Oral

Historically, the fragmented, pluralistic, and poorly coordinated US health care system has left large subpopulations uninsured and typically with neither usual sources nor continuity of care. Racial and ethnic minorities, over-represented among groups who report no health insurance, lack usual sources of care and suffer disproportionately excess burdens such as cardiovascular diseases, diabetes, arthritis and obesity. Community health centers (CHCs) and hospital emergency departments (EDs) often respond to these needs--for better or worse--and are sometimes the only providers for such populations. The morbidity and mortality ramifications of irregular health service access, negative situational/environmental social determinants of health and lifestyle-amenable factors beg the question of how well any system meets the health needs of vulnerable populations especially with respect to complex chronic conditions. For more than 45 years, CHCs have delivered comprehensive, high-quality preventive and primary health care to patients regardless of their ability to pay. Prior and contemporaneously to CHCs, EDs have also filled the gap of provider of last resort or safety-net providers. Both sources of care have become the default primary care medical home for millions of Americans including some of the nation's most vulnerable populations like those with limited English language skills, undocumented persons, homeless individuals, children and the severely impaired. Even after the 2010 Patient Protection and Affordable Care Act (PPACA) is fully implemented, there will be an estimated 20 million individuals without insurance who will rely upon safety-net providers. The papers contained in this session describe how well needs are met within these Centers and Departments, particularly when it comes to chronic conditions such as obesity, cardiovascular disease, diabetes. The authors confront the ramifications that these conditions can manifest. Such conditions require a myriad of testing, behavioral modification support, and medication--making them among the most challenging conditions to manage. Although thousands of safety-net providers attempt to deliver high-quality care, we must objectively examine how well the goal of health equity for persons with complex social and medical needs is achieved. Whether the clients/participants of all ages, races/ethnicities, and other characteristics have equal services delivered and potentially positive morbidity and mortality impact as a result of interaction in these resource-scarce, high time-pressured environments is the question that weaves a thread through exciting and somewhat surprising results in this session's four presentations.

Session Objectives: Describe the current burden of overweight/obesity among patients of different ages utilizing safety-net providers. For at least one of the conditions, explain the extent to which racial/ethnic disparities exist in the prevalence of chronic diseases such as overweight/obesity, cardiovascular disease, or diabetes. For at least one of the conditions or age groups in this session, idenfify the extent to which racial/ethnic treatment variation/disparities exist for overweight/obesity, cardiovascular disease, or diabetes.

CE Credits: Medical (CME), Health Education (CHES), Nursing (CNE), Public Health (CPH) , Masters Certified Health Education Specialist (MCHES)