first responders focus group
Summary
A focus group consisting of critical care responders was held in March 2004 at the Jones Center in Springdale , Arkansas . This focus group was one of four focus groups conducted in Northwest Arkansas as part of the Four-County Community Health Needs Assessment. The focus group was facilitated by members of the University of Arkansas ' Social Work Research Center. It was designed to provide in-depth information in regard to the perceived health care needs in Northwest Arkansas , from the perspective of first responders. Information obtained from this focus group was utilized to augment the findings obtained from the Four-County Community Health Needs Assessment.
Six critical care responders from the Benton , Washington , Carroll, and Madison Counties were invited to participate in the first responders focus group. Three critical care responders participated in the focus group. The participants included a deputy sheriff from a rural Northwest Arkansas county, a director of a homeless shelter, and a lead pharmacist who operates a large pharmaceutical program that offers free and reduced costs for prescriptions.
Observed Health Problems
Each of the participants noted that they serve a significant volume of community residents who experience all of the expected health conditions which are prevalent in the community: heart disease, cancer, diabetes, arthritis, asthma, respiratory illnesses, substance abuse, and mental health issues. Additional health concerns cited included: assisting isolated elderly residents, child endangerment and abuse, severe skin conditions (secondary to poor hygiene and living conditions, living outdoors, and marginal economic resources), untreated chronic health conditions (back injuries), and chronic pain.
In the opinion of the focus group participants, many of these health conditions are complicated by, and sometimes caused by, untreated mental health and/or substance abuse problems. A common scenario, as noted by the focus group members, involves an individual who loses their employment and health care insurance following an illness or an injury. In these instances, these individuals are no longer able to access affordable health care in order to receive treatment for their medical care problems. These individuals not only are unable to access affordable health care in order to treat their ongoing pain and reduced physical capacity, but they often manifest substance abuse, alcohol, and mental health concerns as a "coping mechanism", secondary to their untreated health problems.
In each of the settings in which the first responders provide services, they reported an increasing incidence in which people have been diagnosed with a variety of health care conditions (e.g. , diabetes, heart disease, mental health problems) , however, these individuals were not consistently taking their medications. A typical scenario involves an individual who is suffering from a medical or mental health condition but does not have someone in their life who is able to assist them with compliance with their ongoing medical treatment and medication regimen.
It was further observed by members of the focus group that urban areas often attract people from outlying rural areas due to the relative unavailability of essential and specialized medical services within these regions. The following scenario was presented as indicative of this concern expressed by first responders over the lack of available mental health services:
"Once it is attempted [suicide], it falls to the authorities to get them to a place for their own protection. Ozark Guidance.they do all they can, but in the past year, we have had cases where the person needed to be committed, you contact Little Rock State Hospital, they don't have any facilities, so you end up taking them home and put them back in the same situation".
The number one underserved health care issue within Northwest Arkansas , as identified by the focus group participants, was mental health care issues. The focus group members stated that a lack of services needed to diagnose, treat, and monitor persons with mental health problems often results in people either going untreated, under treated, or with people treating themselves (e.g. , substance abuse, alcohol). This lack of adequate mental health care treatment services may also contribute to the incidence of substance abuse and alcohol problems, unemployment, or other difficulties that serves to jeopardize the health and well being of the residents of Northwest Arkansas .
Lack of Health Insurance
Members of the focus group noted that the lack of health care insurance and affordable health care prevented many of the residents of Northwest Arkansas , for whom they provide services, from successfully accessing needed health care treatment. The following reasons were cited by members of the focus group as being representative of the type of issues that make it difficult to access health care insurance:
- Individuals that work for local companies that provide insurance for the employee only, but the employee has two to five other family members who are not covered by health care insurance.
