4. Bryant, J. Health and the Developing World. Cornell University Press, Ithaca, NY, 1969. 5. Morley, D. Paediatric Priorities in the Developing World. Butterworth, London, 1973. 6. Omran, A. R. The Health Theme in Family Planning. Monograph No. 16. Carolina Population Center, University of North Carolina, Chapel Hill, 1971. 7. Banerji, D. Impact of Rural Health Services on the Health Behavior of Rural Populations in India-A Preliminary Communication. Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, November, 1973 (mimeographed). 8. Barns, T. E. C. Rural Services for Maternal and Child Health. Trop. Doct. 2:79-84, 1972. 9. Taylor, C. E. Health Team Concept at the Primary
Health Centre Level and the Staff Pattern and Their Roles. Indian J. Med. Educ. 11:86-92, 1972. 10. Ransome-Kuti, 0. Contribution. In Priorities in National Health Planning-Proceedings of an International Symposium, edited by Akinkugbe, 0. O., Olatunbosun, D., and Folayan Esan, G. J., pp. 58-62. Ibadan, 1973. Dr. Martin is a Lecturer in Maternal and Child Health, School of Public Health, University of North Carolina, Chapel Hill, North Carolina 27514. He works presently as Field Representative of the African Health Training Institutions Project of the University of North Carolina, and is based at the University Centre for Health Sciences, Yaounde, Cameroon.
Assessing Ambulatory Medical Care Utilization Patterns in the Community: A Brief Questionnaire Survey of Young Families DAVID W. GORDON, PhD
Introduction An increase in the number and variety of community requests for both hospital-based and satellite clinic services for medical care has become commonplace. In part, these requests are derivative of greater community involvement in comprehensive health planning activities. Whatever the source or reason for such community interest, we felt that it would be worthwhile to be able to assess quickly, accurately, and at low cost the medical care needs and utilization patterns of young families in a low and middle income area served by municipal and voluntary hospitals. Our overall impression had been that these families generally were receiving ambulatory medical care, although there existed an expressed desire for increased availability of general practitioners, especially for home visits and emergency conditions. We expected approximately 10 per cent of the families to be Medicaid-eligible; this expectation was based upon U.S. Census data for 1970.
Purpose The purpose of this study was to ascertain the usual sources of ambulatory medical care for the married couples
and their young children living in an area serviced by a satellite medical clinic. The information on medical care and utilization patterns, used in conjunction with existing census data, for example, would enable us to consider the feasibility of providing additional satellite medical clinic services in the community.
Setting and Method Approximately 1400 children attend two primary public schools and two community day nurseries located in an area of Manhattan's East Side served by the New York Hospital-Stanley M. Isaacs Medical Clinic, at 93rd Street and First Avenue. This clinic is administratively part of the New York Hospital's General Medical Clinic and it provides adult and pediatric sessions four mornings per week for the residents of the Isaacs Houses and Holmes Towers, as well as for the adjacent neighborhood. The neighborhood is predominantly white, low and middle income, with concentrations of Puerto Rican and black populations in the areas immediately above 96th Street. A single page, multiple choice and open end questionnaire was pretested and 600 copies were distributed to the children at the two schools and to the parents of those PUBLIC HEALTH BRIEFS
177
TABLE 1-Usual Source of Ambulatory Medical Care According to Selected Characteristics
Usual Source of Ambulatory Medical Care
Hospitals Municipal Voluntary Others* Subtotal Private physiciant Health station None
Total
Families (466)
Children (1085)
Medicaid (123)
Medicare (32)
25.1 10.9 18.2 54.2 32.2 4.5 9.1
28.7 12.2 11.7 52.6 33.4 4.8 9.2
33.3 17.9 13.0 64.2 17.1 5.7 13.0
40.6 12.5 21.9 75.0 21.9 3.1 0.0
100.0
100.0
100.0
100.0
* Refers to municipal and voluntary hospitals not located within local area. t Includes 64 families with membership in Health Insurance Plan.
attending the day nurseries. The questionnaires were made available in both English and Spanish and were to be filled out by the parents and returned to the teachers.
