Abstract
BackgroundMobile (MHCs), Community (CHCs), and School-based health clinics (SBHCs) are understudied alternative sources of health care delivery used to provide more accessible primary care to disenfranchised populations. However, providing access does not guarantee utilization. This study explored the utilization of these alternative sources of health care and assessed factors associated with residential segregation that may influence their utilization.MethodsA cross-sectional study design assessed the associations between travel distance, perceived quality of care, satisfaction-adjusted distance (SAD) and patient utilization of alternative health care clinics. Adults (n = 165), child caregivers (n = 124), and adult caregivers (n = 7) residing in New Orleans, Louisiana between 2014 and 2015 were conveniently sampled. Data were obtained via face-to face interviews using standardized questionnaires and geospatial data geocoded using GIS mapping tools. Multivariate regression models were used to predict alternative care utilization.ResultsOverall 49.4% of respondents reported ever using a MCH, CHC, or SBHC. Travel distance was not significantly associated with using either MCH, CHC, or SBHC (OR = 0.91, 0.74–1.11 p > .05). Controlling for covariates, higher perceived quality of care (OR = 1.02, 1.01–1.04 p < .01) and lower SAD (OR = 0.81, 0.73–0.91 p < .01) were significantly associated with utilization.ConclusionsProvision of primary care via alternative health clinics may overcome some barriers to care but have yet to be fully integrated as regular sources of care. Perceived quality and mixed-methods measures are useful indicators of access to care. Future health delivery research is needed to understand the multiple mechanisms by which residential segregation influences health-seeking behavior.
Highlights
Mobile (MHCs), Community (CHCs), and School-based health clinics (SBHCs) are understudied alternative sources of health care delivery used to provide more accessible primary care to disenfranchised populations
The goal of this study was to explore the extent to which Mobile Health Clinic (MHC), Community Health Clinic (CHC), and School-based Health Clinic (SBHC) are utilized by marginalized populations and to assess the factors associated with geographic residential segregation that influence their utilization
Study setting and study population The study was conducted in New Orleans, Louisiana where a long history of residential segregation continues to this day [21, 22]
Summary
Mobile (MHCs), Community (CHCs), and School-based health clinics (SBHCs) are understudied alternative sources of health care delivery used to provide more accessible primary care to disenfranchised populations. Underutilization of primary care services is predominantly experienced in minority and low socioeconomic populations, two groups subject to high rates of chronic conditions [2, 3]. This is Preliminary research suggests that residential segregation is a prominent barrier to accessing primary care [6,7,8,9,10]. Geographic inaccessibility, primarily defined as distance, has been highlighted as a key mechanism by which
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