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This is part of our Building Support for Latino Families: A Research Review »
The Benefits of Medical Homes
What can be done to make medical offices more accessible and comfortable for low-income Latino individuals?
Recent research has introduced the concept of patient-centered “medical homes” as a model of high-quality primary care that can eliminate disparities.8
Defined by key structural practice features, the medical home provides “enhanced access for routine primary care, improved delivery of preventive services, high-quality chronic disease management, and reduced emergency department and hospital utilization.”120
While still in the early stages of broad application and assessment, the theory behind the medical home model is appealing for application in high-risk, low-income populations that face many barriers to health care utilization. It has been suggested that this model of health care delivery, involving detailed health risk assessments, integrated comorbid disease management programs, assigned health care teams, home visits, and tracking of subspecialty use, may be most effective for patients with multiple chronic comorbidities, concomitant mental illness, and poor social support.120
For the Latino population at large, identification of desirable characteristics to be practiced in a “Latino medical home” would be beneficial. Bilingual, bicultural staff would be an obvious first goal; use of bilingual, bicultural physicians would also be desired, since patient-physician racial concordance improves health care uptake and satisfaction in Latino populations.121
Provision of on-hand interpreters for patients with limited English proficiency would be beneficial, as would availability of Spanish-language medical handouts and forms. Offering evening and weekend hours, as well as flexible scheduling (seeing patients in “sign-in” order versus time of appointment) could better align medical services with Latino work schedules and cultural preferences.
Finally, simple changes such as more modest medical gowns and recognition of Latino holidays could do much to make medical offices more welcoming for Latino patients.21
The Impact of Medical Homes for Latinos
A recent national survey demonstrated that when minorities make use of high-quality primary care, as in a patient-centered medical home, they experience no disparities in access, preventive care, or chronic disease care.122
Latinos currently report the lowest rates of access to a medical home of all racial/ethnic groups (15% of Latinos versus 28% of whites).122
This suggests there is much work to be done in creating Latino-targeted medical homes.
Moving from ‘Sick Care’ to ‘Well Care’
As stated earlier, poor education, cultural beliefs, and social stigma play a large role in medical decision-making within Latino communities.
The primary reason that Latino respondents gave for not having a regular health care provider was their belief that they did not need one, or because they are “seldom sick”.20
The mentality of “sick care” as opposed to “well care” is heavily ingrained in the Latino community, suggesting a strong need for prevention education and an understanding of mental health disease.
Latinos have disproportionately higher rates of obesity and diabetes than the non-Latino white population (43% of Mexican-Americans versus 33% non-Latino whites),123 and higher-calorie diets, more sedentary lifestyle, and genetic factors all contribute to these problems. As diet and physical activity are modifiable risk factors, targeted public health campaigns are needed to encourage weight control. In this case, use of media and community groups may be effective outlets for education within Latino communities35.
However, in the case of mental illness, many Latino cultures do not recognize these diseases as “sickness,” and thus more intensive interventions are needed. Read more in the Salud America! Mental Health & Latino Kids Research Review.124
Additionally, negative perceptions about mental health care with regards to stigma and masculinity (machismo) are significant barriers to mental health education and treatment in Latino populations.19
In a community-based study, when Latino high school youths were directly asked, “What does mental health mean to you?” the majority of students used terms including “psycho,” “crazy,” “schizophrenic,” “bums,” “weak” and “retarded” to describe a person with mental illness.19 The concept of mental health as an aspect of physical health is lacking in Latino culture, even among the youngest generations.
School programs that incorporate mental health education as part of general health education are needed to loosen fears of stigma and change the conversation regarding mental health from “crazy” to “healthy.”
More from our Building Support for Latino Families: A Research Review »
- Introduction & Methods
- Key Research Finding: Latinos’ Big Healthcare Gaps
- Key Research Finding: Early Cognitive Development
- Key Research Finding: ECE Programs
- Key Research Finding: Disconnected Latino Parents
- Key Research Finding: Head Start Centers as Resource Hubs
- Key Research Finding: Promotores de Salud
- Key Research Finding: Latino Medical Homes (this section)
- Key Research Finding: Latino Community Schools
- Policy Implications
- Future Research Needs
References for this section »
21. Juckett, G. Caring for Latino Patients. Am. Fam. Physician 87, 48–54 (2013).
120. Schwenk, T. L. The Patient-Centered Medical Home: One Size Does Not Fit All. JAMA 311, 802–803 (2014).
121. Saha, S., Komaromy, M., Koepsell, T. D. & Bindman, A. B. Patient-Physician Racial Concordance and the Perceived Quality and Use of Health Care. Arch. Intern. Med. 159, 997–1004 (1999).
122. Beal, A., Doty, M. M., Hernandez, S. E., Shea, K. & Davis, K. Closing the Divide: How Medical Homes Promote Equity in Health Care—Results from the Commonwealth Fund 2006 Health Care Quality Survey. (2007). Available at: http://www.commonwealthfund.org/publications/fund-reports/2007/jun/closing-the-divide–how-medical-homes-promote-equity-in-health-care–results-from-the-commonwealth-f. (Accessed: 29th September 2017)