An Assessment of the Barriers to Rendering and Receiving Preventative Care at the Center for Community Health Ngozi Emuchay, JWCH – Center for Community Health, Los Angeles, CA
GE – National Medical Fellowship, Primary Care Leadership Program Pur urpose: pose: To provide students with the unique opportunity to gain a better understanding of the challenges and rewards that come along with practicing primary care in community health centers across the country. Goals: ls: To encourage future health care professionals to pursue a career in primary care To foster leadership development by paring each participant with a health center senior staff mentor
How I Spent My Time at the CCH • Expl plorin oring g some e of the e res esour urces, ces, ser ervic ices es, , an and d pr progr grams ms in in pl place e at the e JWCH • PCMH • PATH Mobile Unit • Downtown Women’s Center • Shado dowi wing g di differ erent ent clin inic icia ians s • Lea eade dership ip Trai aini ning ng • Inde depe pende dent Project oject
Introduction • Downward trend in preventative care health screening, • Specifically mammograms, PAP, and Hemoccult testing • Purpose rpose: To asses ess the e spe pecif ific ic challe lenges ges and b d barrie iers s faced ed by the e home mele less s pa patie ient po popu pulati tion on at the CC e CCH in in r rec ecei eivin ing g pr preven entati tive e care
Background • Barriers to care according to previously conducted studies: 1. 1. “Difficulty meeti eting ng subsist istence ence needs (securing ring food, , shelter, , cloth othing, ing, a place e to wa wash, h, bathroom m facilities) lities) may be contrib ibut uting ing to the observed pattern rn of health h behavio vior r whereby y homeless ss adults lts do not ot seek pre revent ntativ ative care re or r care re in the earl rly stages s of illness ss, , but delay y seeking ing care until il their r need is acute.” • "Competing priorities as a barrier to medical care among homeless adults in Los Angeles." Gelberg, Lillian, et al. 2. 2. “Health is not ot a pri riorit rity y for r homeless s people.” • “Access to women's health care: A qualitative study of barriers perceived by homeless women.” Gelberg, Lillian, et al. 3. 3. “Transportation and scheduling duling can be p partic ticul ularl arly y burdensome.” • “Access to women's health care: A qualitative study of barriers perceived by homeless women.” Gelberg, Lillian, et al.
Methodology • (I) On One on one intervie views ws with h patie ient nts assessin ing the following wing: • Regular source of care • Family history • Thoughts and beliefs about preventative care • Perceptions about barriers to care • (II) ) On One on one intervie views ws with th provide iders rs assessing sing the followi wing ng: • Beliefs about barriers patients face • Challenges providers face in rendering preventative care • Suggestions for improving the trends in preventative health screenings • (III) I) Compariso arison n betwee etween n what t patients ients believe are the barrie iers s they face to a accessing sing prevent ntativ ative care and the providers’ beliefs
Key Findings – From the Patients’ Perspective • Reg egular ular sour urce ce of ca care: e: 1. Do you have a regular provider here? • Majori rity ty of particip cipants ants are regular r patients ents of the e CCH, , 20 of 30 responde ponded d yes to having ing a regular ular provi vider der here re 2. How often do you see this provider? Of the 20 who responded yes to the above question: • Once ce a month nth: : 13 13 • Ev Every y three ree mon onth ths: s: 1 • Sparing ingly ly OR when en presenti senting ng sympt ptoms: oms: 4 • Didn’t answer: 2
Key Findings – From the Patients’ Perspective • Reg egular ular sour urce ce of ca care: e: 3. Do you have any chronic medical conditions such as hypertension or diabetes? • 24 of 30 partici icipants ants had at least t one e chron onic ic illness ess • Of Of thos ose 24, , 16 had more re than n one ne of the e chronic onic illnes ess 18 18 16 16 14 14 12 12 10 10 8 6 4 2 0 High igh BP BP High igh Diab iabete etes Asthm hma Hear eart HIV Chole Cho lester erol ol Prob oble lems
