Health Professions Students at the U.S. - Mexico Border: Decreasing Barriers to Accessing Care

1. Health Professions Students at the U.S. - Mexico Border: Decreasing Barriers to Accessing Care Marylyn McEwen, MS, APRN, BC Marion K. Slack, Ph.D. University of Arizona

2. Purpose • To present a model for preparing interdisciplinary students (pharmacy, nursing, public health, medicine, social work, and nutrition) to provide culturally relevant care that results in decreasing barriers to accessing care for residents in a rural U.S. - Mexico border community.

3. Barriers to Accessing Care • Providers not prepared to provide culturally relevant care • Lack of familiarity with: • Cultural values and beliefs of clients served • Community resources • Eligibility requirements for care / services • Language • Immigration and Immigrant health policies • Client unfamiliar with U.S. health care system • Cultural, financial, linguistic barriers

4. Promotoras • Community Health Workers • Community members • Share clients’ culture and language • Cultural brokers • Connectors between client, provider, & student • Promote health to groups that have lacked access to care • Facilitate student cultural self-awareness • Provide social support • Build student cultural self-efficacy

5. Students • Graduate and Undergraduate students from the disciplines of: • Pharmacy • Nursing • Public Health • Nutrition • Social Work • Medicine

6. Clients • Residents of a rural U.S. - Mexico border community • Primarily Hispanic (Mexican) who maintain connections with family in Mexico • At risk of / diagnosed with diabetes, primarily diabetes type 2 and gestational diabetes • Age range 14 months - 95 years • Primarily undocumented residents, below poverty level, underemployed or unemployed • Spanish speaking / limited English language skills with less than a high school education • Uninsured / underinsured receiving care at private provider, community health center, and in Mexico

7. Interdisciplinary Case Management Model • Structure • Interdisciplinary rural health training grant • Curriculum modules introduce critical concepts • Two universities partner with local community health center • Promotoras, local providers, students, and faculty are members of the interdisciplinary team (IDT) • Client caseload maintained by promotoras • Weekly case management seminars

8. Model cont’d • Process • Students have weekly client / promotora encounters (home visits) • Students / promotoras present clients to the IDT in weekly seminar • Problem solutions identified in an interdisciplinary context • Disciplinary knowledge and skills shared • Cultural knowledge shared • Social support for students

9. Interdisciplinary Case Management Model - Outcomes • Client • Receives interventions that increase access to care: • Teaching / Counseling / Guidance • Case Management / Surveillance • Increased knowledge and skills for accessing community resources • Increased knowledge of diabetes and increased self-care abilities related to diabetes • Increased self-efficacy related to self and family health issues

10. Outcomes cont’d • Student • Knowledge of an interdisciplinary case management model • Knowledge of rural / border health issues • Knowledge of cultural self-efficacy / cultural values and beliefs • Knowledge of relationship between immigration and immigrant health policy and access • Increased Spanish language skills

11. Outcomes cont’d • Promotora • Knowledge of an interdisciplinary case management model • Increased knowledge of client health care needs • Increased knowledge of health professions disciplines • Increased English language skills

12. Outcomes cont’d • Provider • Increased knowledge of community health care systems and resources • Increased awareness of cultural barriers • Formalized knowledge of immigration issues • Increased expertise in using interdisciplinary models • Increased knowledge of other disciplines

13. Conclusions • Decreasing barriers to accessing care requires a multidimensional approach that must address health professions education, education of local providers, and the health care delivery system. • We maintain an interdisciplinary approach for health professions education and an interdisciplinary case management delivery model facilitates decreasing barriers to accessing care along the U.S. - Mexico border. • Nuestra Comunidad, Nuestra Salud Project (Spanish for “Our Community, Our Health”) is funded by HRSA Grant No. 2D36 HP 10033-08.