September 19, 2014

ACU Columns

In each issue of the Journal of Health Care for the Poor and Underserved, ACU contributes an invited column on some aspect of health care for the underserved. ACU members and subscribers to the Journal can read these columns online. Others can download a PDF version of each article using the links provided.

In a Neighborhood Near You: How Community Health Workers Help People Obtain Health Insurance and Primary Care(PDF)
Debi Lang, MS, Linda J. Cragin, MS, Deborah Raymond, CHW, Sue Kane, BA

Lack of health insurance has been linked to decreased preventive services, increased hospitalizations and emergency room visits, and diagnosis at later stages of disease, leaving those without insurance vulnerable to poor health outcomes. In 2006, Massachusetts instituted health care reform that by 2011 resulted in the highest health insurance rate in the country, with over 90% of residents having access to a consistent source of care. As many states prepare to enroll millions of low- income uninsured Americans, the experience of Community Health Workers (CHWs) in Massachusetts can inform outreach and enrollment efforts across the country.

Expanding and Supporting the Health Care Workforce* (PDF)
Amber Richert, FNP, Kendall Campbell, MD, Jose Rodriguez, MD, Iris Wagman Borowsky, MD, PhD, Rajesh Parikh, MD, MPH, Ashley Colwell, BS, MS
November 2013

With implementation of the Patient Protection and Affordable Care Act (PPACA), health insurance coverage will expand to an additional 34 million people in the United States. In addition, the PPACA calls for increasing the number of patients served in federally qualified health centers (FQHCs) from 20 million to 40 million. When the Commonwealth of Massachusetts mandated health insurance in 2006, primary care wait times increased, even though the state had the country’s second highest ratio of primary care physicians to population, the third highest ratio of nurse practitioners to population, and a robust network of community health centers (CHCs).

Community Health Centers’ Role in Family Planning(PDF)
Ruth Lesnewski, Lisa Maldonado, Linda Prine
May 2013

“Whenever I see a woman who has an unintended pregnancy, I make a point of looking through her chart to see if she had a recent office visit. About 75% of the time, I find she did have a visit within the previous three months, but contraception was not addressed.” — Family physician and medical director of a federally qualified health center

Cultural Competency in the Trenches* (PDF)
Michael Rowland, PhD, V. Faye Jones, MD, MPH, PhD, Vicki Hines-Martin, PhD, CNS, RN, FAAN, and Linda Hart Lewis, RDH, MEd
February 2013

For health care workers and health profession schools, cultural competence education and training has been identified as one solution to the problem. However to educate and properly train a culturally competent health care workforce is not an easy task. The literature on cultural competency is growing, with numerous studies that have focused on specific traits of cultural competency but unfortunately, a consensus on the best approach to achieve the desired outcomes has not been reached.

Advice from the Inside(PDF)
Kameron Leigh Matthews, MD, JD and Andrea Weisman, PsyD, CSOTP
November 2012

From the viewpoint of an outsider, correctional medicine seems difficult. Prior to taking up our roles at correctional facilities, we certainly felt that it must be. We shared the same questions: How do you deliver care to a criminal? Do you ask what they’ve done? How do you remain impartial?The detainees in jails (prior to conviction) and prisons (post-conviction) are the single group guaranteed health care under the U.S. Constitution (see Estelle v. Gamble, 429 US 97).

Assessing mHealth: Opportunities and Barriers to Patient Engagement(PDF)
Thomas Martin, MBA

mHealth—the practice of medicine and public health through the use of mobile devices—presents an opportunity to revolutionize the health care system both in the U.S. and globally. Key words: mHealth, mobile, health disparities, Text4Health, health care, meaningful use, HIT.

Addressing Hepatitis B: Community Health Centers, Partnerships and the Affordable Care Act* (PDF)
Corinna Dan, RN, MPH, Kenneth Tai, MD, Su Han Wang, MD, Jeffrey Caballero, MPH, Melinda Martin, MPH, Stacy Lavilla, MS and Nina Agbayani, RN

Hepatitis B virus (HBV) infection is a major preventable health problem in the U.S. and the most pronounced health disparity disfavoring Asian Americans and Pacific Islanders (AAPIs). Despite constituting only 5% of the U.S. population, AAPIs account for at least 50% of all individuals with chronic HBV infection. Additionally, rates of liver cancer, often caused by chronic HBV are up to 13 times higher in some AAPI subgroups than average. Vaccination, testing, and treatment tools needed to eliminate new HBV infections and prevent liver disease and liver cancer caused by chronic HBV infection exist, but these tools are inadequately implemented. Read full text (PDF)

The Forgotten Minorities: Health Disparities of the Lesbian, Gay, Bisexual, and Transgendered Communities* (PDF)
Lea Mollon

Many lesbian, gay, bisexual, and transgendered (LGBT) people have negative experiences with their health care providers and the health care system. in addition to the lack of adequate, informed, and culturally sensitive provider and patient education, the LGBT communities face undue health disparities and inequities that should be addressed. Health care professions should be made aware of these disparities in order to improve quality and cultural sensitivity in care for this underserved population.
Read full text (PDF)

HIV Management Returning to Primary Care Providers*
Ronald D. Wilcox, MD, FAAP and Donna M. Gallagher, APRN-C, MS, ANP, FAAN, MA

A 32-year old uninsured woman, living in a rural town in the Deep South, presents to the emergency room at a local hospital with complaints of cough and fever. She is diagnosed with pneumonia and given a prescription for an antibiotic. It takes a few days to raise the money for the prescription but she eventually fills it and improves with treatment. Over the next several months, she goes to three different free-care clinics for vaginal yeast infections. One year after the initial episode of pneumonia, she returns to the same hospital with gradually increasing shortness of breath, a non-productive cough, and a low-grade fever.
Read full text
(PDF)

