1. Assessing the Primary
Care Needs of Women
in Middle Tennessee
Jacquelyn Favours, MPHc
TSU – MPH Program Capstone Presentation
May 7th, 2015

2. Overview
Health Care Access for Women in the U.S.
Planned Parenthood of Middle & East Tennessee – Internship Site
 Current Planned Parenthood healthcare services
Capstone Project – Goals & Objectives
Capstone Project – Results
Project Recommendations – Site, Students, & Future Studies
Lessons Learned
Acknowledgements

3. Health Care Access Definitions
Primary (Preventive) Care11,12
• Concept used to describe
nature of services &
provider type
• Integrated/coordinated,
affordable & accessible, first-
contact, long-term
• HHS – “Services which help
you avoid illness & improve
health”
Comprehensive
care for patient
needs
Integration;
Coordination of
care
1st contact access
for each new
need
Long-term
focused care
Primary
Care

4. Health Care Access Definitions
Health Care Safety Net
• Public or private health care
providers that deliver care in a
variety of settings to a diverse
patient population, who are
other wise unable to afford or
access care
Health Care Safety Net4

5. What are the issues with
women’s preventive care in
the U.S.?

6. Issues in Women’s Preventive Health in U.S.
Primary Care Physicians (PCPs)
• Shortage in U.S. – 1: 88315,16
• Low % of uninsured & underinsured
patients
• No clear cut definition for primary care vs.
reproductive care - misdiagnosis &
underdiagnoses1
Inconvenient Healthcare Expectations10
• PCP & OBGYN – fragmentation
• Belief that annuals consist of all preventive
health care services
Uninsured, Underinsured, &
Low-Income
• Most likely to not identify a PCP
• Rely solely on family planning
clinics1

7. Coverage Gap
Garfield, R., Damico, A., Stephens, J., & Rouhani, S. (2015). The coverage gap: uninsured poor adults in states that do not expand Medicaid
– an update. The Henry J. Kaiser Family Foundation. Retrieved from http://kff.org/health-reform/issue-brief/the-coverage-gap-
uninsured-poor-adults-in-states-that-do-not-expand-medicaid-an-update/

8. Scope of the Problem – Coverage Gap

9. The Coverage Gaps in Tennessee17
 Approx. 284,000 uninsured in TN – 44% women
 66% of uninsured women see cost as a barrier vs. 24%
insured
- Not qualified for Medicaid in TN
- Not qualified for tax credits

10. Women who need preventive care the most continue to
fall through the gaps of the fragmented U.S. health
care system1.
Don’t receive
full extent of
recommended
primary care.
At higher risk for
chronic diseases.
Continue to
face barriers
to health
care.
Miss opportunity
to prevent/treat
disease and illness
at the initial
stages.
The Big Picture

11. U.S. Health Reform Passed
Additional & “Free”
Preventive Services
for Women1
Women are now
accessing “affordable”
health care insurance
Health Care Status for Women in
the U.S.

12. Preventive Health
Services for Women
under
Health Care Reform
http://www.ghcbettertogether.com/basics/womens-health-care/

13. Capstone Project
What strategies can be put in place to diminish the gap in health care access for women in TN?

14. Planned Parenthood of Middle &
East Tennessee (PPMET)– Nashville
Health Center
Internship Site – June 2014 to August 2014

15.  1 Central Office (London)
 6 Regional Offices:
- New York, Western
Hemisphere
- Nairobi, Africa
- Tunis, Arab World
- New Delhi, South Asia
- Kuala Lumpur,
East/South East Asia &
Oceania
- Brussels, European
Network

16. Located in all 50 states & D.C. – 65 affiliates nationally

17. 3 clinics: Nashville, Knoxville, & Johnson City
Covers 76 of 95 counties in TN & 39
Southeastern counties in KY.
Serving nearly 20,000 women a year
Mission – “…provide access to reproductive, sexual, an
complimentary healthcare and complimentary sexuality
services and education…protect the right to privacy … for
men, women, and teens. On the belief that … an
individuals' pursuit of sexual health is essential to one’s
well-being regardless of race, age, income status, religion,
or sexual orientation.9”
Health Services Offered:
- Sexual Health Education
- Contraception
- Gynecological care
- Family planning counseling
- HIV testing/counseling
- STI screening & treatment
- Prenatal care
- Primary care
- General health care
- Specialized care referrals

