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
Disease Burden
Health Behaviors
Health Care Access
Health Insurance
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 physicians
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 physicians 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