Our project aimed to create and study a neurology clinic targeted towards marginalized patients in the City of Toronto. Specifically, we wished to understand the neurological care needs of this population to better serve them. Marginalized patients include but are not limited to patients with any of the following identifies: LGTBQ+, racialized, uninsured, low income, homeless, refugees, indigenous, and/or disabled.

Research into the social determinants of health shows that marginalized patients have worse health outcomes. A number of clinical programs exist for internists and psychiatrists in Toronto to reach out specifically to marginalized patients, but none existed for neurology.

We created a weekly half-day general neurology clinic based out of St. Michael’s Hospital  with outreach days to see patients in homeless shelters. We contacted community partners to solicit neurology referrals. Then, we analyzed our clinic records to understand the demographics of our patient population, their neurological complaints, and our rates of no show.

Our patients had a wide array of neurological disorders often in advanced stages including seizure, stroke, cognitive impairment, functional neurological disorders, multiple sclerosis, Parkinson’s disease, neuropathy, and migraine. Our clinic had a 35% no show rate due to homelessness, substance use, mental illness, and death. Approximately 7% of our patients died before presentation to our clinic and sometimes due to seizure or stroke.

Marginalized patients have significant unmet neurological care needs with high morbidity. Outreach to community partners with experience working with marginalized patients can help facilitate referrals to neurological care. Marginalized patients have high no show rates, but this can be mitigated by meeting patients in familiar spaces like clinics embedded in homeless shelters and community care centres.