Results Ambulatory medical care information pertaining to the adults and children was provided by 466 adult respondents. Information, with respect to approximately 150 respondents who did not return the questionnaires is not available. The following data, therefore, refer to 466 families with 1085 children. (In some instances there were duplicate responses from families with more than one child attending these institutions. Since the respondents provided their names and addresses, it was possible to exclude duplicate questionnaire returns from individual families.) Usual Sources of Ambulatory Medical Care The findings reveal that 90 per cent of the respondents reported a "usual source of medical care." As shown in Table 1, slightly more than one-half (54.2 per cent) of the families reported that hospital clinics were their usual source of ambulatory care. In particular, one-fourth utilized a nearby municipal hospital (Metropolitan) and one-tenth similarly made use of the clinic services of the two voluntary hospitals serving the area (Mt. Sinai and New York Hospital). Table 1 also shows that almost one-fifth (18.2 per cent) of the families traveled throughout New York City in order to attend clinics at other hospitals, which are, with the exception of one proprietary hospital (Wadsworth), all large university-affiliated teaching hospitals (University, St. Luke's, Columbia-Presbyterian). Almost one-third (32.2 per cent) reported that private physicians were their usual sources of care. While 64 families indicated membership in H.I.P. (Health Insurance 178
AJPH FEBRUARY, 1975, Vol. 65, No. 2
Plan of Greater New York), one-third of these families utilized the hospital clinics, instead of the local H.I.P. group in the area. The city's local health station was utilized by 4.5 per cent of the families; 9.1 per cent mentioned that they had no usual source of medical care. Among the latter group, some respondents indicated that they visited various private physicians and hospitals, depending on their medical needs at the time.
Medicaid and Medicare Medicaid coverage was reported by 123 families (26.3 per cent), with almost two-thirds of this group utilizing hospital clinics. The response to the question asking whether a member of the household had Medicare revealed that 32 (6.9 per cent) were covered under Medicare. Table 1 shows that 75 per cent of this Medicare population received their ambulatory care at the hospital clinics.
Satisfaction with Medical Care The response to the general inquiry regarding ambulatory medical care revealed that 13.5 per cent were "dissatisfied" with the medical care received by the family. Among this group of 63 respondents, there were complaints about the hospital clinics (60.4 per cent), private physicians (17.5 per cent), and the health station (9.5 per cent). These complaints were in the realms of excessive waiting time and the high cost of medical care. In terms of medical care needs, the lack of general practitioners and the reticence of physicians to make house calls were mentioned occasionally. There were no specific comments that could be classified in terms of complaints about the "quality of medical care."
Comments The data* do confirn our working impressions that ambulatory medical care is received by more than 90 per cent of the families responding to the questionnaire. However, access to medical care for episodic health problems or emergencies does appear problematic for a number of families. For the most part, they are among the 9 per cent who did not list a usual source of medical care and specifically mentioned that physicians were not available for house calls and that medical care costs were too high. It appears, then, that the young adults and their children, with few exceptions, have a usual source of ambulatory medical care. Although some 36 per cent of the families utilized the local municipal and voluntary hospitals, it is significant to note that 18 per cent travel to other hospitals not in the area. Unfortunately, we do not have information that would reveal whether these utilization patterns had existed * It should be kept in mind that sampling techniques were not used for this brief survey and therefore no claims are made regarding the representativeness of these findings with respect to the larger population.
prior to their residence in the neighborhood, or if they are based upon employment location or other factors. The finding that 26.3 per cent of the families were covered by Medicaid was not expected; we had anticipated 10 per cent, based upon U.S. Census data. In summary, the brief one-page questionnaire did provide us with data quickly at low cost and without difficulty. Concurrently, the findings confinned to us that this population had been utilizing the hospital clinics and physicians for their ambulatory medical care. In this light it became clear that our efforts directed toward community medicine in this neighborhood should focus on amenities in the clinic settings and improved access for episodic medical problems, rather than on additional satellite clinics. The empirical data obtained in this study have been useful in our discussions with community representatives; a little data goes a long way toward reducing conflict, especially if it is shared data. Dr. Gordon is a Research Associate in the Department of Public Health, Cornell University Medical College, and Health Planner, The New York Hospital-Cornell Medical Center, New York, New York 10021.
Editor's Note: The articles which appear in PUBLIC HEALTH BRIEFS have been condensed by the authors for publication in the American Journal of Public Health. An extended version of each report published in this Journal Department is on file at APHA headquarters. Single copies of the extended version are available for a limited period of time from the American Journal of Public Health, APHA, 1015 Eighteenth Street, NW, Washington, DC 20036. When requesting the extended report, please cite the title of the published article, name of principal author, and the AJPH issue in which the condensed report appeared in PUBLIC HEALTH BRIEFS.
