Recorded presentation

Ruth Wetta-Hall, RN, MPH, MSN¹, Ed Dismuke, MD, MSPH², Craig A. Molgaard, PhD, MPH¹, Doren D. Fredrickson, MD, PhD¹, and Elizabeth Ablah, MA¹. (1) Preventive Medicine & Public Health, University of Kansas School Of Medicine-Wichita, 1010 N. Kansas Avenue, Wichita, KS 67214, 316-293-2627, rwettaha@kumc.edu, (2) Dean's Office, Dean, KU School of Medicine-Wichita, 1010 N. Kansas, Wichita, KS 67214

Study Purpose: The study purpose was to investigate the antecedents of medical care seeking behaviors, barriers to care, and cultural influences that precede a visit to the ED for primary care medical services among low-income, uninsured residents of Sedgwick County, Kansas.

Methods: Eight focus groups were conducted with an age, gender and ethnically representative convenience sample of uninsured adults who had self-reported ED use during the previous year.

Focus Group Results: Participants were younger, female, less educated, and single. Approximately 45% were unemployed. Those who were employed reported income of less than $20,000 per year. Four general themes emerged when participants were asked what are the most common problems that make it difficult to get medical care, including financial, access to care, provider, and language/cultural barriers. The majority of participants indicated they would purchase insurance, if it were available at a reasonable price. Several common barriers to staying healthy emerged, which included, stress, lack of access to primary care, lack of access to regular medical care for chronic conditions, not being able to afford life necessities (food, shelter, transportation), and not being able to afford prescription medications. Another consistent finding was a perceived lack of providers showing respect.

Conclusions and Recommendations: Low-income uninsured sought ED care for illnesses they perceived as urgent due to interference with daily activities of life. Participants understood the difference between an urgent and nonurgent condition, and sought care at an ED as a last resort due to financial, access, provider or language/cultural barriers. Findings suggest that provider and patient definitions of conditions “appropriate” to be seen in the ED are vastly different, and that categorization of ED visits may need to be based on psychosocial problems as well as medical problems. Removing financial, access and transportation barriers are just the beginning to improving access to the primary care system. Understanding how, why, and when the uninsured make decisions to seek medical care will be crucial in changing care seeking behaviors and achieving Healthy People 2010 primary care objectives. Study findings suggest there is still a need for cultural and literacy sensitivity that is not only ethnically based, but socio-economically based as well. The health care community must understand and appreciate a patient’s cultural background, as well as information exchange (both questions and answers), health-related instruction, insurance and billing information, must be offered in a manner that the patient, and/or patient’s family can understand.

Learning Objectives: