Assessing the need for improved access to rheumatology care: a survey of Massachusetts community health center medical directors
| Autor: | LeRoi S. Hicks, Tabatha Norton, Elmer Freeman, Daniel H. Solomon, Candace H. Feldman |
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| Rok vydání: | 2013 |
| Předmět: |
medicine.medical_specialty
Psychological intervention Medicare Health Services Accessibility Article Physician Executives Rheumatology Community health center Internal medicine Intervention (counseling) Rheumatic Diseases Surveys and Questionnaires medicine Humans Response rate (survey) Insurance Health business.industry Data Collection Community Health Centers Health equity United States Layperson Massachusetts Family medicine Antirheumatic Agents business Medicaid Immunosuppressive Agents |
| Zdroj: | Journal of clinical rheumatology : practical reports on rheumaticmusculoskeletal diseases. 19(7) |
| ISSN: | 1536-7355 |
| Popis: | OBJECTIVE Access to rheumatology care can expedite diagnosis and treatment of rheumatic diseases and reduce disparities. We surveyed community health center (CHC) medical directors to evaluate rheumatology care in underserved areas and potential strategies for improvement. METHODS We identified 77 Massachusetts CHCs that provide adult medical services and sent a 40-item survey to their physician medical directors. Survey questions assessed the centers' prevalence of rheumatic diseases, prescribing practices of immunosuppressive medications, and possible interventions to improve care. We compared CHC characteristics and rheumatology-specific items and then stratified our data by the response to whether improved access to rheumatology care was needed. Qualitative data were analyzed thematically. RESULTS Thirty-six CHC physician medical directors returned surveys (47% response rate). Fifty-five percent indicated a need for better access to rheumatology care. Eighty-six percent of CHC physicians would not start a patient with rheumatoid arthritis on a disease-modifying antirheumatic drug; 94% would not start a patient with systemic lupus erythematosus on an immunosuppressant. When we compared CHCs that reported needing better access to rheumatology care to those that did not, the former described a significantly greater percentage of patients with private insurance or Medicaid who required outside rheumatology referrals (P < 0.05). Language differences and insurance status were highlighted as barriers to obtaining rheumatology care. Sixteen directors (57%) ranked the patient navigator-a layperson to assist with care coordination-as their first-choice intervention. CONCLUSIONS Community health center medical directors expressed a need for better access to rheumatology services. A patient navigator for rheumatic diseases was proposed to help improve care and reduce health disparities. |
| Databáze: | OpenAIRE |
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