TWO-DAY PROGRAM ON BIRTH DEFECTS AND GENETIC COUNSELING Birth defects and genetic counseling will be the topic of a 2-day program to be held March 14 and 15, 1975, at the Holiday Inn-Golden Gateway, San Francisco, by the University of California, San Francisco. What genetic counseling is, where it is today, and what the implications are for the future will be emphasized for nurses, social workers, physicians, and allied professional health care personnel. The faculty will familiarize participants with the organization and services of a genetic counseling group in a medical center setting and with the delivery of genetic counseling via a team concept. Further information on the program may be obtained from: Continuing Education in Nursing, University of California, San Francisco, San Francisco, CA, (415) 666-1817.
Health Centre Level and the Staff Pattern and Their Roles. Indian J. Med. Educ. 11:86-92, 1972. 10. Ransome-Kuti, 0. Contribution. In Priorities in National Health Planning-Proceedings of an International Symposium, edited by Akinkugbe, 0. O., Olatunbosun, D., and Folayan Esan, G. J., pp. 58-62. Ibadan, 1973. Dr. Martin is a Lecturer in Maternal and Child Health, School of Public Health, University of North Carolina, Chapel Hill, North Carolina 27514. He works presently as Field Representative of the African Health Training Institutions Project of the University of North Carolina, and is based at the University Centre for Health Sciences, Yaounde, Cameroon.
Assessing Ambulatory Medical Care Utilization Patterns in the Community: A Brief Questionnaire Survey of Young Families DAVID W. GORDON, PhD
Introduction An increase in the number and variety of community requests for both hospital-based and satellite clinic services for medical care has become commonplace. In part, these requests are derivative of greater community involvement in comprehensive health planning activities. Whatever the source or reason for such community interest, we felt that it would be worthwhile to be able to assess quickly, accurately, and at low cost the medical care needs and utilization patterns of young families in a low and middle income area served by municipal and voluntary hospitals. Our overall impression had been that these families generally were receiving ambulatory medical care, although there existed an expressed desire for increased availability of general practitioners, especially for home visits and emergency conditions. We expected approximately 10 per cent of the families to be Medicaid-eligible; this expectation was based upon U.S. Census data for 1970.
Purpose The purpose of this study was to ascertain the usual sources of ambulatory medical care for the married couples
and their young children living in an area serviced by a satellite medical clinic. The information on medical care and utilization patterns, used in conjunction with existing census data, for example, would enable us to consider the feasibility of providing additional satellite medical clinic services in the community.
Setting and Method Approximately 1400 children attend two primary public schools and two community day nurseries located in an area of Manhattan's East Side served by the New York Hospital-Stanley M. Isaacs Medical Clinic, at 93rd Street and First Avenue. This clinic is administratively part of the New York Hospital's General Medical Clinic and it provides adult and pediatric sessions four mornings per week for the residents of the Isaacs Houses and Holmes Towers, as well as for the adjacent neighborhood. The neighborhood is predominantly white, low and middle income, with concentrations of Puerto Rican and black populations in the areas immediately above 96th Street. A single page, multiple choice and open end questionnaire was pretested and 600 copies were distributed to the children at the two schools and to the parents of those PUBLIC HEALTH BRIEFS
177
TABLE 1-Usual Source of Ambulatory Medical Care According to Selected Characteristics
Usual Source of Ambulatory Medical Care
Hospitals Municipal Voluntary Others* Subtotal Private physiciant Health station None
Total
Families (466)
Children (1085)
Medicaid (123)
Medicare (32)
25.1 10.9 18.2 54.2 32.2 4.5 9.1
28.7 12.2 11.7 52.6 33.4 4.8 9.2
33.3 17.9 13.0 64.2 17.1 5.7 13.0
40.6 12.5 21.9 75.0 21.9 3.1 0.0
100.0
100.0
100.0
100.0
* Refers to municipal and voluntary hospitals not located within local area. t Includes 64 families with membership in Health Insurance Plan.
attending the day nurseries. The questionnaires were made available in both English and Spanish and were to be filled out by the parents and returned to the teachers.
Results Ambulatory medical care information pertaining to the adults and children was provided by 466 adult respondents. Information, with respect to approximately 150 respondents who did not return the questionnaires is not available. The following data, therefore, refer to 466 families with 1085 children. (In some instances there were duplicate responses from families with more than one child attending these institutions. Since the respondents provided their names and addresses, it was possible to exclude duplicate questionnaire returns from individual families.) Usual Sources of Ambulatory Medical Care The findings reveal that 90 per cent of the respondents reported a "usual source of medical care." As shown in Table 1, slightly more than one-half (54.2 per cent) of the families reported that hospital clinics were their usual source of ambulatory care. In particular, one-fourth utilized a nearby municipal hospital (Metropolitan) and one-tenth similarly made use of the clinic services of the two voluntary hospitals serving the area (Mt. Sinai and New York Hospital). Table 1 also shows that almost one-fifth (18.2 per cent) of the families traveled throughout New York City in order to attend clinics at other hospitals, which are, with the exception of one proprietary hospital (Wadsworth), all large university-affiliated teaching hospitals (University, St. Luke's, Columbia-Presbyterian). Almost one-third (32.2 per cent) reported that private physicians were their usual sources of care. While 64 families indicated membership in H.I.P. (Health Insurance 178
AJPH FEBRUARY, 1975, Vol. 65, No. 2
Plan of Greater New York), one-third of these families utilized the hospital clinics, instead of the local H.I.P. group in the area. The city's local health station was utilized by 4.5 per cent of the families; 9.1 per cent mentioned that they had no usual source of medical care. Among the latter group, some respondents indicated that they visited various private physicians and hospitals, depending on their medical needs at the time.
