Increasing Access to Care among Low-Income, Uninsured Populations: Community-Suggested Strategies

While the barriers to health care access have been well-documented, those facing such barriers are rarely involved in developing strategies to address them. The purpose of this community-based participatory research (CBPR) project was to develop community-suggested strategies to reduce access barriers to health care among low-income, uninsured populations in Montgomery County, MD, and to test the impact of a community-suggested strategy on access to care. Methods: A delayed intervention control study was used to measure the differences in access to care. Barriers to health care access and strategies to increase access were elucidated via 15 focus groups (n=100) with local health promoters and uninsured individuals, phone interviews with “no-show” participants who had been scheduled for appointments, and discussions with a CBPR advisory panel and community partners. In the intervention year, we tested the impact of placing an on-site “facilitator” to help address common barriers to attending a scheduled follow-up appointment at safety-net clinics. Results: Attendance at follow-up increased as compared to the baseline year; for African-Americans attendance almost doubled (45% increase: OR= 1.8 (1.07 - 3.14)). Among Latinos, attendance increased 10% (OR= 1.2 (0.8-1.7)) and was four-fold better than attendance for others who did not received the intervention that same year (OR= 4.4 (1.2 - 16.35)). Conclusions: The community-suggested intervention and CBPR process had a positive impact on access to care for participating uninsured patients.