COMPILATION OF KEY FINDINGS & IMPRESSIONS-ISSUES

DAVIESS COUNTY HEALTH NEEDS ASSESSMENT

RELEASED AUGUST 15, 2000

(Prepared by Rodney Berry 8/25/00)

Return to OWENSBORO-DAVIESS COUNTY HEALTH 2000 REPORT

Contents

HEALTH STATUS

Key Findings:

Daviess Countians have a higher level of health than the Kentucky population in terms of physical health, role functioning, and mental health.
Education and income significantly affect health.
Good health is also related to diet, exercise, and availability of insurance; and for women, those factors, plus preventive pap smears and mammograms examinations.

Impressions-Issues:

While not surprising, should education and income be a key determinant of good health and health care? Is this the value we, as a community, want to embrace or accept? Education is linked to health nationally.
Does this reinforce the theory that, over the long term, improving education may be the best thing we can do to build a healthier community?
How can our community affect lifestyle choices?

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DISEASE BURDEN

Key Findings:

High blood pressure affects 15,704 Daviess Countians (26%), slightly higher than the statewide percentage (24.4%).

Heart disease affects 7,852 (13%) of us, killing 200 per year (31% of all deaths, our leading cause of death). Our heart disease death-per-100,000 rate is slightly less than the state rate.

Strokes affect 2,416 (4%) of us, killing 57 per year (9% of all deaths) . Our stroke death rate is 15 points higher (per 100,000 people) than the state rate.

Asthma affects 7,248 (12%) of adults, plus a significant number of undetermined children. Our rate is five points lower than the state rate.
Chronic lung disease affects 5,436 (9%) of us, killing 52 per year. This is slightly higher than the state rate.
Influenza affected 10,872 (18%) of adults last year and many children additionally.
8,456 (14%) of adults have been diagnosed with pneumonia, slightly lower than the statewide percentage.
Arthritis, our most common chronic illness, affects 18,120 (30%) of us. This is nearly twice the statewide rate.
Diabetes affects 5,074 (8.4%) of our adults, many other children. This is nearly twice the statewide rate. Twenty-five local deaths per year are attributed to diabetes, which is lower than the state averages.

Cancer has been diagnosed in 4,832 (8%) cases, killing 206 per year, which is less than the state rate. Our incidence rate for major cancers is lower than the rest of the state, but our death rate is higher and represents our second leading cause of death.
Our infant mortality rate is less than the state average (4 per 1,000 live births compared to 7.2 per 1,000), but the rate is 14.1 per 1,000 to non-white mothers.
Teen pregnancy occurs in 196 (15.7%) cases, slightly less than the state rate. This has been decreasing.
Low birthweight babies have been born in 22% of our households, and 27% of our women smoked during pregnancy.
More than 6,000 (10%) of our adults needed to talk with a mental health professional last year. More than 4,000 of these were women. (Mental illness affects 20% of the U.S. population per year.) Approximately 300 (1%) of our households had a family member who attempted suicide last year.

Impressions-Issues:

Heart disease is our leading cause of death, as it is in our nation. Our high stroke rate is also troubling. There is an obvious connection to smoking, obesity, sedentary lifestyles, and a lack of screenings-preventive care.
There is no apparent explanation for our high arthritis rate.
Our diabetes diagnosis rate is nearly twice the state average, but our death rate is lower. This may be a result of extensive obesity, but it may also suggests an unusually effective screening process by local agencies.
Infant mortality among non-whites is troubling, although the low number (five deaths in the last year data is available) may distort the percentage.
Our cancer diagnosis rate is low, but our death rate is high. This may reflect the need for more screenings and early detection. This may also be affected by our high lung cancer rate; lung cancer is difficult to detect in an early stage, and it is almost always fatal. This may also reflect that individuals get care outside of Daviess County (the incidence data comes from hospital discharge summaries).
There is an obvious connection between smoking and low birth weight babies in our community. We must develop more effective education programs.