Medicaid and Medicare Medicaid coverage was reported by 123 families (26.3 per cent), with almost two-thirds of this group utilizing hospital clinics. The response to the question asking whether a member of the household had Medicare revealed that 32 (6.9 per cent) were covered under Medicare. Table 1 shows that 75 per cent of this Medicare population received their ambulatory care at the hospital clinics.
Satisfaction with Medical Care The response to the general inquiry regarding ambulatory medical care revealed that 13.5 per cent were "dissatisfied" with the medical care received by the family. Among this group of 63 respondents, there were complaints about the hospital clinics (60.4 per cent), private physicians (17.5 per cent), and the health station (9.5 per cent). These complaints were in the realms of excessive waiting time and the high cost of medical care. In terms of medical care needs, the lack of general practitioners and the reticence of physicians to make house calls were mentioned occasionally. There were no specific comments that could be classified in terms of complaints about the "quality of medical care."
Comments The data* do confirn our working impressions that ambulatory medical care is received by more than 90 per cent of the families responding to the questionnaire. However, access to medical care for episodic health problems or emergencies does appear problematic for a number of families. For the most part, they are among the 9 per cent who did not list a usual source of medical care and specifically mentioned that physicians were not available for house calls and that medical care costs were too high. It appears, then, that the young adults and their children, with few exceptions, have a usual source of ambulatory medical care. Although some 36 per cent of the families utilized the local municipal and voluntary hospitals, it is significant to note that 18 per cent travel to other hospitals not in the area. Unfortunately, we do not have information that would reveal whether these utilization patterns had existed * It should be kept in mind that sampling techniques were not used for this brief survey and therefore no claims are made regarding the representativeness of these findings with respect to the larger population.
prior to their residence in the neighborhood, or if they are based upon employment location or other factors. The finding that 26.3 per cent of the families were covered by Medicaid was not expected; we had anticipated 10 per cent, based upon U.S. Census data. In summary, the brief one-page questionnaire did provide us with data quickly at low cost and without difficulty. Concurrently, the findings confinned to us that this population had been utilizing the hospital clinics and physicians for their ambulatory medical care. In this light it became clear that our efforts directed toward community medicine in this neighborhood should focus on amenities in the clinic settings and improved access for episodic medical problems, rather than on additional satellite clinics. The empirical data obtained in this study have been useful in our discussions with community representatives; a little data goes a long way toward reducing conflict, especially if it is shared data. Dr. Gordon is a Research Associate in the Department of Public Health, Cornell University Medical College, and Health Planner, The New York Hospital-Cornell Medical Center, New York, New York 10021.
Editor's Note: The articles which appear in PUBLIC HEALTH BRIEFS have been condensed by the authors for publication in the American Journal of Public Health. An extended version of each report published in this Journal Department is on file at APHA headquarters. Single copies of the extended version are available for a limited period of time from the American Journal of Public Health, APHA, 1015 Eighteenth Street, NW, Washington, DC 20036. When requesting the extended report, please cite the title of the published article, name of principal author, and the AJPH issue in which the condensed report appeared in PUBLIC HEALTH BRIEFS.
TWO-DAY PROGRAM ON BIRTH DEFECTS AND GENETIC COUNSELING Birth defects and genetic counseling will be the topic of a 2-day program to be held March 14 and 15, 1975, at the Holiday Inn-Golden Gateway, San Francisco, by the University of California, San Francisco. What genetic counseling is, where it is today, and what the implications are for the future will be emphasized for nurses, social workers, physicians, and allied professional health care personnel. The faculty will familiarize participants with the organization and services of a genetic counseling group in a medical center setting and with the delivery of genetic counseling via a team concept. Further information on the program may be obtained from: Continuing Education in Nursing, University of California, San Francisco, San Francisco, CA, (415) 666-1817.
