260985 Supplemental Health Care Services for Poor and Homeless Women: A Cross-Sectional Study

Monday, October 29, 2012 : 10:30 AM - 10:50 AM

Kym Williams, MBA, MPH , Monitoring and Evaluation, Women of Means, Inc., Wellesley, MA
Roseanna H. Means, MD MSc , Department of Medicine, Brigham and Women's Hospital, Wellesley, MA
Rachel Kaufmann, BA , Women of Means, Inc., Wellesley, MA
Background: Despite the 2006 Massachusetts health care insurance reform legislation intended to increase health care access for the urban poor, additional barriers affecting utilization of mainstream medical care persist. Navigating the labyrinth of medical care services requires a skill set often lacking in this at-risk population making them more vulnerable to adverse health care experiences, varying health outcomes and discontinuity of care. Supplemental health care services have emerged to close the gaps. To further understand the key factors that contribute to the use of supplemental health care, survey and observation data were collected from poor and homeless women in Boston who use day-shelter medical services. Study Objective: Determine what factors drive the use of supplemental health care services for poor and homeless women using day-shelter services. Methods: Mixed methods using a patient survey (N=102) and non-participant patient-practitioner observations (N=72) administered from June to December 2011 in two women's day-shelters in Boston. Patient self-reported demographic, health status, comorbidity, psychosocial, life style, medication, housing and other risk factor data were collected to identify predictive characteristics. Level of provider-patient relationship, services sought, services used, visit frequency, duration, satisfaction with care and other encounter experience data were collected and evaluated. Data analysis was conducted using frequency tables, proportion analysis and thematic coding in NVivo9. Preliminary Results: Predictive characteristics (prevalence): completed high school (64%), housed (61%), receive public assistance (83%), mood disorder (44%), chronic health issue (64%), comorbidities (53%), medications (78%), smoking (32%) and poor to fair health status (57%). Health care experience (prevalence): provider addresses anxiety, depression, stress concerns mainstream PCP (36%), supplemental (53%); provider makes mental and/or behavioral health referrals - mainstream PCP (30%) supplemental (48%); missed PCP appointments forgot, wait time, copay/cost, location, unclear who to see or where to go (44%), supplemental - no appointment necessary; patient has time to describe primary health issues - mainstream PCP (64%) supplemental (94%); patient's main health problem addressed mainstream PCP (71%) supplemental (89%); patient received social assistance and/or social support mainstream PCP (11%) supplemental (64%). Encounter frequency 4 times or more past year - mainstream PCP (39%) supplemental (62%). Conclusions: Poor and homeless women who utilize free gap health care services at women's day-shelters in Boston identify varying patient-provider relationships and multiple barriers to care, and may benefit from targeted services and the supportive health care experience available through supplemental health care programs.

Learning Areas:
Provision of health care to the public
Public health or related research

Learning Objectives:
1. Identify predictive factors that impact the use of supplemental health care services in vulnerable populations. 2. Describe the varying health care experience of poor and homeless women who use mainstream medical care and shelter based health care services. 3. Articulate the benefits of gap care services for improving the health care experience, addressing health care needs and connecting patients with mainstream medical care.

Keywords: Vulnerable Populations, Women's Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a consultant in monitoring, evaluation and program planning and have worked with vulnerable populations for over 20 years. I have been the principle or co-principle investigator of studies evaluating the impact of health services on school dropout, community based health services in rural settings with and micro-lending cooperatives on health outcomes. I currently work with Women of Means, designed the study for which this abstract is being submitted and conducted the analysis.
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.