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

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.