Transcript No Slide Title

Involving Communities in Multicultural Network: From Screening to Access to Care
Watson, M.R. (1); Izquierdo, A.M. (2); Markey, M. (1); Kaltman, S. (3); and Community Collaborators (4).
(1) Primary Care Coalition of Montgomery County, Maryland (2) Spanish Catholic Center, Washington, DC
(3) Georgetown University Center for Trauma and the Community (4) See list below.
ABSTRACT
This community-based participatory research (CBPR) project aims
to reduce disparities in access to health care among uninsured
African-American, Asian-American, and Latino communities in
Montgomery County, Maryland. Through the participatory research
process, the project seeks to garner suggestions on culturallyappropriate approaches to improve outreach and access to care
specifically in the area of cardiovascular risk factors. Methods: We
are conducting a delayed CBPR (intervention) control study design
to measure the differences in access to care in three groups (African
American, Asian American, and Latinos). Specifically, we first
measured actual return for medical care following a screening
session without carrying out any community outreach efforts; we
then implement the community participatory approach and then, a
year later, we again screen and monitor return for medical care to
determine whether community-based efforts made a difference in
attendance of follow-up appointments. Convenience samples of
Latinos (n=116), Asian-Americans (n=57), and African-Americans
(n=104) were recruited for cardiovascular risk screenings in their
communities, and we measured body mass index, waist-hip ratio,
blood pressure, and blood glucose. Project staff then scheduled
follow-up appointments for at-risk patients at Montgomery County
clinics for the uninsured and tracked patient attendance. Focus
groups are being conducted in the various communities to assess
and document major barriers to health care access and determine
appropriate interventions as suggested by the participating
communities. Ultimately, findings will be used to develop an
innovative, community-based model for improving access to health
care within an established safety net system of care [NIH: 1 R21HL-08400101]
RESULTS
METHODS
Sp. Aim 1
Gathering and documenting
local resources for access to care
% ATTENDING FOLLOW-UP APPOINTMENTS AFTER
HEALTH FAIR (Year 1):
Sp. Aim 2
Validation of Data &
Needs
Sp. Aim 6
Dissemination of
Findings
Sp. Aim 5
Evaluation and Refinement of
CBPR process and
intervention.
Sp. Aim 3
Development of
targeted intervention
Sp. Aim 4
Implementation of our
community-driven intervention
Adaptation of PRECEED-PROCEDE model
Latino
AfricanAmerican
Chinese
Cambodian
Number
screened
112
104
Number
referred
46
11
Number
attending appt
24
6
% attending
57
32
7
0
7
0
100.00%
0
52.17%
54.55%
REASONS FOR NON-ATTENDANCE:
• Other priorities or concerns
• Could not get out of work
• Cost of care
• No one to transport patient (esp. elderly)
At Health Fair:
•Increase opportunities for preventive health promotion and
preventive focus
•Improve services available, especially for uninsured adults
•Increase staff/provider sensitivity and professionalism
•Train laypeople in health advocacy and self-advocacy in order to
help people to navigate the system
•Increase community outreach on services available to the
uninsured, especially through media outlets and by “going where the
people are”
•Increase documentation of needs
•Share findings with local officials
•Provide interpretation services
•Provide relevant documents and information in the appropriate
language(s)
•Focus outreach and screening on uninsured service sector workers
FOCUS GROUP FINDINGS ON MAJOR BARRIERS TO
HEALTH CARE ACCESS: 3 COMMUNITIES
Greatest barrier Barrier #2
Informed consent &
registration
Cardiovascular screening
Latino
AfricanAmerican
Community Collaborators:
• The African American Health Program of Montgomery Co.
• The Asian American Health Initiative of Montgomery Co.
• Capital Technology Information Services, Inc.
• CASA de Maryland
• CBPR Advisory Panel
• The Chinese Cultural and Community Center (CCACC)
• The Latino Health Initiative of Montgomery Co.
• Glorifying Our Spiritual & Physical Existence for Life
(G.O.S.P.E.L.) Program,
• Georgetown University Center for Trauma and the Community
• George Washington University
• Montgomery Cares clinics for the uninsured:
•Community Clinics Incorporated (CCI)
•Community Ministries of Rockville
•Mercy Health Clinic
•Mobile Med
•Proyecto Salud
•Spanish Catholic Center
•Peoples Community Wellness Center (PCWC)
•Pan Asian Health Care (PAHC)
•Holy Cross Health Center
• The National Kidney Foundation of the National Capital Area
• Primary Care Coalition volunteers and interns
• Suburban Hospital
COMMUNITY-SUGGESTED STRATEGIES
FOR INCREASING ACCESS TO CARE:
Follow-up appointment
for at-risk patients
Baseline data collection
Data collected:
Clinical data – cardiovascular screening/ risk factors, i.e., body mass
index, waist-hip ratio, blood pressure, and blood glucose.
Demographic info – gender, age, marital status, occupation,
insurance status, length of time in U.S., country of origin
Acculturation scale – measures acculturation by language used
Social support scale – instrumental, emotional, community-level
Computer literacy index – measures computer ability and access
Post health fair:
AsianAmerican
Barrier #3
System-related Immigration Lack of
barriers
-related
information
concerns
System-related Lack of
Language
barriers
information (provider/
patient
communicati
on)
Language/
Lack of
Long wait for
communication information appointment
Others
Language
Distrust of
medical
system
No one to
accompany
older family
members
•System-related barriers (e.g. poor customer service,
unwieldy eligibility requirements, cost of care, long wait
times, inconsistent quality of care)
•Immigration-related concerns (e.g. fear of approaching a
public location or providing identifying information)
•Lack of information (lack of info on available services,
lack of knowledge about preventive health care
Follow-up phone call to
find out experience at
scheduled
appointment, and if
patient did not attend,
reasons why
Focus groups with health
promoters and community
members to determine major
barriers to health care access and
potential strategies for improving
access to health care.
•Language barriers (No bilingual staff or interpreters
available, providers use unfamiliar terminology, documents
in English difficult to understand)
SIGNIFICANT LEARNINGS THUS FAR
In our community, we found that health fairs were an effective mechanism for
facilitating access to care for uninsured persons. However, community
members pointed out the need for health fairs to have the following attributes:
•Implementation of an educational component, not just flyers and freebees;
•Tendering free medical screenings (not just information);
•Offering follow-up appointments at local safety-net clinics;
•Providing hours and locations (of the fair) that accommodate schedules of
service sector workers;
•Supplying detailed information about public transportation access and/or
providing shuttles to and from health fair site;
•Targeting outreach and publicity prior to the fair to the desired community.
Community advocates, navigators, and/or health promoters who follow
patients through the process can provide important support in assisting
patients to prepare for their appointments (so that they do not get lost in the
follow-up process) – in terms of how to get there, what documents they need
to bring, potential fees, and what to expect at the visit.
If health services provision depends on a set of “eligibility requirements,” these
requirements should consider the barriers for community members to be able
to comply with supplying required documentation.
Learn more about the Primary Care Coalition at: www.primarycarecoalition.org