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HEALTH BEHAVIORS

Key Findings:

Nearly 55,000 (91%) of Daviess County adults checked their blood pressure last year.
More than 45,000 (75%) of our adults checked their cholesterol in the last two years.
More than 33,000 of our adults (55%) are smokers and a large undetermined number of young people smoke as well. This is 25% higher than the Kentucky rate, which has the highest smoking rate of any state in the nation.
Approximately 20,000 of our adult women (67%) received mammograms in the last two years, and 23,500 (78%) received cervical screenings in the last three years. Only 14,800 of our adult men (49%) received colorectal screenings, although 64.3% of men over 65 years of age received such a screening.
Flu shots were received by 25,972 (43%) of our adults, but 72% of our adults over 65 received their shots.
More than 35,000 (58%) of our adults are overweight or obese, particularly women. Many young people are overweight as well. A high rate of physical activity was reported, but researchers dismiss that finding because work activity was included in the survey. It should be noted that adding work is more reflective of rural life.
Nearly 22,000 (36%) of our adults reported eating a healthy diet, and less than 17,000 (28%) adults eat at fast food restaurants more than 1-2 times per week. Women generally have healthier diets than do men.
Seat belts are used regularly by 45,541 (75.4%) of our adults, and women are more likely to use them than men.
Alcohol is consumed regularly (in the last month) by 25,368 (42%) of our adults. More than 1,200 (2%) admit driving when they having too much to drink.

Impressions-Issues:

The prevalence of smoking is our greatest detriment a healthier community.
Poor diets and a lack of exercise are also fundamental problems.
Perhaps a task force could assess the various programs and organizations that address these issues, and develop a collaborative, aggressive community plan including specific, measurable goals, projects, timetables, resources needed, etc. The tobacco settlement funds could jump-start the effort, but long-term cultural change will require a sustained effort beyond the availability of tobacco industry funds.

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HEALTH CARE ACCESS

Key Findings:

Nearly 56,000 (92%) of Daviess County adults have a regular place for medical care. 47,112 (78%) of these are served in physician’s offices, 8,456 (14%) in clinics. The poor generally use the hospital emergency room or urgent care center.
Routine check-ups are received by 46,508 (77%) of our adults. Women are more likely than men to have these check-ups. Nearly all these (90% for all, 92% for elderly) occurred within the last year, and nearly all (89%) occurred in physician’s offices. Four percent use the emergency room even during regular office hours when physicians would be available.
Asthma patients are less likely to have a primary care physician than others with chronic illnesses.
Having a routine source of care and regular check-ups increases the likelihood that various preventive screenings and shots will be received, but it does not affect smoking.
26,576 (44%) of our adults used the emergency room at least once last year, and 15,704 of us used it two or more times.
In Daviess County, we have 46.7 primary care physicians per 100,000 population; the statewide rate is 78 per 100,000.
Patients reported that it took 12 days to get an appointment; Medicaid, Medicare, and uninsured patients reported that it takes 90 days to see the doctor.
Waits to see a physician range from 20-90 minutes (and 19% are dissatisfied with that); 18% changed physicians last year.
Most (74%) felt physicians spend adequate time with them, that they involved them in decisions (82%) and that they were treated with respect (87%).
Nearly 13,000 (21%) of our adults say that they or a member of their family needed to see a physician last year but did not because of costs. (This is most likely for women and those uninsured, but also includes those with insurance.)
Because of costs, 10,872 (18%) adults did not fill prescriptions last year.
Nearly 48,000 (79%) of our adults have seen a dentist in the last two years, but 7,852 (13%) have not seen a dentist in more than five years. This is directly related to income.
Most of our adults (94%) expressed overall satisfaction with the health care they receive. The uninsured and poor were less satisfied.

In focus group meetings, people complained about long waits in doctors’ offices, the need for after-hour pediatric care, more adult day care, and more long-term beds for severe behavior and closed dementia units.
Medicaid and indigent patients feel that others receive preferential treatment, shorter waiting periods, shorter waits for appointments, etc.

