Addressing Barriers to Care Using Patient Advocacy, Financial Assistance, and Electronic Medical Record Database Referral System: Experience in Rural El Salvador

Background

Although rudimentary primary care infrastructure exists in rural communities in northeast El Salvador, access to specialty care and diagnostic tests is extremely limited. We designed and implemented a system to help poor, rural patients overcome barriers to accessing this care.

Methodology

In January 2007 we implemented system of intensive advocacy and coordination of care for patients seen in rural clinic and referred for specialty care and diagnostic testing. We also provided funds for travel to receive care and for some diagnostic services and treatment. In September 2008 we implemented custom-designed database to monitor patient care and use of funds. We report on the time period since database implementation.

Preliminary Results

During 1491 patient encounters, 390 (26%) referrals were made, of which 35% were men and 23% were children < 18 years of age. The total amount of money spent was $1363USD with the two major expenses being medications (45%) and transportation (36%). An average of $3.50USD was spent for each referral. 10% of referrals were for emergency care, 57% for specialist consultation, and 33% for diagnostic testing. The most common subspecialty referrals were ophthalmology (28%), orthopedics (9%), general surgery (8%), gynecology (7%), dentistry (6%), and cardiology (6%). The most common barrier to care identified was money for transportation.

Conclusions and Next Steps

Using a triad of systematic advocacy, patient counseling and coordination of care, and modest financial assistance we are facilitating specialty care, diagnostic testing, and treatment for population that has previously been unable to access that care.