Patient education crucial for underserved population
Education can lower costs, boost self-management
Lack of access to health care can keep people from learning how to self-manage a chronic disease and how to appropriately use medical care to achieve good health.
To remedy this, some institutions have set in place ways for the underserved, uninsured, needy population to receive treatment and education. This includes Mount Carmel health care system in Columbus, OH.
The organization has created "health stations," fully equipped physicians' offices, within churches in the inner city of Columbus. The overall goal is to eliminate health disparities within minority populations.
"Our purpose is to promote healthy lifestyle choices, to sustain education interventions, and improve access to care as well as providing holistic health care," says Jacquelyn Godfrey Hilton, RN, director of health stations and church partnership at Mount Carmel Hospital.
Another program, "church partnerships," empowers people to take care of their own health. "We try not to be enablers but to educate and promote health in a way that the individual begins to take responsibility for his or her health," says Rebecca Madine, RN, coordinator for church partnerships.
At the Medical Center of Central Georgia in Macon, a full service clinic called the the W.T. Anderson Health Center serves those who cannot afford health care. Like Mount Carmel, serving the underserved is part of the organization's mission. The largest division at the health center is the internal medicine clinic where primary care providers and two nurse practitioners treat patients. The medical center is affiliated with a school of medicine so internal medicine residents make up most of the staffing.
It is in this clinic that people receive continuity of care for chronic diseases and health problems that need to be managed over time, says Sandra Higgison, RN, MSN, MBA, FACHE, director of ambulatory health services.
The impact of education
These are examples of different methods of outreach to provide health care to the underserved. Patient education is an integral component of all of them.
Higgison says education helps keep costs under control. Education, by definition, is measured by a change in behavior and that is often key in the management of chronic disease, which can be costly.
Although the Anderson Health Center receives several forms of funding including patient payment on a sliding scale, grant money, and some state and county funds, this does not totally cover the operating costs.
Behavior change through education that results in good disease management will help reduce costs. Such change is often a slow process. Higgison says one of the biggest barriers to education at the Anderson Health Center is a patient's priorities, based on his or her value system. For example, many patients seen at the health center don't always make the purchase of medications a priority.
It is important to determine how to make behavior change valuable to the patient or determine how to fit good health practices into the patient's value system. Higgison says diet impacts a lot of chronic diseases and is the focus of many educational efforts. For example, patients are sent to diet classes. Many patients seen at Anderson Health Center eat a high-fat, high-salt, high-cholesterol diet.
Working with outside groups
The partnership Mount Carmel forms with churches provides an opportunity to target the physical, emotional, and spiritual health of a congregation and its surrounding community through health promotion activities. Madine helps churches in the program form a health ministry team that assesses the needs of the congregation and community. This assessment is completed by direct observation and a written questionnaire, and the information is used to develop a plan along with intervention programs to meet the needs of the community.
Madine says Mount Carmel partners with churches in all types of communities regardless of socio-economic status because the one thing people have in common are health issues such as hypertension, high cholesterol, diabetes, and stress. However, in less affluent areas, it is important to meet people's basic needs before doing a lot of education.
"Often, we work with food pantries, not only to provide food for the individual but to provide information about healthy eating and other disease conditions or concerns they may have," says Madine.
The congregation and community also are taught how to donate healthy items to food pantries.
Education does not focus on physical health alone but takes a holistic approach, providing classes on emotional issues such as grieving or dealing with a family member with Alzheimer's. Churches also are given a spiritual assessment tool to screen participants for spiritual distress, says Madine.
The education needs of patients who seek medical care at health stations often are met through the church partnership programs, says Godfrey Hilton. For example, people are connected to exercise or cooking classes. One-on-one education does take place as well as group education, she adds.
Higgison says at Anderson Health Center, many educational strategies are used. Literature is at a low reading level with lots of pictures to accommodate those who don't read well. Staff work with patients to not only educate them on a topic such as proper foods for people with diabetes, but to help them apply the information. For example, a nurse might help the patient review their favorite foods, selecting those that best fit a diet for a diabetes patient.
Sometimes people are more receptive if the message is delivered by someone who shares their culture. So this strategy is used as well, says Higgison. Group visits for people with diabetes are also in place so patients can discuss the lesson with one another.
Whatever the strategy, repetition is key, adds Higgison.
Health ministry teams in the faith community working with Mount Carmel are helped with their education efforts with written materials that fit the needs of the congregation. And they are given screening tools, says Madine. For example, if hypertension is a health problem, the church would receive a couple of blood pressure cuffs as well as literature on the topic. In addition, the health ministry team receives training in holistic health practices.
Team leadership can participate in a bi-monthly educational program where a health topic is covered, such as the prevention of infection in churches. Mount Carmel also produces a monthly newsletter, with information on health topics and programs and conferences in nearby communities, that is sent to church partnerships.
According to Godfrey Hilton, participation in education is higher if some sort of social aspect is added. For example, health screenings and education might be paired with a car show or information might be presented in the form of games or a contest.
The greatest barrier to education in the church partnership programs is literacy and language.
"We are always looking at providing education at the level of understanding of the person. Most of our printed education does that very well," says Madine.
In addition to low literacy materials, foreign language materials are also offered for those people who do not read English. People in the congregation are used as interpreters during education sessions.
Madine says time is sometimes spent in one-on-one education if people don't seem to understand what is being taught.
Multiple benefits
There are many benefits to providing education and health services to the underserved and uninsured populations. Mount Carmel conducted a survey of participants in outreach programs and found that many did not receive regular medical care before being introduced to health stations. Those without regular care are often uncovered in the church partnership programs and referred to a health station.
"Most of the patients tell us the way they got medical care before was through the emergency room when they were in medical crisis," explains Godfrey Hilton.
Madine says that by working specifically with churches, the medical center is able to enter a relationship with people in an environment where they feel safe. "People don't always feel safe coming to the hospital or doctor's office but we know if we go to the church where they are comfortable and that is where their peers are, we are entering an environment where they feel more comfortable; they are more accepting of health education, health care, and health promotion in those facilities," she explains.
Whatever the program, it is important to stress empowerment of the individual to take responsibility for their health, says Madine.
Lack of access to health care can keep people from learning how to self-manage a chronic disease and how to appropriately use medical care to achieve good health.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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