The Role of Clinicians to Empower Communities through Utilization of the Built Environment*
Sarah Kureshi, MD, MPH, Kim Bullock, MD, August 2011

In recent years there has been a growing awareness about the impact of built environments on individual behavior, health and disease risk, morbidity, and mortality. The authors describe three pioneering clinicians who have worked to improve community health by improving the infrastructure to support healthy eating and active lifestyles.
Read full text
(PDF)

Trans-disciplinary Care: A New Approach to Improving the Effectiveness of Tobacco Use Interventions*
Robert Hoffmann, MA, Virna Little, PsyD, LCSW-r, SAP, May 2011

Tobacco use disorder devastate lies and financial well-being, and constitute one of the largest public health problems the world faces today. One of the news ways to increase effectiveness of tobacco intervention is the utilization of trans-disciplinary teams.
Read full text
(PDF)

Street Medicine: An Example of Reality-based Health Care*
Jim Withers, MD, February 2011

Street medicine, an emerging field of medicine in the United States, is the provision of health care directly to those living on the streets of our communities. As such, it represents a trend in both health care delivery and medical education in which the reality of those we serve is central.
Read full text
(PDF)

Transdisciplinary Care: Opportunities and Challenges for Behavioral Health Providers*
Virna Little, PsyD, LCSW-r, SAP, November 2010

The transdisciplinary model of care is an important new tool for improving physical and mental health outcomes. It is an essential approach to combating some of the major chronic illnesses such as depression and diabetes and other co-morbid conditions that cripple many communities. Its potential as a successful approach to improving community health should be recognized and embraced by the behavioral health community.
Read full text (PDF)

A Childhood Obesity Program in Federally Qualified Community Health Centers*
Erica L. McClaskey, MD, MS, August 2010

As the prevalence of childhood obesity reaches a new high, efforts must be made to reverse and protect children from this preventable disease. This column will describe how two federally qualified health centers used a modified version of a nationally known obesity prevention program called We Can to implement childhood obesity clinics.
Read full text (PDF)

The State of Health Care Services for Mobile Poor Populations: History, Current Status, and Future Challenges* 
Candace Kugel, FNP, CNM, MS, Edward L. Zuroweste, MD, May 2010

The migrant workers of the United States in 2010 are members of diverse populations moving rapidly between sending and receiving locations. The migrant’s temporary social and physical environments affect his or her health and well-being. The occupations engaged in by migrants, as well as the fundamental factor of mobility itself, combine to create a lifestyle that carries multiple health risks. A review of the history and current status of health care services for United States migrant workers provides a glimpse into the efforts of a few to tend to the unique needs of an otherwise disenfranchised
population. Read  full text (PDF)

Transdisciplinary Health Care Education: Training Team Players*
Deepa Rani Nandiwada, Christine Dang-Vu, February 2010, pp. 26-34 (Article)

Transdisciplinary health care involves reaching into the spaces between the disciplines to create positive health outcomes through collaboration. This model of care effectively integrates clinicians such as physicians, nurses, social workers, physical therapists, complementary and alternative medicine practitioners, physician assistants, community health workers, and other health care providers to create a team that provides comprehensive preventative primary care. Read full text (PDF)

The Primary Care Crisis and Health Care Reform*
Peter Sherman, MD, Susan Moscou, FNP, MPH, PhD and Christine Dang-Vu, November 2009, pp. 944-950

Primary care crisis is a phrase we have heard many times. Often, it reflects not just a societal circumstance but the reality for health care professionals working first-hand with the medically underserved or vulnerable populations. These professionals are considered safety net providers because they deliver health care to uninsured patients, underinsured patients, and Medicaid patients. Safety net providers work in community health centers, federally qualified health centers, public hospitals, school-based clinics, teaching and community hospitals, and local public health clinics. Read full text (PDF)

Health Information Technology: Addressing Health Disparity by Improving Quality, Increasing Access, and Developing Workforce*
Ricardo Custodio, MD, MPH, Anna M. Gard, MSN, FNP-BC, Garth Graham, MD, MPH, May 2009

Health IT is a vital tool in achieving the goals of health care reform to increase health care access, improve care delivery systems, engage in culturally competent outreach and education, and enhance workforce development and training. The first national survey of federally funded community health centers shows that although 26% reported some electronic health record (EHR) capacity and 13% have the minimal set of EHR functionalities, the centers serving the most poor and uninsured patients were less likely to have a functional EHR system. Read full text (PDF)

Nurse Practitioners in Community Health Settings Today*
Lois A. Wessel, RN, MS, CFNP

An NP is an essential part of a transdisciplinary health team. The combination of medical skills and nursing care provide a unique role that can fill gaps in many primary care settings, and improve patient outcomes. Read full text (PDF)

Health Literacy: Improving Quality of Care in Primary Care Settings*
Sharon E. Barrett, MS, Doctoral Candidate, MSUPHP, Jennifer Sheen Puryear, MPH

The Social Worker on the Medical Transdisciplinary Team*
Margaret Dawson Hobbs, MSW

Primary Care in Public Housing: Voices of Clinicians*
Kathie Culhane-Pera, MD, Dillard Ellmore, DO, and Lois A. Wessel, RN, CFNP

 

*Reprinted with permission from Meharry Medical College, the copyright holder for the Journal of Health Care for the Poor and Underserved.