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Title & Content |
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Addressing Health Disparities: Using a culturally relevant community partnered mobile clinic to provide health care to high-risk women in an urban setting
Rita Singhal, MD, MPH
Ellen Eidem, MS; Amy Y. Chan, MPH; Lucie McCoy, MPH
Los Angeles County Department of Public Health:
Office of Women's Health
Office of Health Assessment & Epidemiology
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The Need for a Mobile Clinic
- Health of women in Los Angeles County
- Women living in poverty 3X more likely to have fair to poor health than women >200%FPL
- Racial/ethnic disparities
- Barriers to accessing care among uninsured
- 60% difficulty accessing services
- 44% w/o regular source of care
- 42% could not afford it
- Transportation, child-care, long wait times
- Language & culture
- Lack of preventive care among 'at risk' women
Source: Women's Health Status and Access to Health Care Services, L.A. Health Los Angeles County Department of Health Services
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Mobile Clinic Outreach Program
- Preventive screening provided via a mobile van to underserved women in Los Angeles County
- Services provided at no cost
- 1-3 times a week, usually weekends
- ~ 25 women served per event
- May 2002-September 2006
- 3,436 women screened
- 175 sites visited
(image: photo of mobile health clinic van)
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Program Goals
- Improve the health of 'at risk' women in Los Angeles County
- Improve access to care
- Overcome barriers of cost, transportation, childcare, language
& culture
- Establish a regular source of care for women requiring ongoing health care
- Provide preventive health screenings
- To detect dormant disease at an earlier and preventable stage
- Increase awareness of the importance of prevention
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Target Population
'At risk' women in Los Angeles County
- Uninsured
- <200% FPL
- Live in underserved areas
- Recent immigrants
- Age 40-64 years
- Ethnic groups
- African American, Armenian, Chinese, Korean, Latina and Vietnamese
(image: photo of two women hugging)
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Services Provided
- Comprehensive preventive health assessment
- Hypertension
- Diabetes
- Hyperlipidemia
- Body Mass Index
- Breast cancer screening – clinical breast exam
- Cervical cancer screening
- Preventive health education
- Chronic disease prevention
- Mobile mammography
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Community Involvement
- 300 Community Partners
- Request clinic and provide site for event
- Recruit women for screenings
- Publicize event
- Venues
- Health fairs
- Community centers
- Religious institutes
- Consulates
- Festivals
- Adult schools
(image: drawing of flower)
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Culturally & Linguistically Appropriate Staff
- Patient Resource Workers
- Community liaisons
- Schedule appointments
- Interview clients
- Patient information
- Medical history
- Translate as needed at events
- Make follow-up appointments after the event
- Clinician & Nurse/Educator
- Serving African American, Armenian, Chinese, Latina, Korean and Vietnamese communities
(image: drawing of five women)
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Follow-Up
- Conducted by nurse and physician at OWH
- Follow-up appointments scheduled for women with detected abnormalities
- Attempt to establish a medical home for women with any abnormal results
- Results sent to client
- In language satisfaction survey distributed within 1 week of mobile clinic visit
(image: photo of 3 women)
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Research Aims
- Demonstrate target population was reached
- Evaluate prevalence of major preventable diseases in an underserved population
- Describe disparities in disease prevalence based on demographics and access to care
(image: an abstract drawing of a woman)
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Data Collection & Analysis
- Questionnaire Design
- Demoimage: age, zip code, marital status, birthplace, ethnicity, preferred language, FPL
- Access: insurance status, regular source of care, last physician visit, last preventive screenings
- Clinical outcomes
- BP, HbA1c, direct LDL, BMI, Pap test, breast exam, GYN exam
- Analysis
- Chi Square
- Logistic regression
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Demographics
2,597 women seen at 130 events over 3 years
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MC (n=2,597)
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LAC* (n=4,682)
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Born outside of the US,%
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82.4
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43.2
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Preferred language other than English,%
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75.4
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28.9
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Ethnicity,%
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Caucasian
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3.2
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35.1
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Armenian
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7.6
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---
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African American
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12.3
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10.3
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Asian
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35.1
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14.9
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Latina
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41.3
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39.7
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*Source: 2002-03 Los Angeles County Health Survey
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Access to Care
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MC (n=2,597)
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LAC* (n=4,682)
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Federal Poverty Level (FPL) < 200%
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93.8%
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49.6%
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No health insurance
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93.8%
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20.8%
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No regular source of care
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76.9%
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15.8%
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Last physician visit > 2 yrs
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34.0%
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---
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Last mammogram > 2 yrs (women > 40 yrs)
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47.8%
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27.2%
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Last Pap smear > 3yrs
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30.9%
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10.7%
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* Source: 2002-03 Los Angeles County Health Survey
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Outcomes and Ethnicity
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High Blood Pressure
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Diabetes
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High Cholesterol
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Abnormal Pap Test
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Abnormal Breast Exam
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Overall, %
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23.1
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18.8
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26.0
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5.3
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3.9
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White
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Caucasian, %
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22.1
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7.4
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21.1
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3.2
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5.8
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Armenian, %
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26.7
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12.8
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45.0*
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4.7
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1.8
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African American, %
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28.0*
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24.1*
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27.6
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6.8
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2.3
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Asian
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Chinese, %
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18.2
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16.9
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17.6
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3.9
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4.2
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Korean, %
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25.5
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14.8
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20.7
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3.8
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1.3
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Latina
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Mexican, %
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20.1
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18.6
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23.9
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4.1
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5.1
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Central American, %
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22.5
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28.6*
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36.5*
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10.6*
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6.6
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* p<0.05
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Outcomes and Ethnicity.Adjusted Odds Ratio
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Adjusted OR
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95% CI
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p-value
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High Cholesterol
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Armenian
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4.26
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2.93,6.17
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0.0001
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All others
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1.00
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Central American
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1.48
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1.03,2.13
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0.0358
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All others
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1.00
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High Blood Pressure
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African American
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1.47
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1.06,2.03
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0.0221
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All others
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1.00
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Diabetes
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Central American
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1.70
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1.14,2.52
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0.0088
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All others
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1.00
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African American
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1.55
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1.03,2.31
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0.0336
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All others
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1.00
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Body Mass Index
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Overweight or Obese BMI
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Overall, %
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56.9
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White
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Caucasian, %
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66.7
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Armenian, %
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67.0
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African American, %
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75.4
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Asian
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Chinese, %
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22.7
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Korean, %
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24.4
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Latina
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Mexican, %
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75.9
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Central American, %
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79.1
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Note: Began calculating in year 2 (data not representative of entire sample; N=1,717 instead of 2,597)
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Conclusions
- Reached target population
- Overall rates of disease was high is this population
- Specific ethnic groups were at higher risk for certain diseases
- Central Americans – diabetes, high cholesterol, abnormal Pap test
- Armenian – high cholesterol
- African American – diabetes, high blood pressure
(image: photo of women holding hands in front of the mobile clinic van)
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Strengths
- Builds grassroots connections between the OWH and the women, community and CBOs
- Increases access to care for high-risk women
- Promotes early detection of disease
- Mobile clinic is the first step into ongoing care
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Challenges
- Mobile services are expensive
- Extensive administration and coordination required to work with community partners
- Detecting disease is not enough – getting women to change behaviors is much more difficult
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Opportunities
- Shift focus from service delivery to maximizing client education
- Changed to Point-of-Service testing with on-site results
- Further build network of CBOs and partners
- Follow-up survey to determine whether women have established a medical home
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