Optimizing Access to Healthcare for Diverse Populations

Facilitator Guide Transformation of High-Performing Primary Care in Education ACCESS The UCSF Double Helix Curriculum: Time: 15 minutes Audience: First through third year residents Objective(s): Understand ways in which we fail to provide comprehensive access for individuals that are non-English speaking, have limited literacy, or have diverse cultural backgrounds. Consider novel ways to optimize access for diverse populations. Soraya Azari, MD Education Team UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital

Transformation of High-Performing Primary Care in Education ACCESS The UCSF Double Helix Curriculum: Barriers to Comprehensive Access to Care Adapted from the Center for Excellence in Primary Care Soraya Azari, MD Education Team UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital

Transformation of High-Performing Primary Care in Education Group Share ACCESS The UCSF Double Helix Curriculum: Describe a time in which a patient had trouble access healthcare. Think of ways this may have been prevented. Soraya Azari, MD Education Team UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital

Transformation of High-Performing Primary Care in Education Access Denied ACCESS The UCSF Double Helix Curriculum: Barriers to Effective Access Geography Lack of language and interpretations services Lack of proper accommodations for individuals with disabilities Decreased health literacy Hours of operation Literacy requirements to accessing care Lack of health coverage Cultural misunderstanding Different ethnic and/or racial groups, chronic medical conditions (i.e., mental health or substance use) Others? Soraya Azari, MD Education Team UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital

Transformation of High-Performing Primary Care in Education Overcoming Barriers ACCESS The UCSF Double Helix Curriculum: Universal health coverage Comprehensive language access Robust cultural competency training Improved telemedicine services Access to phones, housing, computer/internet Community engagement Engaging stakeholders Phone visits; expanded hours Soraya Azari, MD Education Team UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital

Examples of Overcoming Barriers Transformation of High-Performing Primary Care in Education ACCESS The UCSF Double Helix Curriculum: Telemedical cervical cancer screening program for rural women 18mos: 1812 visits serving 68/75 counties in Arkansas Qualitative study of Spanish-speaking patients with behavioral health clinicians Bilingual providers associated with greater privacy, trust, accurate communication Fewer pediatricians using family members as interpreters between 2004 & 2010 (69% 57%) and more formal interpreter use (55 v. 49%) Hitt WC, et al. Telemed JE Health. 2013;19(5):403-8. Villalobot BT et al. Psychol Serv. 2016;13(1):49-59. DeCamp LR et al. Pediatrics. 2013;132 (2). Soraya Azari, MD Education Team UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital

Transformation of High-Performing Primary Care in Education Reflection ACCESS The UCSF Double Helix Curriculum: How can access be optimized in your clinic? Will any of your clinical practice change? Soraya Azari, MD Education Team UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital

Transformation of High-Performing Primary Care in Education ACCESS The UCSF Double Helix Curriculum: Evaluation Soraya Azari, MD Education Team UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital