Continence Coach: Community Clinics Filling Care Gaps

  The gap continues to widen and deepen between the served and the underserved in the US — a problem exacerbated by the extended economic recession. Health reform legislation passed in March 2010 by Congress put in place many tools and initiatives to fill that gap: among other improvements, the legislation is expected to extend health insurance coverage to 32 million uninsured people. But many changes will need to be put in place to get patients to alter their habits in order to lower care cost and improve care quality. For example, the legislation is counting on disease prevention to save money down the road; in turn, disease prevention relies heavily on access to primary care for preventive check-ups and tests to detect or confirm early warnings of a problem. Yet healthcare costs, particularly for those lacking insurance coverage or without the personal household income to cover such services, deter some people from seeking preventive measures. In addition, many patients — even those covered — do not get enough reminders about maintenance medical visits.

  Under the new legislation, specific steps to improve preventive care include:
•    Requiring Medicare and private insurance plans to cover prevention and wellness benefits and exempting these benefits from deductibles and other cost-sharing requirements in order to remove cost barriers to seeking wellness care;
•    Investing in innovations such as community health teams to improve chronic disease management and placing lay health educators in hard-to-reach, nonurban communities;
•    Investing in the primary care workforce to ensure all Americans have access to a primary care physician so they stay healthier longer;
•    Strengthening the system of safety-net hospitals and clinics, providing significant infusions of funding for community health centers to ensure they are high-quality and accessible.

  Federally qualified health clinics are a cornerstone of this effort. They are not new. These community-based organizations provide comprehensive primary and preventive care that includes health, oral, and mental health/substance abuse services to persons of all ages, regardless of their ability to pay. Under the supervision of the Health Resources and Services Administration, which is part of the US Department of Health and Human Services, these health clinics originally were meant to provide comprehensive health services to the medically underserved to reduce the patient load on hospital emergency rooms. Their mission has changed since their founding — they now bring primary healthcare to underserved/underinsured/uninsured Americans, including migrant workers and non-US citizens regardless of ability to pay; they charge for services on a community board approved sliding-fee scale based on patients’ family income and size. Impressed by the concept, the Veterans Administration has set up its own community clinics for a more cost-effective, pragmatic means of serving veterans all across the country.

  How does all of this relate to bladder and bowel health? Often, symptoms of bladder and bowel control problems, such as frequency, can be early warning signs of type 2 diabetes, ovarian cancer, enlarged prostate, or even multiple sclerosis.

  Practitioners who listen, look for, and act on these signals can be the difference between addressing medical issues when they are still clinically and cost-effectively manageable and expensive intervention or even early death down the road. Community health centers are one important solution to facilitating timely and cost-effective access to primary care. We urge you to support this concept in your community.

The National Association For Continence is a national, private, non-profit organization dedicated to improving the quality of life of people with incontinence. The NAFC’s purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments, and management alternatives for incontinence.

This article was not subject to the Ostomy Wound Management peer-review process.