A Preventative Care Delivery Twist

A new study by UCLA researchers has concluded that the best way to provide preventative care to underserved populations may be to deliver it within their communities as opposed to waiting for them to show up and ask for it.

An examination of 20 such preventative care outreach programs by the UCLA Center for Health Policy Research has concluded that they all provide far higher success rates in getting underserved and minority communities screened for conditions such as breast and colorectal cancers. Four of the programs are based in California, including three in San Francisco.

“The research shows that health providers might need to think outside the box on how and where to deliver health services,” said Janet Frank, an adjunct professor at the UCLA Fielding School of Public Health and the lead author of the study. “The programs that fared the best did not wait for patients to come to them — they went to where the patients were.”

Currently, there are yawning gaps in preventative screenings such as colorectal screenings and mammograms. For example, 47% of Asian-Americans and African-Americans between the ages of 50 and 75 have been screened for colorectal cancer, according to national data compiled by the University of Minnesota. That's 14 percentage points lower than the screening rate among whites and 24 points below the rate the U.S. Department of Health and Human Services wants to achieve nationwide by the end of the decade. The gap in mammogram screenings is smaller but still considerable.

Services that were studied by UCLA researchers were provided in non-traditional settings for healthcare delivery: Churches, adjacent to voting booths, and sometimes even the homes of would-be patients.

In Northern California, the Daniels Bay Area Project delivered flu and other vaccinations in a church. In Southern California, Maxwell Los Angeles used nurses and physicians from the Philippines used educational sessions in informal settings to increase rates of breast and cervical cancer screenings. Pathways performed a similar service for Vietnamese women in San Francisco, often visting them in their homes.

Frank noted that the projects broke the mold of healthcare delivery both for providers and patients.

“Traditionally, providers wait for people to come in and see them, and I think that reflects the low rates of preventative healthcare,” she said. “And low-income people and underrepresented minorities don't think about going to the doctor when they're healthy. They think about using clinical services when they're sick. It's like a mindset for both (constituents).” 

Although specific data was not available from UCLA, Frank indicated that all of the programs enjoyed significant success in bumping up rates of preventative care in the communities they targeted.

And while Frank believes such outreach programs could prove a solution for some not-for-profit hospitals under pressure to better define the community benefits they provide to the Internal Revenue Service and other tax authorities, keeping such programs going on a long-term basis remain a challenge. Several operated on one-time grants and have since stopped operations.

As a result, the study concluded that “funders should be encouraged to promote the dissemination, replication, and expansion of successful clinical preventive services programs, especially for older ethnic and racially diverse populations and for programs found effective in  diverse geographic areas, so that more individuals in vulnerable populations can benefit.”