Addressing Health Disparities: Using a culturally relevant community partnered mobile clinic to prov

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Addressing Health Disparities Using a
culturally relevant community partnered mobile
clinic to provide health care to high-risk women
in an urban setting

• Rita Singhal, MD, MPH
• Ellen Eidem, MS Amy Y. Chan, MPH Lucie McCoy,
  MPH
• Los Angeles County Department of Public Health
• Office of Womens Health
• Office of Health Assessment Epidemiology

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The Need for a Mobile Clinic

• Health of women in Los Angeles County
• Women living in poverty 3X more likely to have
  fair to poor health than women 200FPL
• Racial/ethnic disparities
• Barriers to accessing care among uninsured
• 60 difficulty accessing services
• 44 w/o regular source of care
• 42 could not afford it
• Transportation, child-care, long wait times
• Language culture
• Lack of preventive care among at risk women

Source Womens Health Status and Access to
Health Care Services, L.A. Health Los
Angeles County Department of Health Services
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Mobile Clinic Outreach Program

• Preventive screening provided via a mobile van to
  underserved women in Los Angeles County
• Services provided at no cost
• 1-3 times a week, usually weekends
• 25 women served per event
• May 2002-September 2006
• 3,436 women screened
• 175 sites visited

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Program Goals

• Improve the health of at risk women in Los
  Angeles County
• Improve access to care
• Overcome barriers of cost, transportation,
  childcare, language culture
• Establish a regular source of care for women
  requiring ongoing health care
• Provide preventive health screenings
• To detect dormant disease at an earlier and
  preventable stage
• Increase awareness of the importance of prevention

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Target Population

• At risk women in Los Angeles County
• Uninsured
• Live in underserved areas
• Recent immigrants
• Age 40-64 years
• Ethnic groups
• African American, Armenian, Chinese, Korean,
  Latina and Vietnamese

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Services Provided

• Comprehensive preventive health assessment
• Hypertension
• Diabetes
• Hyperlipidemia
• Body Mass Index
• Breast cancer screening clinical breast exam
• Cervical cancer screening
• Preventive health education
• Chronic disease prevention
• Mobile mammography

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Community Involvement

• 300 Community Partners
• Request clinic and provide site for event
• Recruit women for screenings
• Publicize event
• Venues
• Health fairs
• Community centers
• Religious institutes
• Consulates
• Festivals
• Adult schools

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Culturally Linguistically Appropriate Staff

• Patient Resource Workers
• Community liaisons
• Schedule appointments
• Interview clients
• Patient information
• Medical history
• Translate as needed at events
• Make follow-up appointments after the event
• Clinician Nurse/Educator
• Serving African American, Armenian, Chinese,
  Latina, Korean and Vietnamese communities

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Follow-Up

• Conducted by nurse and physician at OWH
• Follow-up appointments scheduled for women with
  detected abnormalities
• Attempt to establish a medical home for women
  with any abnormal results
• Results sent to client
• In language satisfaction survey distributed
  within 1 week of mobile clinic visit

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Research Aims

• Demonstrate target population was reached
• Evaluate prevalence of major preventable diseases
  in an underserved population
• Describe disparities in disease prevalence based
  on demographics and access to care

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Data Collection Analysis

• Questionnaire Design
• Demographics age, zip code, marital status,
  birthplace, ethnicity, preferred language, FPL
• Access insurance status, regular source of care,
  last physician visit, last preventive screenings
• Clinical outcomes
• BP, HbA1c, direct LDL, BMI, Pap test, breast
  exam, GYN exam
• Analysis
• Chi Square
• Logistic regression

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Demographics

• 2,597 women seen at 130 events over 3 years

Source 2002-03 Los Angeles County Health Survey
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Access to Care

• Source 2002-03 Los Angeles County Health Survey

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Outcomes and Ethnicity

• p

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Outcomes and EthnicityAdjusted Odds Ratio
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Body Mass Index
Note Began calculating in year 2 (data not
representative of entire sample N1,717 instead
of 2,597)
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Conclusions

• Reached target population
• Overall rates of disease was high is this
  population
• Specific ethnic groups were at higher risk for
  certain diseases
• Central Americans diabetes, high cholesterol,
  abnormal Pap test
• Armenian high cholesterol
• African American diabetes, high blood pressure

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Strengths

• Builds grassroots connections between the OWH and
  the women, community and CBOs
• Increases access to care for high-risk women
• Promotes early detection of disease
• Mobile clinic is the first step into ongoing care

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Challenges

• Mobile services are expensive
• Extensive administration and coordination
  required to work with community partners
• Detecting disease is not enough getting women
  to change behaviors is much more difficult

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Opportunities

• Shift focus from service delivery to maximizing
  client education
• Changed to Point-of-Service testing with on-site
  results
• Further build network of CBOs and partners
• Follow-up survey to determine whether women have
  established a medical home