Understanding the Barriers to Health Care for Vulnerable Populations: A Program Evaluation of Service Utilization at a Free Health Care Clinic

Valorie Orton

Date of Award

2019

Document Type

Thesis

College/School

College of Nursing

Degree Name

Master of Science in Nursing (MSN)

Abstract

"Background: Free and charitable clinics play an important role in the health care system safety net in providing health care to uninsured, under-insured, and medically underserved individuals. Barriers to accessing and utilizing health care services may prevent vulnerable members of communities from seeking and obtaining needed care in a timely manner. Objective: A program evaluation was undertaken for a newly established free clinic in the Pacific Northwest to identify barriers in accessing and utilizing health care services. Methods: A mixed methods approach was utilized to assess organizational and consumer characteristics that may create actual or perceived barriers to seeking and obtaining needed health care. Chart reviews and a community survey were employed to identify consumer demographic characteristics and medical conditions for the target population. Open-ended community survey questions and key informant interviews were employed to identify perceived barriers to access and utilization of clinic services. Results: Patient characteristics were consistent with national data on patients seeking care at a free clinic, with similar demographic and medical conditions. Four key barriers were identified by consumers: transportation difficulties, availability and scheduling issues, timeliness, and patient-provider relationships. Four themes emerged from the key informant interviews: determinants of health (affordable housing, employment and educational opportunities, and public transportation), wealth disparities (affordability and stigmatization), health care system complexity (health system literacy and health insurance), and health care workforce shortages. Implications: Findings from the program evaluation was utilized by the clinic leadership to inform strategic planning to improve program effectiveness and to promote strategies for sustainable health care services for vulnerable members of the community."

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