232070 Addressing disparities through curbside community connections

Tuesday, November 9, 2010 : 8:50 AM - 9:00 AM

Caterina Hill, MSc , Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
Jennifer Bennet , Family Van, Harvard Medical School, Roxbury, MA
Rainelle White , Direct Service Manager, Family Van, Harvard Medical School, Roxbury, MA
Jamie Osman , Harvard School of Public Health, Boston, MA
David Zurakowski, PhD , Department of Anesthesia, Boston's Children's Hospital, Boston, MA
Nancy Oriol, MD , Office of Student Affairs, Harvard Medical School, Boston, MA
Background: Mobile health clinics (MHCs) aim to address health disparities by providing curbside, patient-centered prevention and management of chronic conditions including Diabetes. They act as a community hub enabling health management amongst clients. Objectives: a) to compare rates of Diabetes amongst first time Family Van (FV) clients to Boston as a whole; b) to investigate the impact of the MHC intervention on Diabetes management, by comparing Diabetes control amongst first time and repeat FV attendees. Methods: Previously diagnosed diabetes was self-reported. Boston Behavioral Risk Factor Surveillance System was used to represent Boston as a whole. Undiagnosed Diabetes was indicated by high blood glucose levels (>200 or >140 if fasting) with no previous Diabetes history. Diabetes control indicators included Hemoglobin A1c (HbA1C), blood glucose, hypertension and body mass index (BMI). Prevalence rates and bivariate and multivariate linear regression analysis were carried out using STATA 11. Results: During 2006-9, 19% of first time FV clients had previously diagnosed Diabetes, compared to 6% in Boston as a whole. An additional 3% of first time FV clients had high glucose levels indicative of undiagnosed Diabetes. Amongst diagnosed Diabetics, repeat attendees had lower mean HbA1C, blood glucose, hypertension and BMI than first time clients, after adjusting for other co-factors. Conclusions: MHCs serve patients with a disproportionate burden of Diabetes. Amongst diagnosed diabetics, repeat attendees have better diabetes control than first time attendees, suggesting that this curbside ‘community connections' intervention may be effective at Diabetes management in these underserved minority communities.

Learning Areas:
Chronic disease management and prevention
Communication and informatics
Conduct evaluation related to programs, research, and other areas of practice
Program planning
Provision of health care to the public
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
To understand that Mobile Health clinics reach individuals from underserved minority communities. To be able to describe the prevalence of Diabetes amongst Family Van clients, compared to Boston as a whole. To be able to describe the evidence suggesting that the Family Van Mobile Health Clinic ‘community connections’ intervention improves Diabetes management amongst Diabetics in underserved minority

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I oversee research at the Family Van and am research associate for the Harvard Medical School Department for Global Health and Social Medicine. I trained in Epidemiology and Demography at the London School of Hygiene and Tropical Medicine in 2002-3 and have worked as an epidemiologist/demographer ever since.
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.