Developing primary care services to the hood in Virginia: The effects of good public policy

Richmond City is an urban area with a large minority population subdivided by census tracts. Vast differences exist throughout the city for the primary care needs of all residents. The East End is predominately non-white and is designated medically underserved. The far West End is predominately white with an array of resources.

In 1991, the Virginia General Assembly directed a study to be conducted under the auspices of the Senate Joint Resolution (SJR) 179 designed to assess underserved population groups statewide, and to determine their need for primary care services. At the time of the SJR 179 study, approximately 27,000 persons in Richmond were eligible for Medicaid, with only about 13,000 (less than half) enrolled as Medicaid recipients. To achieve the directive of SJR 179, local health district directors in Virginia were charged with calling together representatives from various communities to assess the primary care needs of the area and to develop an action plan for addressing those needs. A variety of local and city politicians responsible for constituents in their specific region were engaged in this statewide initiative. As a result of the study findings, Virginia Commonwealth University (VCU) partnered with the city of Richmond and more than 30 local community agencies to establish the Richmond Urban Primary Care Initiative (RUPCI). The targeted population for the RUPCI project included approximately 8,000 family members resulting in more than 20,000 patient visits to an established community-based health center during the years of 1995 and 2003. The primary study variable was the three patient residence locations (zip codes) as determined by the South Richmond Health Survey (SRHS). The application of public policy resulting from the Virginia General Assembly's passage of SJR 179 provides other metropolitan areas across the U.S. with an effective strategy for addressing the primary care services needs of vulnerable populations.