Journal of Health Care for the Poor and Underserved

290 Brief communication COMMUNITY PARTNERSHIP TO IMPROVE ACCESS TO CARE FOR THE POOR AND UNDERSERVED Lack of access to primary care has become a critical concern in many communities, particularly those with a disproportionate share of the poor and minority populations.1,2 Access is inadequate for the working poor who are uninsured or underinsured and not eligible for Medicaid.3 Aproactive way to improve access to care is through a community partnership approach where community leaders, providers, and residents become partners in community organizing, needs assessment, and service restructuring and evaluation (Table I).4"10 This article describes the application of a community partnership model in Richland County, the third largest county in South Carolina. This study was undertaken for the purpose of developing a plan to reduce barriers to care and improve access to health and human services for low-income persons in the community. Richland County is one of the poorest counties in one of the poorest states of the country, with widespread pockets of low-income and homeless individuals and families. The Richland experience could be adapted in many similar communities that experience problems with access to primary care. Community organizing To improve access to primary care and reduce service fragmentation, leading health care providers and human services organizations in the Richland community formed the Richland County Health and Human Services Coalition (RCHHSC). The participating organizations included the Richland Memorial Hospital, a community teaching hospital; the county health department ; the county department of social services; community health centers; a Richland health maintenance organization (HMO); a family planning clinic; local shelters; and volunteer and citizen organizations. Community needs assessment An assessment of community health service needs was conducted using a variety of methods, including analyzing existing data, conducting focus groups with major community providers, interviewing patients and clients, Journal of Health Care for the Poor and Underserved · Vol. 7, No. 4 · 1996 SM et al. 291 TABLE 1 COMMUNITY PARTNERSHIP MODEL COMMUNITY ORGANIZING COMMUNITY NEEDS ASSESSMENT COMMUNITY RESTRUCTURING COMMUNITYBASED EVALUATION Tools • Form ad-hoc · Available community · Distribute findings committee data · Community-wide • Build coalition · Provider study program planning • Identify funding · Patient/client study · Seek funding sources · Consensus meetings · Implement interventions • Community health status indicators • Patient/client surveys • Provider surveys • Outcome measures Objectives • Broad-based · Problems participations identification • Ownership of · Problems prioritizing community-based· Targeted outcomes programs • Concerted efforts • Informed agency and community policymakers • Determine strategies and time lines • Integrated health and human services systems • More effective and efficient service provisions • Program monitoring • Timely feedback • Desired outcomes • Program adjustments and conducting focus groups with patient/client representatives. Core funding for these efforts was provided by a variety of sources, most notably, the Duke Endowment through its assistance in developing an integrated primary care program for Medicaid recipients and other low-income persons. Existing data. The secondary data we gathered were mainly published information available in the public domain and private administrative records and materials provided by collaborating community organizations. Provider focus groups. Separate focus groups were conducted with representatives from each of the major health and human services agencies in the community. Upon the completion of individual focus groups, a joint focus group was conducted with representatives from each of the major agencies who had participated in the individual focus groups. Participants were asked to discuss and prioritize the problems that had been identified during the individual focus groups. The major problems identified, ranked in descending order of reported frequency, were lack of a common computer-based information system covering all agencies, thus causing problems with referral and follow-up and resulting in excessive paperwork; lack of an adequate transportation system; lack of funding for prescription drugs; complex eligibility requirements; high staff turnover; and low pay. 292 Community Partnership Patient/client survey. To assess the perspective of area patients/clients in terms of health care access, we conducted a large-scale survey with a representative sample (N = 800) of the patient/client population. Some of the highlights of survey findings are as follows. Twenty-nine percent of the respondents indicated having delayed seeking medical care. Among the factors identified as related to such a delay, 56 percent thought the problems were not as serious as they were, 42...