208744 Primary care settings for poor and homeless women in Boston

Monday, November 9, 2009: 1:00 PM

Deborah Blazey-Martin, MD , Department of Medicine, Tufts University School of Medicine, Wellesley, MA
Kym Williams , Boston University School of Public Health, Boston, MA
Roseanna H. Means, MD MSc , Department of Medicine, Brigham and Women's Hospital, Wellesley, MA
Background: Despite Massachusetts' 2006 universal insurance coverage legislation, many impoverished women in Boston remain underserved. Women of Means conducted a survey of 50 women who regularly utilized shelter health care services. This showed a discontinuity of primary care with only 4 percent of these women maintaining a relationship with the same provider over five years; 23 percent acknowledged using four or more different "primary" doctors in a five-year period. To further understand this disparity, we initiated a chart review to determine more broadly where poor and homeless women report they get their primary care.

Study Objective: Determine source of primary care for poor and homeless women of Boston using day shelter services.

Methods: Chart review of approximately 1500 records of women seen by Women of Means over the past year at two different day shelters in Boston, PCP and location of service were recorded and placed in a separate database. Names of providers were searched to determine setting using curent lists of MDs, residents and nursees. setting was cross-referenced with provider lists from teaching hospitals, community health centers, private practices, HMOs and Homeless Clinics.

Results: Preliminary results: 179 homeless care, 404 community health centers, 588 academic medical centers, estimated at least half of patients at medical centers are care for by residents. Many women identify a facility without naming a provider.

Conclusion: Impoverished women who access free medical services at day shelters identify PCP's in multiple settings including medical trainees, who by nature cannot provide longitudinal care.

Learning Objectives:
1. Describe the types of settings in which primary care is provided to urban poor 2. Identify the settings and types of providers most often utilized by poor and homeless women using day shelter resources. 3. Articulsate the strengths and weaknesses of each setting and provider type in caring for this vulnerable patinet population.

Keywords: Vulnerable Populations, Primary Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As Medical Director of Women of Means I am coordinating this project and as a physician caring for homeless women I have worked closely with this population.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.