Assessing the Primary Care Needs of Women in Middle TennesseeJacquelyn Favours, MPHcTSU – MPH Program Capstone PresentationMay 7th, 2015

Overview

Health Care Access for Women in the U.S.

Planned Parenthood of Middle & East Tennessee – Internship Site Current Planned Parenthood healthcare services

Capstone Project – Goals & Objectives

Capstone Project – Results

Project Recommendations – Site, Students, & Future Studies

Lessons Learned

Acknowledgements

Health Care Access Definitions

Primary (Preventive) Care11,12

• Concept used to describe nature of services & provider type

• Integrated/coordinated, affordable & accessible, first-contact, long-term

• HHS – “Services which help you avoid illness & improve health”

Comprehensive care for patient

needs

Integration; Coordination of

care

1st contact access for each new

need

Long-term focused care

Primary Care

Health Care Access Definitions Health Care Safety Net

• Public or private health care providers that deliver care in a variety of settings to a diverse patient population, who are other wise unable to afford or access care

Health Care Safety Net4

What are the issues with women’s preventive care in

the U.S.?

Issues in Women’s Preventive Health in U.S.

Primary Care Physicians (PCPs)• Shortage in U.S. – 1: 88315,16

• Low % of uninsured & underinsured patients

• No clear cut definition for primary care vs. reproductive care - misdiagnosis & underdiagnoses1

Inconvenient Healthcare Expectations10

• PCP & OBGYN – fragmentation

• Belief that annuals consist of all preventive health care services

Uninsured, Underinsured, & Low-Income• Most likely to not identify a PCP

• Rely solely on family planning clinics1

Coverage GapGarfield, R., Damico, A., Stephens, J., & Rouhani, S. (2015). The coverage gap: uninsured poor adults in states that do not expand Medicaid – an update. The Henry J. Kaiser Family Foundation. Retrieved from http://kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid-an-update/

Scope of the Problem – Coverage Gap

The Coverage Gaps in Tennessee17

Approx. 284,000 uninsured in TN – 44% women

66% of uninsured women see cost as a barrier vs. 24%

insured- Not qualified for Medicaid in TN

- Not qualified for tax credits

Women who need preventive care the most continue to fall through the gaps of the fragmented U.S. health care system1.

Don’t receive full extent of recommended primary care.

At higher risk for chronic diseases.

Continue to face barriers to health care.

Miss opportunity to prevent/treat disease and illness at the initial stages.

The Big Picture

U.S. Health Reform PassedAdditional & “Free” Preventive Services

for Women1

Women are now accessing “affordable” health care insurance

Health Care Status for Women in the U.S.

Preventive Health Services for Women

under Health Care Reform

http://www.ghcbettertogether.com/basics/womens-health-care/

Capstone ProjectWhat strategies can be put in place to diminish the gap in health care access for women in TN?

Planned Parenthood of Middle & East Tennessee (PPMET)– Nashville Health CenterInternship Site – June 2014 to August 2014

1 Central Office (London) 6 Regional Offices:

- New York, Western Hemisphere

- Nairobi, Africa- Tunis, Arab World- New Delhi, South Asia- Kuala Lumpur,

East/South East Asia & Oceania

- Brussels, European Network

Located in all 50 states & D.C. – 65 affiliates nationally

3 clinics: Nashville, Knoxville, & Johnson CityCovers 76 of 95 counties in TN & 39

Southeastern counties in KY. Serving nearly 20,000 women a year

Mission – “…provide access to reproductive, sexual, an complimentary healthcare and complimentary sexuality services and education…protect the right to privacy … for men, women, and teens. On the belief that … an individuals' pursuit of sexual health is essential to one’s well-being regardless of race, age, income status, religion, or sexual orientation.9”

Health Services Offered:- Sexual Health Education- Contraception- Gynecological care- Family planning counseling- HIV testing/counseling- STI screening & treatment- Prenatal care- Primary care- General health care- Specialized care referrals

PPMET & Primary Care Expansion- By expanding primary care services to serve as a safety net for low-income, underserved, & uninsured patient population.

Potential Services:• Check-ups• School physicals• Immunizations (influenza, pertussis,

hepatitis)• Minor health problems (strep throat,

bladder infections)• Chronic disease management

(hypertension, asthma, diabetes, smoking cessation, weight management)

Capstone Project – Goals & Objectives Determine PPMET’s potential

for expanding to full extent of primary care services for women 18 – 49.

