A public health nursing model assists women receiving TANF benefits access primary medical care

Background: Women transitioning from welfare to work experience higher rates of health related problems than women in the general population. Most welfare transition programs (WTP) in the US do not include adequate screening for chronic health conditions, assist clients in managing Medicaid related barriers to accessing care, or provide referrals for health related problems.

Methods: This randomized clinical trial tested a public health nursing (PHN) case management intervention to address health-related issues among 432 women with a chronic illness enrolled in a WTP. The intervention group received public health case management support to assist them in navigation of the medical and Medicaid systems. In this secondary analysis of data collected from the primary study, we examined if women with chronic health problems had access to a primary source of health care, utilized health care services, were satisfied with care, and if the public health nursing intervention enhanced finding a medical home.

Results: Even though all women enrolled in the study had a chronic illness, one-third did not have a current medical home at baseline and had an average of 9 months without seeing a health care provider. Of those with a medical home, 62% were mostly or extremely satisfied. Comparisons of the control and intervention group indicated that women receiving PHN case management intervention had nearly a 20% increase in identifying a source of health care compared with the group that did not receive the intervention (Χ2= 11.63, p<0.001). Logistic regression results found that, controlling for other factors, women in the intervention group were nearly 6 times more likely to have a medical home at 3 months (OR=5.7, p<0.001). At the 3 month follow-up, there were no differences between groups in increasing preventive visits among women reporting no healthcare receipt in the previous 2 years (Χ2= 1.71, p=0.19). Analysis of the 6- and 9- month data is ongoing.

Conclusions: At three months, a public health nursing intervention assisted women in identifying a medical home. Public health nurses have incorporated the concepts central to patient centered medical homes (coordination, communication, continuity, advocacy, prevention, health promotion, and whole person orientation) for over 100 years. In the development of policies related to medical homes in the Affordable Care Act, more research should include public health nursing case management as a cost effective way to manage medical homes.