Impressions-Issues:

It is in the best interest of the public, patients, hospitals, and insurance companies to reduce the use of the emergency room for non-emergency care and to increase the number of patients who have a "medical home" with a primary care physician. Compared to the state average, we have a significant shortage of primary care physicians. However, several new physicians (who accept Medicaid, KenPac, and K-CHIP patients) are having difficulty securing new patients. Could this reflect more a problem of information and referral than a physician shortage? Is transportation and proximity a factor?
The 13,000 people who did not seek care last year because of cost — even if insured — is disturbing, and is likely due to the cost of insurance deductibles and co-payments.

Is this purely a marketplace determination? Are there community-based models that lead to affordable deductibles and co-pays?

The high cost of increasingly specialized medications causes serious problems for the uninsured, those covered under Medicare, and those whose insurance plan does not include prescription coverage. This may be addressed at the national level; if not, a community plan should be devised, and include more efficient use of medications contributed by major pharmaceutical companies.
Medicaid, uninsured and indigent patients are often treated differently by physicians and health support staff. Perhaps the medical community could adopt a code of conduct to ensure respect and equal treatment for all.
Dental care is seldom covered by insurance. Consequently, many people postpone care, including what is needed for children. The Rotary Club and Hager Foundation provide funds for emergency dental needs in schools. A community plan is needed to address this area.
Does our growing Hispanic population warrant special planning and services, such as translating?
Methodist Hospital provides 45% more uncompensated care (uncompensated care=charity +bad debt) than Owensboro Mercy Health System. Is this a reflection of collections, the percentage insured, the availability of free clinics, the effectiveness in qualifying people for Medicaid, or a difference in philosophy and policy?
How will our community meet the growing need for geriatric specialists?

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HEALTH INSURANCE

Key Findings:

More than 4,800 of Daviess County adults (8%) were not enrolled in any health insurance at some point last year. These are predominantly women who work part-time. The statewide uninsured rate is 14.1%; the U.S. rate, 16.3%.
Of these 4,800 adults, 1,920 could not afford coverage and 1,008 had lost their coverage due to a job change.
Nearly 900 people experienced credit problems because of an inability to pay medical bills. This was not just the poor.
Nearly 9,500 (17%) of our insured adults expressed difficulty in obtaining information from their health plan.
3,564 families in Daviess County have children who are eligible for K-CHIP insurance coverage. 713 families are enrolled, 2,280 have other coverage, and 570 of those families have no other insurance and are not enrolled.
891 (25%) of these families with K-CHIP eligible children do not have a primary care provider.

Impressions-Issues:

While still substantial, the number of uninsured in our community is lower than expected — 6% lower than the state average, 8% lower than the national average.
Our community has done well enrolling K-CHIP eligible families in the program. We still have 570 families to connect with the program.
Practical, user-friendly information and assistance is needed to enroll and process insurance, particularly for the elderly.

Other Issues Raised:

Communication needs to improve between physicians that serve the same patients (a clinical information system).

Even when insured, some people experience credit problems when their insurance companies are delinquent in paying hospitals.
What is the appropriate and future role of public health?
The Kentucky Commissioner of Health position should be de-politicized (as is the Commissioner of Education).
Do mental health issues get the attention they need? There is a troubling shortage of qualified substance abuse counselors.
Are OMHS net revenues reinvested in the best ways to serve the indigent, contribute to public health, or meet various needs set forth in the needs assessment?
How can the public have more input/control over public dollars spent on health care?
Do we need more nursing case management?
Do we need a telemedicine system?
Does the Henderson Methodist Hospital have more advanced neonatal facilities or specialists than OMHS?

The following report provides a comprehensive picture of the health status, access to health care, and health care coverage for the people of Daviess County. The picture has different views. The information from the report came from several sources, community focus groups, telephone surveys, personal interviews, and data from state and national sources. The information was analyzed and summarized using quantitative and qualitative methods. The results were compared to the Healthy People 2010 goals.

Voices of the people

Focus groups.

