1. Galveston County Health District 4Cs Clinics Summary Needs Assessment for 5 Year Competitive Grant And 4Cs 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- & Underinsured Target 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. 4Cs 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 4Cs 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. BARRIER Access to Prescription Drugs Confusion & limitations of Medicare Drug Benefit Limited budget for drugs on 4Cs formulary Community need for drugs exceeds need for 4Cs healthcare (non 4Cs patients come to clinics merely to get RX of private physicians filled) Differences in prescribing practices (4Cs formulary vs. private practices) Lack of pharmacy inventory systems

12. BARRIER Communications 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 4Cs 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. BARRIER Lack 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. BARRIER Transportation on Mainland No public transportation system (on Mainland) Frequent complaints of patients Available services perceived as inadequate, inconvenient & not time-sensitive

15. BARRIER Lack 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. BARRIER Cultural & 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. BARRIER Efforts 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. BARRIER Professional 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?