18. PPMET & Primary Care Expansion
- By expanding primary care services to serve as a safety net
for low-income, underserved, & uninsured patient population.
Potential Services:
• Check-ups
• School physicals
• Immunizations (influenza, pertussis,
hepatitis)
• Minor health problems (strep throat,
bladder infections)
• Chronic disease management
(hypertension, asthma, diabetes,
smoking cessation, weight
management)

19. Capstone Project – Goals & Objectives
 Determine PPMET’s potential
for expanding to full extent of
primary care services for
women 18 – 49.
• Identified primary care service
parameters for needs assessment form
patient charts
• Analyzed data from primary data
collection
• Interpreted findings to indicate if need
for expanded primary care exist
• Drafted final report
 Facilitate PPMET’s primary
service delivery to target
population through
recommendations.
• Assessed patient & public opinions on
use of primary care from PPMET
• Determined conduciveness of political
environment and funding opportunities
• Identified strategy for expansion of
primary care

20. Project Activities
- Primary Care Needs Assessment for Existing Patient
Population.
Data Collection
 Created instrument in REDCap
 Collected data on demographics,
social risk factors, vitals, medical
history, & medications
 450 patient records surveyed
Data Analysis Results
 Exported data from REDCap to Excel
 Case Summaries
 Presented to Ad Hoc Primary Care
Committee

21. Results – The Breakdown
292 women of reproductive age
(18-49)  65% overall
- Presence of chronic disease
contributors
- Only small % of chronic disease
detected
Surveyed Responses
- 120 TSU students
- 61% would consider using primary
care services
Table1.2–NeedsAssessmentHealthIndicatorsofFemales18-49
Frequency Percentage(%)
Vitals
Overweight/Obesity 115 40%
HighSystolic
BloodPressure
99 34%
BehavioralRisk
CigaretteSmokers 66 23%
AlcoholConsumption 116 40%
HealthHistory
Migraines 84 29%
ThyroidProblems 13 4%
Asthma 32 11%
HighCholesterol 13 4%
Anemia 49 17%

22. Results – Demographic Breakdown
White
60%
Black
25%
Hispanic
9%
Asian
3%
Females Patients Age 18 – 49 by Ethnicity
White
Black
Hispanic
Asian
Amer. Indian/Pacific Islander
Other

23. Results – A Closer Look: Overweight & Obesity
0
10
20
30
40
50
60
Asian Black Hispanic Indian/Pacific
Islander
Other White
Percentage
Ethinicity
Overweight/Obese Female
Patients 18 - 46
by Ethnicity
Obese
Overweight
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
18 - 23 24 - 29 30 - 34 35 - 39 40 - 46
Percentage
Age Group
OVERWEIGHT/OBESE FEMALE
PATIENTS 18 - 46
BY AGE AND ETHNICITY
Other
Amer.Indian/Pacific Islander
Asian
Black
White

24. Recommendations for PPMET
 Expand primary care services? – YES.
 To extent of recommended preventive services for women
 Seek use of resident/students from partnering nursing
and medical schools to provide primary care.
 Launch campaign for service expansion
 Ex. “More Than What You Think” Campaign – used by Planned
Parenthood Action Fund (PPAF)
 Set up program for patient centered medical home for
women 18 – 49 – “Primary Care Safety Net”

25. Recommendations for PPMET (cont.)
Primary Care Safety Net Program
1. Screen patients for insurance & PCP
2. Target uninsured and/or unable to identify
PCP
3. Provide initial primary care; schedule next
annual appt.
4. Monitor/survey use of healthcare services
5. Provide reminders & follow ups for
program
6. Maintain well-documented program for
prospective funding purposes and program
retention

26. Recommendations
Future Studies & Students
 Explore preferences for family planning clinics vs. private practice
 Assess use of services by PPMET vs. Federally Qualified Health
Centers (FQHCs).
 Consider public perceptions of Planned Parenthood clinics.
 Explore strategies to fill gaps or create coordinated
women’s health care.
 Evaluate primary care services, if expanded by PPMET.
 Maintain communication with preceptor(s).
 Be innovative!

27. Lessons Learned
• Healthcare gaps remain despite efforts to break barriers.
• Most women of reproductive age prefer women’s health clinics
due to cost & confidentiality.
• Funding is essential to primary care expansion, but
controversial for the context of PPMET.
• Do not underestimate data collection!
• Focused scope of Public Health Interests.

