis. BC, base case; GDP, gross domestic product; HIV, human immunodeficiency virus; HIV+, HIV-positive; ICER, incremental cost-effectiveness ratio; ZAR, South African Rand
Below: Sensitivity analyses: impact of vaccine efficacy: (a) base case analysis, (b) scenario analysis. CC, cervical cancer; GDP, gross domestic product; ICER, incremental cost-effectiveness ratio; ZAR, South African Rand
Below: Impact of duration of protection in HIV+ subpopulation: (a) overall population, (b) HIV+ subpopulation. BC, base case; CC, cervical cancer; GDP, gross domestic product; HIV, human immunodeficiency virus; HIV+, HIV-positive; HIV-, HIV-negative; ICER, increment
Below: Sensitivity analyses: impact of HIV mortality rate in the HIV+ subpopulation. CC, cervical cancer; GDP, gross domestic product; HIV, human immunodeficiency virus; HIV+, HIV-positive; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life year
Below: Cost-effectiveness acceptability curves for the base case and scenario analysis. ZAR, South African Rand
1Health Economics, GSK Vaccines, Avenue
Fleming 20, Wavre, 1300, Belgium
2Health Economic Research, HEXOR (Pty) Ltd,
Block J, Central Park, 400 16th Road, Midrand, Republic of South Africa
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