Socioeconomic Barriers Hinder Socioeconomic Barriers Hinder Optimal Patient-Physician Optimal Patient-Physician

Relations: A Resource Manual Relations: A Resource Manual for Women and Their Health for Women and Their Health

Care ProvidersCare Providers

Kristi MurphyKristi Murphy

March 17, 2009March 17, 2009

Exercise ScienceExercise Science

Senior Thesis PresentationSenior Thesis Presentation

PT NorthwestPT Northwest

Sports Medicine Clinic in Corvallis, Sports Medicine Clinic in Corvallis, OregonOregon

Physical Therapist Physical Therapist

Jason BallJason Ball

Physical Therapist AidePhysical Therapist Aide

Salem HospitalSalem Hospital

Family Birth Center Clinic (FBCC)Family Birth Center Clinic (FBCC)

Willamette Valley Midwives Clinic Willamette Valley Midwives Clinic (WVMC)(WVMC)

Becky Fisher, program director of Becky Fisher, program director of FBCC and WVMCFBCC and WVMC

Family Birth Center ClinicFamily Birth Center Clinic

No Health Insurance 34%

Private Health Insurance

14%

Oregon Health Plan 29%

Community Prenatal Project

22%

High-risk Patients 47%

Family Birth Center Clinic, Family Birth Center Clinic, cont.cont.

Offers significant support and aidOffers significant support and aid– Accepts all health insurance plansAccepts all health insurance plans– Sliding fee scaleSliding fee scale– Helps with Oregon Health Plan Helps with Oregon Health Plan

application processapplication process– Helps absorb prenatal costs through Helps absorb prenatal costs through

charity funds, paying insurance charity funds, paying insurance premiums, etc.premiums, etc.

Willamette Valley Midwives Willamette Valley Midwives ClinicClinic

Private Health Insurance

39%

Oregon Health Plan 50%

No Health Insurance 11%

High-risk Patients 39%

Table 1: Patient Demographics of Salem Hospital’s Family Birth Center Clinic and Willamette Valley Midwives Clinic, 2009. # of Patients FBCC # of Patients WVMC AVERAGE

Pri 45 13.51% 92 39.48% 24.20% App OHP 38 11.41% 20 8.58% 10.25% OHP 97 29.13% 116 49.79% 37.63% None 74 22.22% 5 2.15% 13.96% CPP 74 22.22% 0 CAWEM 4 1.20% 0 Charity 1 0.30% 0 Total W/Out 112 33.63% 25 10.73% 22.18% Total OHP eligible 135 40.54% 136 58.37% 47.88% MH 78 23.42% 61 26.18% 24.56% DB 49 14.71% 4 1.72% 9.36% SA 28 8.41% 25 10.73% 9.36% TRI 1 158 47.45% 157 67.38% 55.65% TRI 2 69 20.72% 60 25.75% 22.79% TRI 3 28 8.41% 8 3.43% 6.36% MP 264 79.28% 128 54.94% 69.26% PP 70 21.02% 105 45.06% 30.92% Age 15-17 10 3.00% 25 10.73% 18-20 46 13.81% 52 22.32% 21-23 53 15.92% 46 19.74% 24-26 72 21.62% 33 14.16% 27-29 59 17.72% 34 14.59% 30-32 35 10.51% 17 7.30% 33-35 30 9.01% 14 6.01% 36-38 17 5.11% 9 3.86% 39-41 8 2.40% 2 0.86% 42-44 2 0.60% 1 0.43% 45-47 1 0.30%

Patients of the ClinicsPatients of the Clinics

Large Hispanic baseLarge Hispanic base Teenage mothersTeenage mothers Single mothersSingle mothers Poorly educatedPoorly educated High occurrence of miscarriagesHigh occurrence of miscarriages Unreliable transportationUnreliable transportation

Patient NoncompliancePatient Noncompliance Numerous factors strain patient-physician Numerous factors strain patient-physician

relations at the FBCC and WVMCrelations at the FBCC and WVMC– Patient’s socioeconomic statusPatient’s socioeconomic status

Often makes compliance with health care Often makes compliance with health care recommendations difficultrecommendations difficult

Clinics’ staffs restricted due to lack ofClinics’ staffs restricted due to lack of– ResourcesResources– TimeTime– FinancesFinances

Rationale for ProjectRationale for Project

What could be done to improve the situation?What could be done to improve the situation?− Pain and stress-relieving exercises & stretchesPain and stress-relieving exercises & stretches− General pregnancy informationGeneral pregnancy information

Importance of general health, physical Importance of general health, physical activity, and education during pregnancyactivity, and education during pregnancy

Patient education observed to improve Patient education observed to improve patient compliancepatient compliance

Create women’s health resource manualCreate women’s health resource manual

Background ResearchBackground Research

Current handoutsCurrent handouts– Salem HospitalSalem Hospital– Other hospitals and birth clinicsOther hospitals and birth clinics

Presentation to staff of FBCC and Presentation to staff of FBCC and WVMCWVMC– Input, feedback, recommendationsInput, feedback, recommendations

Visited WVMC Visited WVMC – Kathryn Nielsen, Certified MidwifeKathryn Nielsen, Certified Midwife– Patient interviewsPatient interviews– Reviewed patient filesReviewed patient files

Background Research, cont.Background Research, cont.

Erin Devoy, Women’s Health Physical Erin Devoy, Women’s Health Physical TherapistTherapist

Provided valuable literature and Provided valuable literature and handoutshandouts

Recommended specific stretches and Recommended specific stretches and exercises exercises – Visual Health Information Exercise Visual Health Information Exercise

Software (VHI)Software (VHI)

Literature ReviewLiterature Review

Articles, handouts, adviceArticles, handouts, advice– Physical TherapistsPhysical Therapists– MidwivesMidwives– Athletic TrainersAthletic Trainers

Strict inclusion criteria Strict inclusion criteria – Realistic expectations of patients, clinic, Realistic expectations of patients, clinic,

and staff membersand staff members

Creation of Resource Creation of Resource ManualManual

Three types of informationThree types of information– Informative handouts for patientsInformative handouts for patients– Suggested stretches and exercisesSuggested stretches and exercises– More technical/complex information for health More technical/complex information for health

care providerscare providers

Four main sectionsFour main sections– Food/substance/behaviorsFood/substance/behaviors– Common aches/complaintsCommon aches/complaints– General painGeneral pain– Exercise and rehabilitationExercise and rehabilitation

Creation of the Resource Creation of the Resource Manual, cont.Manual, cont.

Translation of all patient handouts Translation of all patient handouts included from English to Spanishincluded from English to Spanish

Assistance of many native and Assistance of many native and advanced Spanish speakersadvanced Spanish speakers

Approval of Resource Approval of Resource ManualManual

Dr. Judy MarvinDr. Judy Marvin

Dr. Lance LobergDr. Lance Loberg

Becky FisherBecky Fisher

Staff of FBCCStaff of FBCC

Staff of WVMC Staff of WVMC

LimitationsLimitations

Anecdotal and subjective evidenceAnecdotal and subjective evidence– Demographic data of patientsDemographic data of patients– Literature reviewLiterature review

AcknowledgmentsAcknowledgments

Becky FisherBecky Fisher Staffs of FBCC and Staffs of FBCC and

WVMCWVMC Erin DevoyErin Devoy Stas StavrianeasStas Stavrianeas

Rachel DunningtonRachel Dunnington Marco FialloMarco Fiallo Luis GuerraLuis Guerra Alejandro JimenezAlejandro Jimenez Mayra LedesmaMayra Ledesma Ali MakiAli Maki