Health status of a low-income vulnerable population in a community health center.

Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA 01655, USA.
The Journal of ambulatory care management 01/2005; 28(1):60-72. DOI: 10.1097/00004479-200501000-00008
Source: PubMed

ABSTRACT Healthcare safety net providers are under increasing pressure to meet the physical and mental health--as well as the range of social service-needs of traditionally vulnerable and hard-to-reach populations. The extent to which health center patients are less well and in poorer health than is the rest of society, thus requiring greater depth and breadth of service, has not generally been the focus of systematic assessment. This case study uses the 12-Item Short-Form Health Survey (SF-12) and selected years of healthy life questions from the National Health Interview Survey to assess the self-perceived health status of patients at one Section 330 community health center in central Massachusetts. Five hundred thirteen patients completed all questions on the SF-12; 619 completed each of the years of healthy life questions. Respondents' physical and mental component summary scores were significantly lower than national norms for all age groups (P < .001). Respondents were also significantly more likely than the civilian noninstitutionalized population to be unable to perform major activities (P < .0001) and to be in fair or poor health (P < .0001). Analyses give an indication of the magnitude of difference in self-perceived health status between this poor, vulnerable population and the citizenry at large and suggest implications for policy related to safety net healthcare facilities.

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    • "Similar to research by Jamal et al. (2012), privately insured patients also were more likely to receive patient teaching and counseling and referrals. Research has suggested that patients with Medicare, Medicaid, or SCHIP insurance typically have higher levels of comorbidity as compared to private or self-payer patients (Cashman et al., 2005; Kronick, Bella, & Gilmer, 2009; Lin, Shaya, & Scharf, 2010). This may result in prioritizing chronic illness management above preventative screenings (Holtrop, Malouin, Weismantel , & Wadland, 2008). "
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    ABSTRACT: Purpose/Objectives: To describe the predictors of nurse actions in response to a mobile health decision-support system (mHealth DSS) for guideline-based screening and management of tobacco use.Design: Observational design focused on an experimental arm of a randomized, controlled trial.Setting: Acute and ambulatory care settings in the New York City metropolitan area.Sample: 14,115 patient encounters in which 185 RNs enrolled in advanced practice nurse (APN) training were prompted by an mHealth DSS to screen for tobacco use and select guideline-based treatment recommendations.Methods: Data were entered and stored during nurse documentation in the mHealth DSS and subsequently stored in the study database where they were retrieved for analysis using descriptive statistics and logistic regressions.Main Research Variables: Predictor variables included patient gender, patient race or ethnicity, patient payer source, APN specialty, and predominant payer source in clinical site. Dependent variables included the number of patient encounters in which the nurse screened for tobacco use, provided smoking cessation teaching and counseling, or referred patients for smoking cessation for patients who indicated a willingness to quit.Findings: Screening was more likely to occur in encounters where patients were female, African American, and received care from a nurse in the adult nurse practitioner specialty or in a clinical site in which the predominant payer source was Medicare, Medicaid, or State Children's Health Insurance Program. In encounters where the patient payer source was other, nurses were less likely to provide tobacco cessation teaching and counseling.Conclusions: mHealth DSS has the potential to affect nurse provision of guideline-based care. However, patient, nurse, and setting factors influence nurse actions in response to an mHealth DSS for tobacco cessation.Implications for Nursing: The combination of a reminder to screen and integration of guideline-based recommendations into the mHealth DSS may reduce racial or ethnic disparities to screening, as well as clinician barriers related to time, training, and familiarity with resources.
    Oncology Nursing Forum 03/2014; 41(2):145-52. DOI:10.1188/14.ONF.145-152 · 1.91 Impact Factor
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    • "More than one third of CHC patients (41%) were uninsured, and about one third (33%) were covered by Medicaid (Bureau of Primary Health Care, 2005). CHC patients also tend to report poorer health status and higher morbidity rates than patients nationally (Cashman et al., 2005; Shi et al., 2001). "
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    ABSTRACT: Community health centers (CHCs) have long served an important safety-net healthcare delivery role for vulnerable populations. Federal efforts to expand CHCs, while potentially reducing the Federal budget for Medicaid, raise concern about how Medicaid and uninsured patients of CHCs will continue to fare. To examine the primary care experiences of uninsured and Medicaid CHC patients and compare their experiences with those of similar patients nationally, cross-sectional analyses of the 2002 CHC User Survey with comparison data from the 1998 and 2002 National Health Interview surveys were done. Self-reported measures of primary care access, longitudinality, and comprehensiveness of care among adults aged 18 to 64 years were used. Despite poorer health, CHCs were positively associated with better primary care experiences in comparison with similar patients nationally. Uninsured CHC patients were more likely than similar patients nationally to report a generalist physician visit in the past year (82% vs 68%, P < .001), having a regular source of care (96% vs 60%, P < .001), receiving a mammogram in the past 2 years (69% vs 49%, P < .001), and receiving counseling on exercise (68% vs 48%, P < .001). Similar results were found for CHC Medicaid patients versus Medicaid patients nationally. Even within CHCs, however, Medicaid patients tended to report better primary care experiences than the uninsured. Health centers appear to fill an important gap in primary care for Medicaid and uninsured patients. Nonetheless, this study suggests that Medicaid insurance remains fundamental to accessing high-quality primary care, even within CHCs.
    The Journal of ambulatory care management 06/2007; 30(2):159-70. DOI:10.1097/01.JAC.0000264606.50123.6d
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    • "A cross-sectional study of 200 patients found that heavy ED users, defined as more than four visits in the previous year, were also heavy users of other services within the health care system, indicating that heavy service users perceived lower social support (Byrne et al., 2003). A study of the health of persons receiving care at federally funded community health centers (CHC) utilized a self-administered survey related to patient satisfaction, sociodemographics, and self-reported health status (Cashman et al., 2004, p. 61-62). "
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