An Academic Centers Approach to Migrant Health Care

An Academic Center’s Approach to Migrant Health Care Javier F. Sevilla-Martir, MD Assistant Professor Gaylen M. Kelton, MD, FAAFP Associate Professor Department of Family Medicine Indiana University School of Medicine Objectives  Describe the proactive approach of the different activities and programs that are designed to serve the needs of the Hispanic/Latino community of Indianapolis Enable participants to identify needs that could be met and design activities and programs specifically tailored for their own communities.  Demographics    Total Indiana Hispanic/Latino Population over 269,000 Now 4.3% of population Indianapolis 5th Fastest Growing City in America from 7,681 in 1990 to over 100,000 in 2006 Research Project Objective  To identify the most common barriers to healthcare access faced by the Hispanic/Latino Community of Indianapolis. Cross-sectional survey of volunteer individuals and a series of Focus Groups involving key individuals from the Design  community. Research Project (cont.) Instrument  A questionnaire designed to obtain information about: 1. Barriers to healthcare access(8) 2. Demographics (5) 3. Health status (SF-12) Results  Total participants 191 Male/female 50:50 Place of origin, >50% Central America, 1/3 Mexico   Age Distribution 40 35 30 25 % 20 15 10 5 0 18-25 26-35 Years 36-45 >45 Migrant Population  Length of time in USA • 56% 5 years or more • 21% Less than 2 years  Length of time in Indianapolis • 31% 5 years or more • 35% Less than 2 years Health status, self reported      Excellent Very good Good Fair Poor 8% 19 % 32 % 39 % 2% Findings      71% have no insurance 39% had a least one selected illness 33% had received treatment for same 33% last medical visit > 2 years 38% had visited ER Barriers Cost of Service Lack of Insurance Language Fear of System Transportation Don't Know Services Other 0 5.2 7.9 27.8 37.7 44.0 52.4 4.2 10 20 30 40 50 60 Suggestions for Improving Access  Community Based Health Center More Bilingual Staff in Clinics 40% 25%   Listing of Services in Spanish More Interpreters in Clinics 22% 13%  Collaboration with Community Organizations       Indiana Latino Institute (ILI)-Smoking Cessation Indiana Minority Health Coalition (IMHC)- Segmentos de Salud and Health Directory Division for Minority Health, Indiana State Department of Health (ISDH)-Jornadas de Salud Clarian Health-Hispanic/Latino Health summit IUPUI School of Languages-Spanish courses IU NCOE for Women’s Health-Health Education Indiana University School of Medicine Society of Latino Medical Students (SOL), established 2002 Encourages participation in and provides faculty mentoring and support for educational and clinical opportunities. • Smoking cessation program in Spanish. This program is on-going and qualifies as fulfillment of competency level III in communication and/or social/community context awareness. • • Participate in Hispanic Health Fairs throughout Indianapolis offering medical interpretation services and providing health education to the community. Visit schools and community organizations through the “Doctors Back to School” program to help young minority children realize they, too, can follow the same path and have a career in medicine. Spanish Integrated Curriculum  Introduction to Clinical Medicine I & II Spanish Integrated Curriculum Innovative program that provides a cultural awareness/competence curriculum with emphasis on the Hispanic/Latino community based on the ICM-I&II content.  Students achieve an intermediate to advanced proficiency level in Spanish in both production and receptive skills (speaking, writing, listening and reading). Special activities are offered as immersion opportunities to learn and apply principles of culture and language.  Intersession at IUSOM  Appropriate Use of Medical Interpreters Through the use of standardized patients, video and a lecture/discussion format, faculty demonstrate to students the appropriate use of medical interpretation services Family Medicine: Clerkship, Electives  FM Clerkship: ALL medical students participate and many have the opportunity to achieve cultural competence while meeting clerkship requirements Care for the Underserved / Hispanic Health Elective: Month-long experience emphasizing high quality care for underserved populations, health disparities, cultural competence and medical Spanish while gaining clinical experience in a full-spectrum Family Medicine community health setting.  Global Health Elective  This 4–week elective in Honduras includes public health training, cross cultural exposure and language immersion while providing clinical services in a resource poor setting. Students achieve their goals by working hand-in-hand with local Honduran physicians as they provide care to the most vulnerable; young children and the elderly in remote communities. Students can also attend a language-immersion training program where they will live with Honduran families, and attend language school. Those already proficient in Spanish can work in a variety of settings: with a private physician; or in hospitals; the national university hospital, a public hospital or in a private not for profit hospital that does community service.   Global Health and International Medicine Interest Group  Encourages global health care awareness and participation in international medical education  Active participation in creating elective rotation immersion experiences in Honduras that enhance the participant’s understanding of the needs of recent immigrants and enables them to better serve the Hispanic/Latino community in Indianapolis. Research  “Barriers to Health Care access faced by the Hispanic/Latino community of Indianapolis”, Sevilla, J., MD. et al Currently under editorial review. “Factors Associated with Hispanic Underutilization of the Indiana Poison Center”, Saywell, RM, PhD, MPH; Zollinger, T., DrPH; Kochhar, K., MBBS, MHA; Roberson, C. MHA, MPH; Cole, B. BS; Mowry, J, Pharm; Sevilla, J., MD. Currently under editorial review   “Herbal use among pregnant and breast feeding Hispanic patients: are physicians informed?” Kochhar, K., MBBS, MHA; Saywell, RM, PhD, MPH; Zollinger, T, DrPH; Mandzuk, C, BSE; Haas, D, MD; Howell, L., MD; Sevilla, J., MD. Currently under editorial review  “Usage of herbal remedies within a Hispanic population living in the Midwestern United States”. Howell, LK, Kochlar, K, Saywell, RM, Zollinger, TW, Koehler, JM, Sutton, BS, Sevilla, JF, Allen, DI., JABFM November-December 2006 Vol. 19 No.6.  “Family Medicine in Honduras: initial consultation report. Sevilla, J. MD, McKeag, D. MD, Kiovsky, R. MD. Pan-American Family Medicine Clinics. Vol. 1/2005.  “Using bilingual staff members as interpreters”. Sevilla, Javier F. MD, Willis, Deanna R. MD, MBA. Family Practice Management. July/August 2004. Clinical Services  Center for Hispanic/Latino Health  Partnership with Community Health Centers Network (HealthNet Inc.) Recruitment of Bilingual/Bicultural Residents, Faculty and support staff  Summary  Assess community needs/assets Networking/collaboration/partnership   Research, educational and clinical goals Be proactive 