Galveston County Health District 4C’s Clinics

1. Galveston County Health District4C’s Clinics Summary Needs Assessment for 5 Year Competitive Grant And 4C’s Healthcare Barriers

2. Service Area • Galveston County – 266,775 • Geographic areas • Island & Texas City Clinic Locations • Medically Underserved Areas • Health Professional Shortage Areas

3. Governing Board Mission “Provide access to quality ambulatory care to uninsured and underinsured Galveston County residents.”

4. Un- & UnderinsuredTarget Population • Underserved Seniors • Women seeking family planning • Counseling for mental health conditions & substance abuse • Prenatal and pediatric care • Managing chronic conditions • Preventing communicable diseases • Homeless • Uninsured small business employees • Persons needing acute care • Dental care for children

5. Factors:Target Population • Uninsured or Underinsured • Poverty – limited income • Unemployment • Mental Health/Substance Abuse • Chronic Diseases • Health Disparities • Social Needs – Competing Needs

6. 4C’s Services 2003 • 57,589 Healthcare Visits • 528 Mental Health Visits • 8632 Dental Care Visits • 8498 Case Management & Education

7. Trends • Increased demand for acute care • Decreased Medicaid population • Increased demand for phone consultation • Increased need for mental health services • Increased need for outreach activities to link underserved to clinic services • Increased need to serve homeless • Expanded disease management for chronic conditions

8. The Healthcare Environment • Fragmented, fluid, and inadequate • Inadequate healthcare financing for primary and preventive care • Current and future restrictions on Medicaid and CHIP • Motivation towards acute care • Lack of focus on lifestyle determinants of health and illness • Need for modernized management and monitoring IT Systems

9. Partners in 4C’s Healthcare • Referral sources for specialist and hospitalization • Mental health & substance abuse agencies • Emergency rooms • Other primary care facilities • Public program eligibility agencies • Social resource & services agencies

10. Healthcare Barriers • Access to and Cost of Drugs • Communications Between Partner Agencies Regarding business changes, medical information, and available resources for patient care • Lack of Emphasis on Clinical Preventive Medical Care • Transportation • Access to inpatient and ambulatory mental health services • Cultural & Language • Health Disparities • Professional Shortages

11. BARRIERAccess to Prescription Drugs • Confusion & limitations of Medicare Drug Benefit • Limited budget for drugs on 4C’s formulary • Community need for drugs exceeds need for 4C’s healthcare (non 4C’s patients come to clinics merely to get RX of private physicians filled) • Differences in prescribing practices (4C’s formulary vs. private practices) • Lack of pharmacy inventory systems

12. BARRIERCommunications regarding agency business changes, medical information, and available resources • Fiscal constraints impacting all partners in healthcare who are responding with new fiscal controls • Legal and system barriers in having immediate access to medical information and lab tests about 4C’s patients shared by clinic and hospitals • Lack of education and easy access to accurate list of community resources for healthcare, mental health, and social needs by community partners • Lack of common electronic medical records systems

13. BARRIERLack of Clinical Preventive Medical Care • A fragmented system which motivates patients to seek treatment only when ill • Lack of support systems to motivate patients towards wellness check-ups and routine follow-up visits for chronic conditions • Lack of case managers and loss of CAP funding

14. BARRIERTransportation on Mainland • No public transportation system (on Mainland) • Frequent complaints of patients • Available services perceived as inadequate, inconvenient & not time-sensitive

15. BARRIERLack of inpatient and ambulatory mental health and substance abuse treatment services • Gulf Coast MHMR fiscally limited with lengthy waiting list for uninsured • Mainland Hospital decreases inpatient services • UTMB hospital limited in capacity to serve local needs, especially uninsured • Lack of case managers and loss of CAP funding

16. BARRIERCultural & Language • Growing proportion of patients who prefer communicating in Spanish during healthcare visit • Limited oral and written health education in Spanish • Need for cultural competency training of healthcare workers to facilitate effective healthcare experiences • Documented health disparities among racial/ethnic groups • Lack of case managers and loss of CAP funding

17. BARRIEREfforts Targeting Health Disparities • Lack of comprehensive analysis of health disparities in Galveston County – who, what, where, and why • Lack of identified resources to specifically address health disparities • Lack of expand partners with community to address disparate population groups • Lack of case managers and loss of CAP funding

18. BARRIERProfessional Shortages • Difficulty recruiting dentist and dental hygienist • Need for enhanced recruitment and retention efforts for dental clinic

19. BARRIERS What would it take to reduce or eliminate these barriers? Are there other barriers?