How Friendly is Access to Care: A Consumer Perspective

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How Friendly is Access to Care? A Consumer
Perspective
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Background

• Infant Mortality
• State 7.3 deaths per 1,000 births in 2003
• County 9.8 deaths per 1,000 births in 2003
• Inadequate use of care
• Friendly Access Area 28 were rated as
  receiving inadequate care (Kotelchuck Index)
• Late entry into care
• Friendly Access Area 20 entered care after the
  first trimester

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Strategy National Model
Phase I
Phase III
Phase II
Find out what users and providers think about
healthcare services
Community develops strategic plan to change the
culture
20 participants attend Disney training
Phase IV
Phase V
Phase VI
Service quality is improved
Customers experience improvements
Customers use services more often
Improved health for moms and babies
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Survey Methodology

• 345 women interviewed in the hospital after
  delivery
• 375 parent of children age 0 to 5 interviewed in
  the pediatric clinics
• 220 item survey assessing satisfaction with care,
  access and barriers to care, facility
  characteristics, and care content
• 5 focus groups with women from target groups
  identified as most likely to receive inadequate
  care

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Survey Results Critical Issues Identified

• Lack of understanding about Medicaid
• Long wait times
• Poor care coordination
• Negative relationships between patients and
  providers
• Lack of patient education
• Inadequate transportation

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Survey Results Supporting Data

• 5 out of 5 focus groups indicated problems with
  getting and using Medicaid
• 60 of prenatal respondents rated the wait time
  with a response other than excellent
• 76 of respondents said the provider did not
  offer help in finding a pediatrician

How Would You Rate the Concern Shown by
Receptionists and Nurses?
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Survey Results Supporting Data

• 47 of the pediatric respondents did not think
  the office staff was always as helpful as they
  should be
• 48 of the prenatal respondents and 33 of the
  pediatric respondents did not have a high school
  diploma
• 5 out 5 focus groups identified lack of reliable
  transportation as a problem

How Would Your Rate the Respect the Provider
Showed You?
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Recommended Strategies

• Provide education to providers and consumers on
  how to access and use Medicaid
• Coordinate appointment times with the provider
  and others who must see the patient
• Require health care providers to provide
  client-centered care by following the Friendly
  Access Service Standards

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Recommended Strategies

• Provide patients with educational materials on
  their health and their childrens health
• Work with the county transportation system to
  provide better transportation to Medicaid
  recipients and their families

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Friendly Access Lessons Learned

• Barriers to care identified by consumers and
  providers do not always match
• Expect the data gathering, analyses, and planning
  phase to take a long time
• Forced-choice vs. focus group approaches

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Public Health Implications

• Consumers do face significant barriers that
  prevent or discourage their use of care
• Involve consumers at every phase !!!