Womens Health Services at UNHS: Increasing Patient Education and - PowerPoint PPT Presentation

Women’s Health Services at UNHS: Increasing Patient Education and Provider Knowledge of Supportive Community Resources Nykia Burke United Neighborhood Health Services Nashville, TN

Overview Introduction Methodology Results Discussion Recommendations

Introduction • The Problem: • Vanderbilt University’s 2009 Health Report Card gave Tennessee’s women failing grades in every indicator of reproductive/sexual health and modifiable risk factors • The 2013 Health Report Card showed marked improvements in some areas, however health disparities remain evident, especially in minority and low-income female populations. • Community clinics such as the United Neighborhood Health Services family clinics are vital to provision of quality and accessible care, especially for women.

Background: Reproductive Health Scores • All measures of reproductive health declined from 2006 to 2011 across all races • African American women received 3 out of 5 Failing scores for reproductive health measures • African American and Hispanic women received THREE failing scores in rates of sexually transmitted infections. • White women received top marks in all four categories.

Background: Causes of Death for Women • Top 5 Causes: • Heart Disease • Stroke • Lung cancer • Breast cancer • Diabetes • Many of these causes of death are impacted by easily modifiable risk factors such as: Hypertension • • High cholesterol • Diabetes • Smoking • Diet/Exercise habits • Overweight/Obesity

Background: Modifiable Risk Factors

Background: Preventive Health

Background: Barriers to Health As of 2009, 683,000 Tennesseans remain uninsured.

Background: United Neighborhood Health Services (UNHS) • Provides care to residents of Davidson County Tennessee, including the city of Nashville. • 9 Family Clinics • 2 Homeless Services Clinics • Population Demographics: • 601,222 residents • 51.5% female. • 56.3% white, non-Hispanic or Latino • 28.4% African American • 10% Hispanic or Latino. • 12% foreign-born • half of that number immigrated to the area within the last 14 years. (2010 US Census) • In 2012, Nashville had the fastest growing immigrant population of any American city and now is home to large Kurdish, Somalian, and Sudanese communities.(Nashville.gov)

Background: UNHS Women’s Health Services • Preconception counseling • Prenatal care (up to 32 weeks gestation) • Behavioral health services • Chronic disease management • Screenings • Strong Start Prenatal health education program

Background: UNHS Women’s Services Awareness and Education Current Women’s health specific marketing and education includes: • ONE exam room poster “Important Screening Tests for women” • One brochure for smoking cessation while pregnant

Background: Strong Start • Centers for Medicare and Medicaid Services 4-year grant • Prenatal Health Education program • Primary goals: To increase timely access to prenatal care thereby reducing infant mortality and low-birth weight deliveries. • Targets at-risk women(low-income, uninsured, under-insured,etc) • Recruits participants primarily through office visits • Any patient seeking a pregnancy test at a UNHS clinic is supposed to receive counseling about and become enrolled in Strong Start • Once enrolled, patients receive Trimester booklets, support via phone, and at least one home visit during pregnancy. • Contributes to the FIMR Barriers Committee • Goal: To increase the number of women benefiting from timely prenatal care • LIMITED outreach to the community about the program

Proposed Intervention The proposed intervention seeks to address the significant health disparities facing minority and low-income women utilizing the UNHS clinic system. Goals: • To assess the health education needs and interest of female patients seen specifically in the Cayce and Main Street family clinics. • To develop marketing and educational materials specific to women’s health. • To develop a compiled single source of resources available for women in the community for use by both providers and patients.

Methodology: Key Informant Interviews • Conducted over 6-weeks • Each Key informant was asked a series of standard questions as well as questions tailored to their role and level of community engagement. • Selection based on role in and level of interaction with the community. • A Total of 14 interviews completed: • UNHS Health Promotion Coordinator • Strong Start Program Coordinator and two Health Coaches • Cayce Family Clinic Obstetrician/Gynecologist • Main Street family clinic Family Medicine Physician • Co- Program coordinator of the Tied Together parenting program at the Martha O’Bryan Community Center Three Department of Public Health TENNDer Care employees, representing the Welcome Baby program, youth outreach, and • community health Cayce Family Clinic Director • UNHS Board president. • UNHS Chief Medical and Chief Executive Officers •

Methodology: Women’s Health Questionnaire Developed to assess women’s health needs and education interests

Results: Key Informant Interviews • 14 total interviews • 100% indicated that Tennessee’s failure to expand Medicaid has been the biggest challenge associated with provision of care and overall health for the communities served at UNHS clinics. Other common obstacles included: • • language and cultural barriers • lack of communication between national and state agencies responsible for assisting with navigation of the new, online health insurance marketplace. • limited financial and staff resources • Health care needs identified included: Assistance obtaining health insurance • • Complex chronic disease management development of prenatal health education classes • • Health education and outreach • Increased awareness and utilization of pre-conception counseling and prenatal health services, More easily accessible translation services •

Results: Women’s Health Questionnaire • Reasons for the clinic visit ranged from • 37 surveys collected: routine follow-up and diabetes care to • Cayce Family Clinic(10) prenatal care and annual exams. • Main Street Family Clinic (15) • Tied Together (12) • Respondents ranged in age from 14-46

Results: Women’s Health Questionnaire • 65% of all respondents had received an annual exam/Pap smear within the last year • 87% within three years. • Of the five respondents who had not receive an annual exam/Pap smear in three or more years: • 3 were age 41+ • 2 were age 14-30

Results: Women’s Health Questionnaire • 75% of respondents were either currently or had ever been pregnant • 93% received prenatal care during their pregnancy. • During their last pregnancy, 65% of respondents saw their physician for prenatal care 1 or more times per month, 27%, every 2-3 months, and 8%, only 1 or 2 times before delivery. • Of women who were currently or had ever been pregnant, only 46% reported ever being offered any pregnancy related educational materials or classes. • 93% had never heard of the Strong Start program.

Results: Women’s Health Questionnaire Information that patients thought might be helpful before, during, and after pregnancy.

Results: Women’s Health Questionnaire • 39% of women expressed some level of interest ( somewhat interested, interested, or very interested ) in participating in free prenatal classes • 66% of women expressed some level of interest in participating in free, monthly women’s health classes or educational workshops held at local clinics or community centers

Results: Women’s Health Questionnaire Health topics patients would like to see presented during free women’s health classes or educational workshops

Discussion: • UNHS family clinics see a variety of patients, children to the elderly. • These clinics are vital to the health of the lower-income, uninsured, and under- insured as services are offered regardless of the patient’s ability to pay. • Because the State of Tennessee did not expand Medicaid after implementation of the Affordable Care Act, the number of uninsured or underinsured has increased in Tennessee. • Minorities, including the growing immigrant population, were most significantly impacted by the new legislation. • Sliding fee scale services and low co-pay options increase accessibility to preventive health care for those who may otherwise delay care or overuse emergency rooms due to un-insurance or an inability to pay for services. • Preventive healthcare for women is especially important as it covers a wide range of needs including chronic disease management, preconception health, prenatal care for mother and baby, and other disease prevention measures.