Community-Based Health Care Navigation's Impact on Access to Primary Care for Low-Income Latinos

Article Figures & Data

Table 1.

Characteristics of Study Participants

	Comparison Group	Intervention Group	P Value
	n = 182% (n)	n = 124% (n)	P Value
Age			<0.001
18 to 34	54 (99)	26 (33)
35 to 44	24 (44)	39 (48)
45 to 54	16 (29)	25 (31)
55 to 64	6 (10)	10 (12)
Sex			0.384
Male	22 (40)	18 (22)
Female	78 (142)	82 (101)
Race/Ethnicity			0.183
Latino	90 (164)	94 (117)
Non-Latino	10 (18)	6 (7)
Employment status			0.179
Full time	17 (31)	23 (28)
Part time	25 (45)	27 (33)
Unemployed	55 (101)	45 (56)
Don't know or refused	3 (5)	6 (7)
Income as a percentage of federal poverty level			0.065^*
<100%	65 (110)	70 (86)
100 to 199%	19 (33)	24 (29)
200 to 299%	11 (18)	3 (4)
300 to 399%	4 (6)	1 (1)
>399%	1 (2)	2 (2)
Level of education			0.004
8th grade or less	25 (45)	27 (34)
Grades 9 to 12	24 (44)	43 (54)
Completed high school	16 (29)	10 (12)
Some college or beyond	22 (40)	14 (17)
Don't know or refused	13 (24)	6 (7)
Primary language			<0.001
English	32 (59)	14 (17)
Spanish	68 (123)	86 (107)
Self-rated health			0.061
Excellent/very good/good	60 (110)	50 (61)
Fair/poor	40 (72)	50 (62)
Referral source to CHOI^{^†}			0.683
Health system	28 (50)	30 (36)
Community	67 (120)	64 (78)

Abbreviation: CHOI, Children's Health Outreach Initiative.
↵* Fisher's exact.
↵† Health system referral sources included emergency room, hospital, clinic, health plan, or online insurance enrollment (such as Covered California); community referral sources included friend or family member, school, Women, Infants, and Children program, other community agencies, brochure or advertisement, Department of Public Social Services, or 211 (Los Angeles County information hotline).

Table 2.

Differences in Access to Primary Care and Health Care Use Among Children's Health Outreach Initiative (CHOI) Clients

	Unadjusted % (n)		Adjusted^*
Outcome	Comparison (n = 182)	Intervention (n = 123)	Odds Ratio (95% CI)
Has a primary care clinic	47.3 (86)	74.8 (92)	3.0 (1.7-5.4)^‡
Has a primary care provider	34.6 (63)	59.0 (72)	2.6 (1.5-4.4)^‡
Has difficulty accessing care	63.5 (113)	47.2 (58)	0.4 (0.2-0.6)^‡
Had a checkup in the past year (n = 144)^{^†}	73.1 (49)	83.1 (64)	1.9 (0.7-4.9)
Any emergency room visits that did not result in a hospitalization in the past 12 months	91.2 (166)	90.3 (112)	1.0 (0.4-2.4)

Abbreviation: CI, confidence interval.
↵* Models are adjusted for age, race/ethnicity, sex, education, language, federal poverty level, employment, self-reported health status, and referral source.
↵† Only 144 participants who had a primary care clinic were asked if they had a checkup in the past year.
↵‡ P < 0.01.

Table 3.

Differences in Barriers to Medical Care Among Children's Health Outreach Initiative (CHOI) Clients

	Unadjusted % (n)		Adjusted^*
Have You Been Delaying or Avoiding Care Due to…	Comparison (n = 182)	Intervention (n = 123)	Odds Ratio (95% CI)
Insurance and cost barriers
Lack of health insurance	61.5 (112)	36.6 (45)	0.3 (0.2-0.5)³
Insurance/health plan that did not approve or pay for the visit	28.0 (51)	21.1 (26)	0.7 (0.4-1.2)
Could not afford to pay for the visit	53.0 (96)	35.8 (44)	0.4 (0.3-0.7)^{^†}
Knowledge barriers
No usual place of care	48.9 (89)	33.3 (41)	0.4 (0.2-0.7)^{^†}
Did not know how or where to get care	47.2 (85)	28.7 (35)	0.4 (0.2-0.7)^{^†}
Clinic barriers
Did not like clinic or provider	11.7 (21)	13.9 (17)	1.4 (0.6-3.0)
Could not get an appointment in a timely manner	26.4 (48)	27.6 (34)	1.4 (0.8-2.4)
Could not contact the clinic over the phone	18.1 (33)	19.5 (24)	1.1 (0.6-2.2)
Long wait times to see the doctor	22.1 (40)	23.6 (29)	1.1 (0.6-2.0)
Clinic was closed when they could go	20.3 (37)	14.6 (18)	0.8 (0.4-1.5)
Other barriers
Lack of transportation	19.8 (36)	9.7 (12)	0.4 (0.2-0.9)^{^†}
Could not take time off work or leave children/family	30.2 (55)	20.3 (25)	0.6 (0.4-1.2)
Fear of getting medical care	18.7 (34)	17.1 (21)	0.7 (0.4-1.5)
Language, communication, cultural problems	12.6 (23)	12.2 (15)	0.6 (0.3-1.3)

Abbreviation: CI, confidence interval.
↵* Models are adjusted for age, race/ethnicity, sex, education, language, federal poverty level, employment, self-reported health status, and referral source.
↵† P < .01.