• Identified primary care service parameters for needs assessment form patient charts

• Analyzed data from primary data collection

• Interpreted findings to indicate if need for expanded primary care exist

• Drafted final report

Facilitate PPMET’s primary service delivery to target population through recommendations.

• Assessed patient & public opinions on use of primary care from PPMET

• Determined conduciveness of political environment and funding opportunities

• Identified strategy for expansion of primary care

Project Activities

- Primary Care Needs Assessment for Existing Patient Population.

Data Collection

Created instrument in REDCap

Collected data on demographics, social risk factors, vitals, medical history, & medications

450 patient records surveyed

Data Analysis Results

Exported data from REDCap to Excel

Case Summaries

Presented to Ad Hoc Primary Care Committee

Results – The Breakdown

292 women of reproductive age (18-49) 65% overall- Presence of chronic disease

contributors- Only small % of chronic disease

detected

Surveyed Responses- 120 TSU students - 61% would consider using primary

care services

Table 1.2 – Needs Assessment Health Indicators of Females 18 - 49 Frequency Percentage (%) Vitals Overweight/Obesity 115 40% High Systolic Blood Pressure

99 34%

Behavioral Risk Cigarette Smokers 66 23% Alcohol Consumption 116 40% Health History Migraines 84 29% Thyroid Problems 13 4% Asthma 32 11% High Cholesterol 13 4% Anemia 49 17%

Results – Demographic Breakdown

White

60%

Black

25%

His-panic9%

Asian3%

Females Patients Age 18 – 49 by Ethnicity

WhiteBlackHispanicAsianAmer. Indian/Pacific Is-landerOther

Results – A Closer Look: Overweight & Obesity

Asian

Black

Hispanic

Indian/Pacif

ic Isl

ander

Other

White

0

10

20

30

40

50

60

Overweight/Obese Female Patients 18 - 46

by Ethnicity

ObeseOverweight

Ethinicity

Per

cen

tage

18 - 23 24 - 29 30 - 34 35 - 39 40 - 460%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ov er w eig ht/ Obes e Fem al e P at i e nt s 18 - 46

by Ag e and E t hnic it y

OtherAmer.Indian/Pacific IslanderAsianBlackWhite

Age Group

Per

cent

age

Recommendations for PPMET

Expand primary care services? – YES. To extent of recommended preventive services for women

Seek use of resident/students from partnering nursing and medical schools to provide primary care.

Launch campaign for service expansion Ex. “More Than What You Think” Campaign – used by Planned

Parenthood Action Fund (PPAF)

Set up program for patient centered medical home for women 18 – 49 – “Primary Care Safety Net”

Recommendations for PPMET (cont.)

Primary Care Safety Net Program

1. Screen patients for insurance & PCP2. Target uninsured and/or unable to identify

PCP3. Provide initial primary care; schedule next

annual appt.4. Monitor/survey use of healthcare services5. Provide reminders & follow ups for

program6. Maintain well-documented program for

prospective funding purposes and program retention

Recommendations Future Studies & Students

Explore preferences for family planning clinics vs. private practice Assess use of services by PPMET vs. Federally Qualified Health

Centers (FQHCs). Consider public perceptions of Planned Parenthood clinics. Explore strategies to fill gaps or create coordinated women’s health care. Evaluate primary care services, if expanded by PPMET. Maintain communication with preceptor(s). Be innovative!

Lessons Learned

• Healthcare gaps remain despite efforts to break barriers.

• Most women of reproductive age prefer women’s health clinics due to cost & confidentiality.

• Funding is essential to primary care expansion, but controversial for the context of PPMET.

• Do not underestimate data collection!

• Focused scope of Public Health Interests.

Acknowledgements Planned Parenthood of Middle & East

Tennessee

Ad Hoc Primary Care CommitteeDr. Ellen Clayton, Committee ChairMr. Steven Emmert, PPMET COO & PreceptorDr. Maureen Sanderson, P.I. & PPMET Board Ms. Denis BentleyMs. Tracey George, PPMET BoardMs. Dakasha Winton, PPMET Board

Ms. Mary Kay Fadden, MMC Supervisor

TSU – Master of Public Health ProgramDr. Mohamed Kanu, Program Director & Field Placement CoordinatorDr. Elizabeth Brown, Faculty AdvisorDr. Elizabeth Williams, Capstone AdvisorMs. Jessica Powell, MPH Program Manager

The TSU MPH Graduating Cohort of Spring 2015!

