Gaps in the System: Californians Struggle with Caring for their Chronic Conditions

1
Gaps in the System Californians Struggle with
Caring for their Chronic Conditions

• American Society on Aging Conference
• March 18, 2009

2
The California HealthCare Foundation

• is an independent philanthropy committed to
  improving the way health care is delivered and
  financed in California.
• By promoting innovations in care and broader
  access to information, our goal is to ensure that
  all Californians can get the care they need, when
  they need it, at a price they can afford.

3
Better Chronic Disease Care

• Goal To improve clinical outcomes and quality of
  life for Californians with chronic disease
• Expand the number of providers who effectively
  care for patients with chronic conditions
• Increase the participation of patients and
  families in all aspects of care
• Promote appropriate care toward the end of life

4
Why support a survey of people with chronic
conditions?

• Better understand challenges opportunities for
  people living with chronic conditions
• Understand how self-care fit into their lives
• Start educating the health care field about
  broadening understanding of self-care
• Patient is a powerful resource -- need to figure
  out how to leverage the person living with
  chronic conditions

5
California Survey Methodology Differences

• N855 Californians 18 and older with chronic
  condition(s).
• Included an oversample of n102 Latinos.
• Interviewing conducted in English and Spanish.
• Margin of sampling error 3.4 percentage points.

5
6
Chronic Conditions Pose Challenges to Younger
Californians
40 of 18 to 34 year olds surveyed have two or
more chronic conditions.
18 to 34 year olds
6
7
Latinos are faced with Disproportionate Challenges

• Latinos face challenges due to income level, lack
  of coverage, and systemic challenges showing
  higher instances of chronic pain, depression,
  stress anger
• 53 of Latinos are least likely to get the help
  and support they need to manage their health
  conditions
• 46 of Latinos with chronic condition have
  postponed healthcare due to cost
• Latinos are among the most likely to have missed
  work (33), cut back on helping family and
  friends (33), and say their family relationships
  have been strained (31)
• Latinos are nearly twice as likely as
  non-Hispanic white Californians to say that cost
  and lack of knowledge are barriers to improving
  their own health (64 vs. 37)

7
8
One in Three Delaying Care Due to Cost
postponed getting prescriptions or health care
in the last year because of cost
8
9
For Many, Health Care System Not Working to
Facilitate Self-Care
9
10
Most Helpful Information and Support
Please tell me how helpful would each of the
following be for you personally saying helpful
10
11
Interest in Getting Help Online
interested in getting information and support
from websites sponsored by health organizations
11
12
Interest in Getting Help in Community
interested in getting information and support
from discussions or events at the local library,
churches, community center or other places in
your community
12
13
Survey Highlights Actions for California

• Strategies for people with chronic conditions
  vary by age but cant assume young dont have
  needs
• Need to address those with most needs
• Latinos, Low-income, Uninsured, Multiple chronic
  conditions
• People need support in different settings
  health system still plays a role just not the
  ONLY role
• How do we make health system community
  systems work better together
• Leveraging the power of peers and family

14
Team Up for Health Support mechanisms for
patients with chronic conditions
Family and friends
People like me on the Internet
Person with chronic condition
Health education
Communi-cation
Health system
Community, including workplace
Follow-up
DM coach
15
Wisdom of Patients Social Networking
16
The Power of Peers

• Promotoras in the community and as extenders of
  health systems
• Chronic Disease Self-Management Programs
• Using Physician Peers to Support Self-Management
  Skills Training
• Investigate leveraging social networks online
  support

17
Other Opportunities in California

• Personal Health Records
• Promote online access to health info
• Telephonic and Text Programs
• Using phone text as follow-up systems
• Training Physicians Staff on Communication
  Skills and Goal Setting
• Using the Family System to have the skills to
  support each other

18
Using the survey data to support changes

• Energy around stimulus and reform may translate
  into new attention to benefits of self-care
• Recognize the importance of health system
  community partnerships
• Investigate how to align efforts around aging,
  public health, and chronic conditions in health
  systems
• Continue efforts to support the underserved with
  an emphasis on Latinos
• Share data with broad stakeholders to raise
  awareness and better understand people with
  chronic conditions.

18