- Medicaid recipients' inability to access the full range of medical services/procedures needed, and/or medications, secondary to stipulated limitations with their health care coverage. As illustrative of the limitations imposed with this health care coverage, Medicaid "allows" for the purchase of up to three medications at one given time, but will permit the distribution of up to six medications to an individual with the provision that there has been a special dispensation by the treating physician. In a recent example cited by members of the focus group, a woman required an expensive antibiotic, which was the seventh medication that was prescribed for her that month. As this medication exceeded the Medicaid monthly allottment for prescriptions, she was unable to afford the cost of this medicine, which ultimately resulted in her hospitalization.
- In was the consensus of the focus group, that uninsured individuals were able to secure money in order to receive medical services, however, they were not able to afford prescription medications.
- The focus group also noted that as the economy has worsened during the past few years, employers have reduced employee's health care benefits. Employers have also attempted to reduce their health care costs by minimizing the number of employees who receive benefits through the increased use of part time and temporary employees. Another issue cited by focus group members involved the increasing number of employers who frequently change their health care coverage due to escalating health care premiums.
- Lastly, uninsured adults may not fully understand their health care coverage and many not access needed health care services. The impact of these health insurance related concerns serves to disrupt the availability, affordability, and continuity of health care services.
As a result of these issues, an increasing percentage of people do not access health care services in a timely manner, that results in an increasing utilization of hospital emergency room visits. Many members of the community have become aware that the emergency room in hospitals cannot deny access to care, regardless of a participants' ability to pay for these services. In each of the focus group's participant's settings (shelters, jail, and the pharmacy) the negative financial impact of providing needed but unreimbursed medical services is increasing. Health care budget overruns within these agencies is leading to a decrease in services, positions, and products.
Critical care response agencies, similar to the hospital emergency room do not have the option to deny needed services to the populous within their care. Emergency medical services (EMT and ambulances), homeless shelters, and jails cannot ignore or deny services for their "clientele" when they are exhibiting potentially serious symptoms like chest pains or require medication for their health problems. The overall challenges that critical care response agencies confront, was characterized as follows:
"Some people look and want to help and the rest of the people look and don't care. "
"If I give something away I have to make it up somewhere else. If the free clinics saw these patients for free, somebody had to pay for it. You only get so many volunteers within the health care system".
Prevention
The focus group members agreed that taking preventative approach to health care issues would alleviate many of the problems they encounter. They noted that individuals require personal health care education beyond their service capabilities in order to understand what health conditions they are at risk for, how to take their medications, or where they can get medical help.
The focus group expressed the opinion that not enough people within Northwest Arkansas care about coming up with a solution to the health needs of the community residents. "Some people look and want to help and the rest of the people look and don't care. " The financial responsibility falls on the small nonprofits to come up with a solution, not the major companies who have benefited from these people being here. " At the same time, the focus group held the perception that the major philanthropic foundations are moving away from supporting health care, in favor of educational initiatives.
The group observed "people providing emergency services are getting richer paying for emergency services than preventative care. "
Population Growth and Demand
"The problems are out-pacing the ability of the agencies to service the infrastructure".
A positive result of population growth in rural settings has been an increase in the number of hospitals and emergency health services, according to the focus group respondents. Hospitals have gone into partnerships together and they have brought more services into the rural area. "People don't have to go only to Springdale or Fayetteville for services". Others observed that the increase in hospitals has increased competition for high revenue patient care and duplicative costs for administration.
Finally, the focus group noted that the current human service and health care system is not well coordinated, duplicative, and has many gaps. "The problems are out-pacing the ability of the agencies to service the infrastructure". At the same time the system is allowing competition, rather than collaboration, among agencies applying for funding. They suggested supporting collaborative efforts to develop programs and apply for limited available financial resources in a coordinated and effective manner.
Recommendations for improvement by members of the First Responders focus group were:
- Consider the negative impact of limited availability of affordable health care services on other community services like pharmacy, the police force, and social service agencies.
- Improve current health system coordination and collaboration
- Understand the negative impacts of untreated mental health and substance abuse problems