Integrated Primary Care for
Low Income and Underserved Populations
Living
in poverty is a
health risk. The stresses of the
lives of people in poverty take a greater toll on their bodies than is true for
people with adequate financial resources. On another page, we document that a high proportion of problems
that are brought to primary care represent pains that are not related to
biological disease. We need to remember that the impact of psychosocial
factors on the body is even greater for people in poverty.
Low
income and underserved populations are less likely than the general public to
accept a mental health definition of their problem and
if they do accept a referral for mental health services, they encounter much
greater difficulty negotiating travel and scheduling problems.
This means that, while primary care physicians are the only providers
treating 50 to 70% of the diagnosable mental health problems treated in the US,
that figure is higher for the underserved.
The fit between the medical care providing system
and the needs of patients from low income and underserved populations is often
very poor. Garrison
and his colleagues in a study done in Springfield, MA, found that while low
income patients have higher levels of psychosocial needs, medical providers
often are less likely to address psychosocial needs in this population than in
more affluent populations. This is both a product of the providers’ approach and of
the patients’ reticence to enlist the aid of their medical providers.
In their study, low income parents at a public pediatric clinic had
higher levels of psychosocial concerns for their children than did parents in
the private practice settings surveyed, yet they were less likely to want to
talk to the pediatricians about their concerns.
When patients indicated they did want to discuss their concerns with
their doctor, physicians were less likely to address the parents’ concerns in
the public clinic.
It is especially important that care for low income and underserved patients be supplied in a way that addresses the needs they present in ways that they can accept. In this page we would like to offer some examples of programs that are attempting to do this.
HRSA Bureau of Primary Health Care Health Disparities Collaborative on Depression
Here is an article about an integrated program for the most medically vulnerable, like homeless injection-drug users, that improves care, lowers ER costs and improves lives.
For a report that uses integrated primary care within a much larger institutional, governmental and community initiative, read the report on the Baltimore program in the Urban Health Initiative report of the President's Council on Urban Health.
On a much more personal scale, programs such as that of Linda Weinreb, MD, are wonderful examples of what sort of environment is necessary to make this population engage effectively with primary care services. Her program for homeless and formerly homeless mothers and children is truly inspiring.
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