References 1.Committee on Preventive Services for Women; Institute of Medicine. (2011). Clinical preventive services for women: closing the gaps. The National Academies Press. Retrieved from http://www.nap.edu/catalog/13181/clinical-preventive-services-for-women-closing-the-gaps

2.Frost, J.J., Gold, R.B., & Bucek, A. (2012). Specialized family planning clinics in the United States: why women choose them and their role in meeting women’s health care needs. Women’s Health Issues, 22 (6), e519-e525. doi: 10.1016/j.whi.2012.09.002

3.Hoffman, E., & Johnson, K. (1996). Women’s health and health reform: who will deliver primary care to women? Yale Journal of Biology and Medicine, 68 (1995), 201-206. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588945/pdf/yjbm00039-0048.pdf

4.Jones, A.S., & Sajid, P.S. (n.d.). A primer on health care safety nets. Robert Wood Johnson Foundation. http://www.rwjf.org/content/dam/farm/toolkits/toolkits/2009/rwjf50923

5.International Planned Parenthood Federation. (2013). About IPPF. IPPF. Retrieved on April 14, 2015. http://www.ippf.org/about-us

6.Martinez, G., Chandra, A., Febo-Vasquez, I., & Mosher, W. (2013). Use of family planning and related medical services among women aged 15-44 in the United States: national survey of family growth, 2006 – 2010. National Health Statistics Reports, 68, 2-16. http://www.cdc.gov/nchs/data/nhsr/nhsr068.pdf

7.Planned Parenthood Federation of America Inc. (2014). Who We Are. Retrieved on April 14, 2014. http://www.plannedparenthood.org/about-us/who-we-are

8.Planned Parenthood of Middle & East Tennessee, Inc. (2015). Who We Are. Retrieved on April 14, 2014. http://www.plannedparenthood.org/planned-parenthood-middle-east-tennessee/who-we-are

9.Saleeby, E. & Brindis, C.D. (2011). Women, reproductive health, and health reform. American Medical Association, 306 (11), 1256-1257. http://jama.jamanetwork.com/article.aspx?articleid=1104344

10.Shi, L. (2012). The impact of primary care: a focused review. Scientifica, 2012, 22. htpp://dx.doi.org/10.6064/2012/432892

11.Starfield, B., Shi, L., & Macinko, J. (2005). Contribution of primary care to health systems and health. The Milbank Quarterly, 83 (3), 457-502. http://www.commonwealthfund.org/usr_doc/Starfield_Milbank.pdf

12.Stormo, A.R., Saraiya, M., Hing, E., Henderson, J.T., & Sawaya, G.F. (2014). Women’s clinical preventive services in the United States: who is doing what? JAMA Internal Medicine, 174 (9), 1512-1514. http://archinte.jamanetwork.com/article.aspx?articleid=1885467 doi:10.1001/jamainternmed.2014.3003

13.Sugerman, S., Halfon, N., Fink, A., Anderson, M., Valle, L., & Brook, R.H. (2000). Family planning clinic patients: their usual health care providers, insurance status, and implications for managed care. Journal of Adolescent Health, 27 (1), 25-33. http://www.jahonline.org/article/S1054-139X(99)00126-3/pdf

14.The Henry J. Kaiser Family Foundation. (2015). Primary Care Physicians by Field. KFF. Retrieved from http://kff.org/other/state-indicator/primary-care-physicians-by-field/

15.U.S. Census Bureau. (2015). State & County Quickfacts – Tennessee. U.S. Census Bureau. Retrieved from http://quickfacts.census.gov/qfd/states/47000.html

16.U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. (2013). Women’s health USA 2012. HHS. Retrieved from http://www.mchb.hrsa.gov/whusa12/index.html

17.National Women’s Law Center. (n.d.). The affordable care act and covering more women and families in Medicaid. NWLC. Retrieved from (http://www.nwlc.org/sites/default/files/tennessee_0.pdf

Questions?