People who don't have a consistent medical provider – a "medical home" – appear to be less likely to receive regular preventive care, according to a new health policy brief from UCLA.
In their report, researchers said a medical home – also referred to as a "patient-centered medical home" – is a place where:
- A patient sees a regular doctor over an extended period of time, rather than jumping from doctor to doctor.
- This regular doctor creates a personalized treatment plan for the patient.
- The doctor coordinates the patient's care.
Mary Valencia, the quality improvement coordinator at South Central Family Health Center, said medical homes are "not the norm" in South Los Angeles. That, she added, often presents logistical problems – ones that can lead to poor health.
"What happens is there's not much coordinated care," she explained. "We have a very transient population. They often move, phone numbers are disconnected, they have a lot of domestic violence issues, a lot of immigration issues."
And a lot of times, they'll leave a clinic, receive care elsewhere and then come back to the original clinic. The problem with that, said Valencia, is health providers don't know what has happened during those interim months. The challenge becomes piecing together "fragmented care."
"It's about educating the patient that we are your medical home, and we coordinate your care," said Valencia. "So if you go to the E.R., we need to know about it. If you self-refer to a specialist, we need to know about it. If you're taking any medications we did not prescribe, we need to know about that as well."
The UCLA study said Californians whose care met the three requirements they laid out were:
- The most likely to get a regular flu shot, compared to patients without a regular source of care.
- More likely to have seen their doctor at least five times within the past year.
- More likely to have called their doctor with a health-related question.
- The most confident about their ability to manage their own health.
Valencia said having a medical home is also more conducive to a more comfortable patient-health provider "partnership."
"It's just common sense that if you see the same provider [over time], you're going to build a rapport with them, you're going to build that trust," she said. "You don't have to start from square one every time you come for a visit, because they will know your medical history."
To that end, she added, it's important for as many visits as possible to be planned – as opposed to walk-ins, which South Central Family Health Center sees a lot of – so patients can be paired with their provider.
The health center is currently in the midst of applying to become certified as a patient-centered medical home. Valencia, who is spearheading that process, says the clinic will be evaluated by the National Committee on Quality Assurance on measures like the availability of appointments, patient access to care outside regular clinic hours and patient access to electronic medical records. As a federally-qualified health center, South Central Family Health Center is required to submit an application, and will learn whether it's been certified in the coming months.
But although it's best for patients to have medical homes, said Nina Vaccaro, the executive director of the Southside Coalition of Community Health Centers, "it's not an easy thing to do."
"We know that patients can be a little migratory in where they seek health care services," she said in a recent interview. "If there's a wait at one clinic, they'll go to the other one."
Mary Valencia says that means, in order to get medical homes to catch on, patients will have to undergo some behavioral modification.
"It's going to take a lot of educating the patient and really explaining why it's important," she said. "I think patients, around this community especially, are more accustomed to acute care." That is, visiting a doctor only when there's a problem that needs treatment.
"They don't really understand the concept of health maintenance," added Valencia.
The UCLA report said uninsured Medi-Cal beneficiaries, Latinos, the poor, Asian-Americans and those receiving care from clinics or "non-conventional providers" were the least likely to report having a medical home.