Preventative Care at the Center for Community Health Ngozi Emuchay, - - PowerPoint PPT Presentation

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

• ring

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

• ject

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

• n 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

• thing,

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

• t 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

• t 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

• f 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

• nth

ths: s: 1

• Sparing

ingly ly OR when en presenti senting ng sympt ptoms:

• ms: 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

• nic

ic illness ess

• Of

Of thos

• se 24,

, 16 had more re than n one ne of the e chronic

• nic illnes

ess

2 4 6 8 10 10 12 12 14 14 16 16 18 18 High igh BP BP High igh Cho Chole lester erol

• l

Diab iabete etes Asthm hma Hear eart Prob

• ble

lems HIV

Key Findings – From the Patients’ Perspective

• Fam

amily ly Histor

• ry:

:

• 1. Are you aware of any illnesses that are common in

your family? (Such as cancers, diabetes, high blood pressure…)

• The

e majori

• rity

ty (24/30 /30) ) had a p positiv sitive e fami family ly hist stor

• ry

y for one ne or more re preventable entable chron

• nic

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

• ut

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

• r recom

comme mend nded ed them em

• 4. How important do you think it is to take these tests
• n a scale from 1 to 5, 5 being extremely

important?

• Al

Almost

• st 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

• st

t peopl ple e could uld not

• t think

ink of any barrier riers that t would uld keep ep them em from

• m coming

ming here re or from

• m comi

ming ng back. . Of those

• se

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
• t 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

• r 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
• t 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

• n-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

• r may have

e misse sed d it because it’s difficult cult to find d

• So many

y other

• ther 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

Key Findings – From the Providers’ Perspective

• Sugg

ggestions estions for improving ving th the e tr tren ends ds in preventati ntative e healt lth h sc screenings nings

• What can you think of that can be done to change the

downward trend the CCH has been experiencing in colon cancer screenings, mammograms, and PAP smears?

• Having

ng some sort of reminde nder r

• Provider

ers have to reall lly y believe e in the imp mportanc tance e of the health lth screening ening tests and nd take on the respons

• nsibil

bility ity of constantly tantly and d consis istently ently urgin ging g patie ient nts to comply mply with them

• Make

e it easier er on the provider ers to actuall tually y get et it done

• Example: “knee-jerk” method: if the patient fits the criteria

then n the test should d just t be ordered ed

• Imp

mprovements ements to Next t Gen so that t aud udit itor

• rs can

an see that t the tests have been done

• Pa

Patie ient nt educati cation

• n

Discussion

• Comparison

parison of Be Beliefs liefs

Discussion

• Pat

Patien ent t No Non-com compliance pliance

• Limi

mited ed Time me wi with th Pat Patients ents

Discussion

• What needs to be done?
• Hea

ealth lth ca care re re reform rm

• Diffuse some of the responsibility placed
• n providers
• Finding a new payment method that

allows for a bigger team approach to care

Discussion

• What needs to be done?
• Health care reform
• Bigge

gger r team am approa

• ach

ch to care

Expansio nsion n of infr frastructure astructure Shared red re respons nsibil ibility ity Increase ncreased d patien ient education ation De Decre reased sed patie ient nt non-com

• mpliance

pliance

Conclusion

• What can be done at the CCH?
• Maxim

imiz ize e NextGe tGen

• Reminders can be electronically generated

to providers to prescribe timely tests or procedures based on the patient’s personal healthcare maintenance needs

• Make

e pr preven entati tive e care e a pr prio iorit ity

Acknowledgements

• Dr. Gregerson
• Kim Tran
• Paul Cha
• The JWCH
• The entire CCH staff
• The patients of the

CCH

• GE - National

Medical Fellowship