Twenty-three people participated in five focus groups held in Owensboro/Daviess County, Henderson County and Ohio County. The focus groups were conducted November, 1999 by Dr. Jim Applegate and Annie Forsythe, a doctoral student in health communications. The majority of the participants were White-non Latino (96%) and female (83%). Over half had a college degree of some kind, but 17% had not completed high school. One-third had an annual income of less than $25,000; another third earned between $25,000 and $50,000; and the remainder earns over $50,000. Family size ranged from 1 to 6 with the majority (64%) having 3 or more people in their family. Over half had private insurance coverage, 26% had Medicaid, 13% Medicare, and 9% had no insurance coverage.

The focus groups were asked about Health Insurance Coverage, Continuity of Care, Preventive and Medical Services, Accessibility to Health Care, and Health Care Priorities.

These are the messages that were heard in Daviess County:

Long wait to see primary care provider
Long wait in physician's office except for OB and peds
Long wait time in the Emergency Department
No after hours pediatric care
No communication between physicians
Cannot afford insurance offered by employer
Those with Medicaid or no insurance are treated differently
Health care costs affect credit
Use free clinic and health department
Specialist only available in urban area
People don't get preventive care

Providers Voices

Mailed survey to physician providers.

A survey was sent to 281 providers in the seven GRADD area. The names of the providers were obtained from the state medical licensing board. A total of 70 physicians responded for a response rate of 25%, including those returned with bad addresses or who were no longer in the area. The physicians were asked some of the same questions as the random

digit dial Survey 2000 about the type of insurance coverage, access, ability to pay, and the health status for their patient population.

The physician respondents specialized predominantly in family practice and pediatrics (GRAPH A). The majority practiced in Daviess and Henderson Counties and had an average of 15 years practicing in the area. The type of health care coverage used by their payments was 39% private insurance, 34% Medicare, 17% Medicaid and 10 self-pay. Over one-fourth, 25.7%, of physicians were not taking new Medicaid patients. Physicians reported a wait to get an appointment from 13 to 15 days and this varied by type of insurance coverage the next available appointment time also varied slightly by type of insurance. The physician reported average office wait prior to being was 25 minutes and they spent an average of 18 minutes with each patient. Physicians reported that on the average they provided 12.4 hours of free care in a one-month period. Nearly one-fourth, 24.3%, of their patients do not get their medication due to costs and 24.3% delayed getting needed medical care or did not get it because of inability to pay. Only 8.6% of physicians have provision for translating for Hispanic patients. Overall physicians rated the health of their patients as good (45%), followed by very good (17.7%), fair (20.7%) excellent (1.4%), and poor (0.7%).

Interviews with non-physician providers.

Interviews were conducted with non-physician health care providers in Henderson, Fordsville, and Owensboro. These individuals represented the continuum of care including primary care, acute care, home care, adult day care, long term care and community based pharmacy. Providers were asked questions about the services they provided and the health status, health care access, and insurance status of the recipients of their services. The following themes came from the information they provided:

Payor mix is similar at the two acute care hospitals, Henderson Methodist and Owensboro -Mercy, and is divided among Medicare 46% and 50%, Medicaid 13% and 11%, private insurance 34% and 32%, self-pay 7% and 13% respectively.

The Owensboro Mercy Health System provides 8.3% of their total patient care revenues in uncompensated care.
The Fordsville Medical Center payor mix is 50% Medicaid, 10% Medicare, 20% private insurance, and 20% self pay.
Home health, adult day care services, and the community based pharmacist see predominately Medicaid and Medicare patients.
None of the providers had a wait time for seeing patients.
Providers rated the health of their patients as poor to fair except for those in long term care and day care who enjoy fair to good health.
Needs identified by these providers include:

More preventive practice-diet, exercise, smoking cessation
Better communication among the different providers along the continuum of care
More physicians who will work with Medicaid patients
More primary care providers and pediatricians
More long term care beds for severe behavior problem patients, closed dementia units
More adult day care services to keep elders in their homes
More access for growing Hispanic population

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