Innovative mobile clinic brings equitable diabetes care to Calgary's underserved communities

A University of Calgary team, led by clinician-scientist David Campbell, has partnered with The Alex Community Health Centre Mobile Health Program to launch a Diabetes Mobile Clinic (DMC) in Calgary, addressing the critical need for accessible diabetes care among underserved groups.

“When faced with homelessness or other major challenges, individuals often prioritize addressing more pressing needs over attending medical appointments,” says Dr. Campbell, MD, PhD, a member of the O’Brien Institute for Public Health and the Libin Cardiovascular Institute at the Cumming School of Medicine (CSM). "Our goal is to ensure that those most in need receive the care they deserve without obstacles." 

As part of a two-year pilot program, the DMC is equipped to screen people for diabetes and assess patients with diabetes for related complications, such as retinopathy and neuropathy. Additionally, diabetes specialty care from an endocrinologist and a diabetes educator are also available.

Combining research and community engagement

"At The Alex, our focus is on supporting individuals who face barriers to accessing care, which includes a significant portion of our population.” says Emma Wissink, clinic manager for youth and mobile health services at The Alex. “Our goal is to increase accessibility. With our mobile health program, we aim to provide essential services, especially in preventive care and improving access to necessary health-care services."

Serving Calgary for over 50 years, The Alex employs a mobile health strategy as a response to the complex health challenges that burden communities in Calgary. Campbell, an associate professor in the departments of medicine and community health sciences at the CSM, worked with the organization to help vulnerable people with diabetes. 

“This partnership with The Alex was really quite fortuitous … they were very supportive, and they’ve been a tremendous partner to work with,” says Campbell. “We have been very fortunate to work with such an engaged ally to make [the DMC] happen.”

Driving improved patient outcomes by enhancing accessibility

The DMC is the first mobile clinic that will provide Calgarians with a range of services and a specialized referral pathway to access diabetes care specialists with expedited follow-ups. 

“What’s unique about this initiative is that we’re providing comprehensive care in a very timely manner, all within one space. This approach ensures that we have all the necessary professionals and services available, making the care both timely and accessible,” says Wissink.

The Campbell research team hopes that the DMC sparks a reorientation of delivering diabetes care that eliminates barriers to ensure underserved people have access to preventive health care.

"Many patients have not been well served by the mainstream medical system, and we hope to see improved engagement with health-care services for these individuals," says Campbell. 

Jeremy Auger, a community member with lived experience of diabetes and homelessness and a co-researcher on the Calgary Diabetes Advocacy Committee who worked alongside Campbell’s research team, hopes the DMC will have a broad impact. “I am excited about the launch of the DMC because I know we are making good change in the community. I joined this project to help people in need so they don’t have to experience what I have — I am happy that the DMC will do that.”

Campbell emphasizes the far-reaching benefits of the DMC, highlighting how its success will positively impact all Calgarians by delivering essential clinical diabetes care to those in need. 

"By reducing the number of hospitalizations due to complications, we can ultimately lessen the burden on our acute care system," he says. “This initiative fosters a healthier community by ensuring that vulnerable populations receive the care and support they deserve."

A SAFER model for providing diabetes care

The DMC is an expansion of the SAFER model that further reduces barriers for people facing disadvantages by going into the community to meet them. 

This new model checks people for diabetes complications by Screening for glycemia (glycated hemoglobin [A1c]), Foot and Eye health, and Renal function (SAFER). This model is designed to provide a more timely and comprehensive way to screen for diabetes and related complications with fewer obstacles for patients. 

SAFER was piloted and offered in clinics at the Drop-In Centre and Mustard Seed Wellness Centre in Calgary for a year in 2022. Campbell’s research group found promising results with the SAFER model of care pilot. It increased uptake and completion of screenings by 75-200 per cent among those who attended the clinics. However, adaptations were needed to serve more people in a comprehensive way. 

Access to care varies for different groups of people. Campbell’s research has found that people who have diabetes and experience homelessness have a higher mortality rate (45 per cent higher than those who are housed), and are twice as likely to have a heart attack or limb amputation. More broadly, people facing financial barriers to their care are 36 per cent more likely to be hospitalized, while Indigenous peoples are six times more likely to be hospitalized. 

Capacity of up to 10 people/day

The mobile clinic has already served several dozen patients and is expected to assist five to 10 people per day once it reaches full capacity. Patients can either drop in or receive scheduled appointments via referral from their health-care provider. On each shift, the clinic is staffed by one or two personnel, which include Campbell (an endocrinologist), a certified diabetes educator, resource specialist, peer support worker, and a nurse.

While specific locations for the mobile clinic are still being finalized, it is anticipated that it will make stops at emergency housing shelters and various other sites throughout the inner city and East Calgary — where specialized diabetes services tend to be less accessible than other parts of the city.

The mobile clinic is made possible by a Healthy Albertan grant from the College of Physicians and Surgeons of Alberta and in-kind contributions from TELUS Health and The Alex.

The DMC was officially launched on July 9 at a community barbecue hosted by The Alex, TELUS and UCalgary. The event was held to raise awareness about the services being offered by the mobile clinic and help educate underserved communities in Calgary about the importance of diabetes.