Maryland FP Leads Efforts to Improve Minority Health

Work Aligns With AAFP's Support for National Minority Health Month

April 18, 2017 11:00 am Chris Crawford

April is National Minority Health Month,(www.minorityhealth.hhs.gov) and for 2017, the theme is "bridging health equity across communities." The AAFP has created a resource page to support this initiative, which emphasizes collaborative, community-level work being done across the country to help achieve health equity.

One of two primary care clinics run by Anne Arundel Medical Center includes this 1,000-square foot office in the Morris H. Blum Senior Apartments in Annapolis, Md., which family physician Patricia Czapp, M.D., calls "tiny yet powerful."

It was this very goal that drove one AAFP member -- Patricia Czapp, M.D., chair of clinical integration at Anne Arundel Medical Center in Annapolis, Md. -- to spearhead a cooperative venture aimed at better serving minority patients in her community.

Keeping Underserved Minorities Out of the Hospital

In 2015, Czapp authored the Academy's position paper on poverty and health. She told AAFP News
at the time that a patient's low-income status does not guarantee he or she will have a poor health outcome, but it does mean that the patient statistically is more likely to be exposed to adverse environmental factors that could impact his or her health.

That's why she worked with her hospital to come up with a strategy to more effectively reach and treat underserved minority patients in the area, Czapp told AAFP News. She said this plan was further accelerated by regulatory changes in Maryland that required all hospitals operating on a global budget revenue system in the state to reduce emergency department (ED) visits and hospitalizations.

Story highlights
  • April is National Minority Health Month, and the AAFP has created a resource page to support this effort, which emphasizes collaborative, community-level work being done across the country to help achieve health equity.
  • In keeping with this ideal, one AAFP member spearheaded a cooperative venture aimed at better serving minority patients in her community by providing focused primary care.
  • Results include fewer emergency department visits, reduced hospitalization rates and a drop in medical 911 calls.

"That can only happen if people get high-quality, affordable care long before they need to dial 911," Czapp said.

To achieve that goal, the administration and family medicine leadership at Anne Arundel Medical Center began planning in 2009 to open new primary care clinics. The first clinic opened in 2010, with another following in 2013.

Setting the Foundation for Opening Clinics

To pinpoint the neighborhoods of people with the highest rates of medical 911 calls, ED use, admissions and readmissions, the group at Anne Arundel Medical Center used a combination of data from the hospital, the local health department and emergency medical services providers, along with informal input from community leaders.

"Our county data tell us that African-Americans are overrepresented in the ED-visiting population, particularly for diagnoses related to hypertension and diabetes -- the bread and butter of primary care," Czapp said.

Anecdotally, the hospital's ED physicians reported that African-American patients often present with the same diseases seen in patients of other races, yet they are often suffering from a more advanced stage of disease, including frequently dealing with wholly preventable disease complications, she said.

"This tells us that African-Americans, at least in our community, might be being diagnosed and treated later in the natural course of their disease," Czapp said.

Czapp said the hospital team worked with the community to choose locations for the primary care clinics in areas of highest need. The medical center received funding from the Maryland Community Health Resources Commission,(dhmh.maryland.gov) an independent commission operating within the Maryland Department of Health and Mental Hygiene, which helped defray some of the initial costs.

These primary care clinics(www.myaamg.org) offer continuous, relationship-based care with dedicated medical staff, accept most insurance and use a sliding scale to accommodate patients' varied levels of income. However, Czapp said these are not free clinics.

The hospital previously had supported a free clinic, she said, but the limitations of that model of care -- including depending on free drug samples from pharmaceutical representatives and using volunteer physicians and staff who might not be best suited to offer primary care -- rendered it untenable.

For the newer clinics, the Anne Arundel Medical Center team chose buildings that required some renovation to accommodate modest but attractive practices. "Long before we opened each (clinic), we worked with official and unofficial leaders in the underserved communities to promote each practice's services," Czapp said.

But most importantly, the group was careful in choosing both the physicians and staff for the clinics, she noted.

"It was important, for example, that we had bilingual staff so that we could serve the Hispanic community, yet we also chose staff representing the local African-American community," Czapp said. "All clinicians and staff continue to receive ongoing training in cultural proficiency, as well as crisis management and situation de-escalation."

Reaping the Rewards of the New Clinics

Czapp said it's surprising how many newly insured patients are benefiting from care at the clinics.

"We take the time to help them navigate the health system; we help them make and keep appointments, and we make sure they know how to get medications and manage refills," she said.

The most gratifying outcome from this venture, according to Czapp, comes from the clinic that's located in a public housing unit -- the Morris H. Blum Senior Apartments in Annapolis -- but also serves the surrounding population. The group tracks medical 911 calls, ED visits, and admissions and readmissions among residents served by the facility.

"A year after opening, we demonstrated significant decreases in all of those forms of potentially avoidable utilization," she said. "And the patients are so grateful. I hear them bragging to others that they get the best care they've ever had -- better than any other practice."

Why Health Equity Is Important

When you see young people who are on dialysis because of renal failure that developed after years of undiagnosed and untreated diabetes and hypertension, said Czapp, as a family physician, you have to do something.

"They and their families may have experienced generations of marginalization, and the only way to break the cycle of poor health and limited lifespans is to meet these individuals and families where they live, literally," she said. "And using peer-to-peer messaging to help make health a priority is a very powerful strategy."

The AAFP has adopted the Healthy People 2020 definition of health equity,(www.healthypeople.gov) which is "the attainment of the highest level of health for all people."

According to the Healthy People 2020 website, "Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities."

"Health holds the key to prosperity," Czapp said. "When individuals prosper, we as a society prosper and enjoy greater quality of life."

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