Improving access to specialty care: A community response

A limited network of primary health care providers exacerbates the problem of access to specialty care, creating a backlog of up to nine months between referral and specialty care treatment in San Bernardino County, California, where approximately 50 percent of the 1.8 million residents identify themselves as Latinos. In response, a trans-disciplinary coalition designed the Specialty Care Improvement Program (SCIP), a community-managed initiative to determine: a) the extent to which residents obtain specialty care, b) variance in access to specialty care between communities, c) factors associated with better or worse access to off-site specialty services, and d) to develop a strategic plan addressing constraints to specialty care access. SCIP consists of five phases: 1) Capacity building: training of community residents to conduct focus groups and administer surveys. 2) Secondary data analysis: Review previous needs and resource assessments, data on access to health care. 3) Data collection: Cross-sectional survey addressing perceived needs and satisfaction with current care. 4) Data analysis: Based on participatory community action-planning model. 5) Strategic plan: The development of solutions to improve quality and access to specialty health care. This presentation describes the formation of a multi-ethnic, multi-institutional coalition and outlines important considerations in involving the community in different phases of research, including meaningful participation in data collection and analysis. The session also discusses methodological issues in participatory community health planning, and describes steps in the development of a community-based strategic plan addressing access to specialty care.