Key Findings – From the Patients’ Perspective • Fam amily ly Histor ory: : 1. Are you aware of any illnesses that are common in your family? (Such as cancers, diabetes, high blood pressure…) • The e majori ority ty (24/30 /30) ) had a p positiv sitive e fami family ly hist stor ory y for one ne or more re preventable entable chron onic ic illness ess
Key Findings – From the Patients’ Perspective • Per erce ceptions ptions ab about t Pr Preventativ ntative e Care: are: 1. Has anyone here or anywhere else ever talked to you about preventative care? • Abo bout ut half lf answ nswered ered yes es (1 (14/3 /30) 0) and nd half lf ans nswered ered no no (1 (16/3 /30) 0)
Key Findings – From the Patients ’ Perspective • Per erce ception tions s ab abou out t Pr Preven entativ tative e Ca Care: • What do the patients think preventative care is? “Doing things that you need to do to keep you healthy” “Exercising and eating right” “Doctor explaining ways to get diabetes and ways to keep from getting diabetes” HIV V test sting ing ⓧ “A disease” ⓧ “Medical treatment you get if you can’t get to the e doctor” ⓧ “Getting on Health althyway LA” ⓧ “I don’t know”
Key Findings – From the Patients’ Perspective • Per erce ceptions ptions ab about t Pr Preventativ ntative e Care are: 3. If the doctor recommended some tests that would help them see whether or not you are at risk for certain cancers and illnesses would you be willing to take those tests? • Al All of the patients ents said that t they y would d take e the e preventa entati tive e tests ts if the e doctor or recom comme mend nded ed them em 4. How important do you think it is to take these tests on a scale from 1 to 5, 5 being extremely important? • Al Almost ost ever ery y patient ent ranked ed the e impor mporta tanc nce e of health alth scree eenin nings gs at a 5 5 and expre ress ssed ed a desire ire to kno now w what t is going ng on with th thei eir r health th espec speciall ially y as s they y are aging g
Key Findings – From the Patients’ Perspective • Bar arrier riers s Car are: • Is there anything can you think of that keeps you from coming here? • Overa rall ll mos ost t peopl ple e could uld not ot think ink of any barrier riers that t would uld keep ep them em from om coming ming here re or from om comi ming ng back. . Of those ose that t did come me up up with h possi sible ble barrier riers, s, the e follo lowing wing were re given: en: • Not ot having ng a place e to live creat ated ed many y obst stacles cles • Makes it difficult to keep up with medications • No place to store belongings while at the clinic • Having ng to take e pub ublic c transpor nsportation tation to get et here re • Many of the people that relied on public transportation to get the CCH either had to take multiple buses to get here or often times did not have money to pay the bus fare • Making ing it to referr erral al appointm ntmen ents ts for PAP AP/mammo mammograms rams can be difficult cult • Wait t time me
Key Findings – From the Providers ’ Perspective • Be Belief liefs s ab about t th the e ba barrier ers s pat atients ients fac ace • What do you believe are the biggest challenges/competing needs patients here face in accessing preventative care? • Ment ntal al illnes ess • Lack ck of trans nspor portation tation • Un Unsta table ble housin sing g • Not ot having ng all servi vices ces available ble at one ne site e • Preventative care is not high on patients’ priority list st
Key Findings – From the Providers’ Perspective • Chal alle lenges nges provide viders s fac ace e in in re rendering ndering pre reventativ entative e ca care re • As a provider, why do you think there has been a downward trend specifically in colon cancer screenings, mammograms, and PAP smears here at the CCH? • Pat Patient ent Non on-com compliance pliance • Many y patien ents ts have e severe ere healt lth h issues ues that t take e up up the e enti tire re visit • NextGen xtGen Issues es • Hard to tell if patient ent has had the e health th scree eenin ning • Ev Even n if it was compl pleted, ed, aud uditor or may have e misse sed d it because it’s difficult cult to find d • So many y other other things ngs that t have been en made de priorit rities ies suc uch as diseas ease e manage geme ment, nt, get etti ting ng organi anize zed d with th integra egrated d servi vice ces, s, PCMH, , et etc
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