28. Acknowledgements
 Planned Parenthood of Middle & East
Tennessee
 Ad Hoc Primary Care Committee
Dr. Ellen Clayton, Committee Chair
Mr. Steven Emmert, PPMET COO & Preceptor
Dr. Maureen Sanderson, P.I. & PPMET Board
Ms. Denis Bentley
Ms. Tracey George, PPMET Board
Ms. Dakasha Winton, PPMET Board
 Ms. Mary Kay Fadden, MMC Supervisor
 TSU – Master of Public Health Program
Dr. Mohamed Kanu, Program Director &
Field Placement Coordinator
Dr. Elizabeth Brown, Faculty Advisor
Dr. Elizabeth Williams, Capstone Advisor
Ms. Jessica Powell, MPH Program
Manager
 The TSU MPH Graduating Cohort of
Spring 2015! 

29. References
1. Committee on Preventive Services for Women; Institute of Medicine. (2011). Clinical preventive services for women: closing the gaps. The National Academies Press.
Retrieved from http://www.nap.edu/catalog/13181/clinical-preventive-services-for-women-closing-the-gaps
2. Frost, J.J., Gold, R.B., & Bucek, A. (2012). Specialized family planning clinics in the United States: why women choose them and their role in meeting women’s health care
needs. Women’s Health Issues, 22 (6), e519-e525. doi: 10.1016/j.whi.2012.09.002
3. Hoffman, E., & Johnson, K. (1996). Women’s health and health reform: who will deliver primary care to women? Yale Journal of Biology and Medicine, 68 (1995), 201-206.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588945/pdf/yjbm00039-0048.pdf
4. Jones, A.S., & Sajid, P.S. (n.d.). A primer on health care safety nets. Robert Wood Johnson Foundation.
http://www.rwjf.org/content/dam/farm/toolkits/toolkits/2009/rwjf50923
5. International Planned Parenthood Federation. (2013). About IPPF. IPPF. Retrieved on April 14, 2015. http://www.ippf.org/about-us
6. Martinez, G., Chandra, A., Febo-Vasquez, I., & Mosher, W. (2013). Use of family planning and related medical services among women aged 15-44 in the United States: national
survey of family growth, 2006 – 2010. National Health Statistics Reports, 68, 2-16. http://www.cdc.gov/nchs/data/nhsr/nhsr068.pdf
7. Planned Parenthood Federation of America Inc. (2014). Who We Are. Retrieved on April 14, 2014. http://www.plannedparenthood.org/about-us/who-we-are
8. Planned Parenthood of Middle & East Tennessee, Inc. (2015). Who We Are. Retrieved on April 14, 2014. http://www.plannedparenthood.org/planned-parenthood-middle-
east-tennessee/who-we-are
9. Saleeby, E. & Brindis, C.D. (2011). Women, reproductive health, and health reform. American Medical Association, 306 (11), 1256-1257.
http://jama.jamanetwork.com/article.aspx?articleid=1104344
10. Shi, L. (2012). The impact of primary care: a focused review. Scientifica, 2012, 22. htpp://dx.doi.org/10.6064/2012/432892
11. Starfield, B., Shi, L., & Macinko, J. (2005). Contribution of primary care to health systems and health. The Milbank Quarterly, 83 (3), 457-502.
http://www.commonwealthfund.org/usr_doc/Starfield_Milbank.pdf
12. Stormo, A.R., Saraiya, M., Hing, E., Henderson, J.T., & Sawaya, G.F. (2014). Women’s clinical preventive services in the United States: who is doing what? JAMA Internal
Medicine, 174 (9), 1512-1514. http://archinte.jamanetwork.com/article.aspx?articleid=1885467 doi:10.1001/jamainternmed.2014.3003
13. Sugerman, S., Halfon, N., Fink, A., Anderson, M., Valle, L., & Brook, R.H. (2000). Family planning clinic patients: their usual health care providers, insurance status, and
implications for managed care. Journal of Adolescent Health, 27 (1), 25-33. http://www.jahonline.org/article/S1054-139X(99)00126-3/pdf
14. The Henry J. Kaiser Family Foundation. (2015). Primary Care Physicians by Field. KFF. Retrieved from http://kff.org/other/state-indicator/primary-care-physicians-by-field/
15. U.S. Census Bureau. (2015). State & County Quickfacts – Tennessee. U.S. Census Bureau. Retrieved from http://quickfacts.census.gov/qfd/states/47000.html
16. U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. (2013). Women’s health USA 2012. HHS.
Retrieved from http://www.mchb.hrsa.gov/whusa12/index.html
17. National Women’s Law Center. (n.d.). The affordable care act and covering more women and families in Medicaid. NWLC. Retrieved from
(http://www.nwlc.org/sites/default/files/tennessee_0.pdf

30. Questions?