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
• ut of 5 Failing scores for reproductive

health measures

• African American and Hispanic women

received THREE failing scores in rates

• f 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
• f 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
• f 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

• 37 surveys collected:
• Cayce Family Clinic(10)
• Main Street Family Clinic (15)
• Tied Together (12)
• Respondents ranged in age from

14-46

• Reasons for the clinic visit ranged from

routine follow-up and diabetes care to prenatal care and annual exams.

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.

Discussion: Support for Increased Health Education and Awareness

• The 2009 and 2013 Vanderbilt University Women’s Health Report Cards

indicate that while health conditions are improving in some areas for Tennessee’s women, there is huge opportunity for improvement as effort is made to achieve Healthy People 2020 goals.

• Most importantly, the data shows that minority women suffer

disproportionately from failing grades in key health measures.

• Health education and community outreach have been successful methods
• f improving health, especially in low-income and minority populations.
• In addition to the potential to reach large numbers of potential patients,

health education materials such as one page handouts, are inexpensive, easy to reproduce, and a sustainable method of on-going education.

Discussion: Support for Increased Provider Awareness and Knowledge

• Development of a brief “go-to” resource brochure specific for

healthcare providers was supported by dialogue with key

• informants. Programs and activities from local community centers,

public health departments, health facilities, and/or schools may provide the support patients need to be successful.

• Although there were a number of resources available to patients

in the community, many providers vocalized a desire to have such resources in a compiled, more easily accessible format. The provider’s brochure was designed to be accessible, easily updateable, and sustainable. It may increase knowledge of available resources and assist with on-going total care of the patient.

Discussion: Strengths, Weaknesses, and Limitations

• Strengths:
• inclusion of multiple stakeholder perspectives
• use of a peer and public health expert reviewed surveying tool
• development of useful, sustainable education, outreach, and engagement marketing materials.
• Engagement with key stakeholders to initiate dialogue around implementation of future interventions

including the free monthly “Women’s Health Wednesdays” education workshops

• Weaknesses:
• Small sample size
• Challenges connecting with essential community stakeholders to interview such as patients and local

housing authorities.

• Inability to facilitate a focus group
• Limitations:
• Amount of time on site.
• No data from previous assessments of UNHS clinics available to use as a guide for development of

the independent service learning project, or to support the proposed interventions.

Recommendations

• Preliminary data from the women’s health questionnaire indicated some

interest in free health education workshops and prenatal health classes. However, the small number of surveys collected may not be indicative of the entire population. Therefore it may be beneficial to conduct surveying

• n a larger scale, including more clinics and surveys in different languages,

to better assess interest.

• Development of “Women’s Health Wednesdays” free education sessions

held at local schools, community centers, and housing authorities may increase overall health knowledge as well as awareness of services available at UNHS clinics and increased utilization of UNHS facilities. This may further support community acceptance of the Patient Centered Medical Home Model as women may be more inclined to receive all healthcare at their local clinic.

• Utilization of local medical students as health educators for the sessions may ensure

consistency, reduce financial burden, and increase overall community resource capacity.

References

• CDC. "Centers for Disease Control and Prevention Mortality Data." 30 July 2014. Centers for

Disease Control and Prevention. 25 July 2014. <http://www.cdc.gov/nchs/deaths.htm>.

• Law, David J, et al. Tennessee Pregnancy Risk Assessment Monitoring System 2009

Summary Report. Summary Report. Nashville, 2009.

• TN Department of Public Health. "Tennessee Pregnancy Risk Assessment Monitoring

System." n.d. Tennessee Department of Public Health. July 2014. <http://health.state.tn.us/statistics/PRAMS/index.htm>.

• United States Census Bureau. "United States Census Bureau State and County Quick Facts."

8 July 2014. United States Census Bureau. 25 July 2014. <http://quickfacts.census.gov/qfd/states/47/4752006.html>.

• Unknown. Mayor's Office: Priorities, New Americans. 2014. Article. 25 July 2014.

<http://www.nashville.gov/Mayors-Office/Priorities/Neighborhoods/New-Americans.aspx>.

• Vanderbilt Institute for Medicine and Public Health, Women's Health Research. 2009

Tennessee Women's Health Report Card." 2009. http://medicineandpublichealth.vanderbilt.edu/twhrc/2009whrc.pdf. 2 June 2014.

• Vanderbilt Institute for Medicine and Public Health 2013 Tennessee Women's Health Report
• Card. 2013. Vanderbilt Institute for Medicine and Public Health. July 2014.

<https://medicineandpublichealth.vanderbilt.edu/twhrc/2013whrc.pdf>.

Acknowledgements

Thank you to everyone who assisted with the guidance and completion of this Independent Service Learning Project:

• GE- National Medical Fellowships Primary Care Leadership

program

• Will Wyatt-UNHS Health Promotions Coordinator. GE-NMF

PCLP Site Supervisor

• William Richie, MD.- Meharry Medical College. GE-NMF PCLP

Faculty Advisor

• Key Informants:
• Chyla Powe and Jerica Randolph- Strong Start Health Coaches