Background

The Continuing Care Clinic (CCC) at Harbor-UCLA Medical center serves the residually uninsured and undocumented population of Los Angeles County. The CCC follows patients who present to the emergency department with an ambulatory care sensitive condition until they are able to establish primary care. The clinic, however, has a high rate of missed appointments and little is known about patient demographics or social factors that may influence whether or not they present for care. 

Objectives

1. Describe the demographics of the patient population seen in the Continuing Care Clinic (CCC) at Harbor-UCLA 
2. Investigate the social factors that may act as barriers to care

Methods

Interviewed 70 patients (≥ 18 years of age) who attended or were scheduled for an appointment between May and June 2018. Patients completed a 23-question oral survey (English or Spanish) using validated screening questions for demographic items and social determinants of health.

Results

A total of 70 patients were screened; 90% were Latino/Hispanic and over 50% had completed a middle school education or less. Patients reported high levels of financial strain, food insecurity, unemployment, and concern for immigration status. Nearly half of the surveyed (45.7%, n=32) patients had missed their appointments. Of the these, 38% (n=12) reported they missed the appointment due to being busy at the time; most commonly reporting they could not miss work. Obtaining medical insurance was a concern shared by nearly 25% of patients, with some patients stating they were likely to miss future appointments once they lost coverage with temporary Medi-Cal.

Conclusion

Our findings suggest that while the LA County safety net has successfully created a point of access for primary care for uninsured patients, patient engagement remains limited due to patients’ financial strain. Future endeavors to provide primary care for these patients could include financial education regarding programs available to assist patients living in poverty and the development of more transparent billing processes to inform patients of their coverage and bill prior to the visit itself. Interestingly, with conversion to telehealth for most appointments during the pandemic, the no-show rate has been very low. Next steps include comparing the no-show rate and patient outcomes for telehealth vs in-person visits as we move to a post-Covid model of care.