Health Resource Capacity Assessment for Putnam, Connecticut, May 2001

Health Needs/Barriers to Care: Availability of Healthcare

Availability of health care was sharply split by population. Access to care for children was universally regarded as good or excellent. The only provider of pediatric care in Putnam is the Pediatrics Center at Day Kimball Hospital. In response to parent requests, the Pediatrics Center expanded to evening and weekend hours in July 2000. This reduced appointment waiting times to two or three weeks. ³⁴ The expansion was widely praised by the community. At the time of this study, all physicians at the Pediatrics Center were accepting new patients.

In contrast to children, access to primary care for adults was reported as a serious problem by many residents and providers. Getting appointments at the few practices taking new patients can take very long, 6 months or more. The nearest community health center, Generations Family Health Center, has a satellite office in the neighboring town of Danielson. Waiting times for other services, such as mammograms, are long for providers within Putnam, but are much shorter if patients are able to travel to neighboring towns. ³⁵

Inappropriate use of the emergency department and consequent long waits for treatment were noted by many in focus groups and interviews as serious problems in Putnam's health care system. Routine ear infections were the most common diagnosis for Emergency Department non-admission visits at Day Kimball Hospital compared to 77th most common diagnosis at emergency departments across Connecticut. ³⁶ Recognizing their safety net role in accepting anyone who comes through the door, the ED has created a Prompt Care area to handle minor problems within an hour; the area is open 12 hours everyday. ³⁷

Seniors and providers reported a reduction in access due to the withdrawal of Medicare HMOs from the region, and the difficulty and cost of obtaining supplemental insurance. High prescription drug costs were often noted as a barrier to care for seniors.

The need for a central resource for information on health care, patients' rights and assistance in applying for programs or accessing care was a common theme across populations. Systems are complex and many give up before they find a source that meets their need. When asked in interviews and focus groups, respondents had a difficult time identifying where most residents get health information. The most common answers were doctor's offices, the hospital and town hall.

A need for case management was stated often, particularly for young families (see Parental Stress) and for seniors. The loss of the prenatal clinic at Day Kimball Hospital was reported as a loss for the community. While private providers have increased capacity to cover Medicaid births, they do not provide the wraparound case management services that were available at the clinic.

A case management program for low income, uninsured or underinsured, elderly patients suffering from chronic diseases was very successful. The Chronic Disease Management (CDM) Program operated from October 1998 to March 2000 in a nine town area; 25% of clients were from Putnam. Clients averaged 5.75 chronic conditions and 5.85 medications per patient. Clients received integrated, comprehensive case management services through Day Kimball Hospital's Center for Healthy Aging, Generations Family Health Center, United Services and the Area Agency on Aging. During the length of the program, hospital days were reduced from 3.77 average to 0.99 days. ER visits were reduced from 0.42 to 0.35/client. ³⁸ The program closed when funding ran out.

Workforce shortages across provider types are common in Putnam as in the rest of Connecticut. The most severe problem was reported for home health and home care workers. These shortages, more than rate issues, threaten the ability of home care programs to continue to meet growing demand and keep frail elderly residents out of costly long term care. ³⁹

Hospital management, providers and town residents all noted a shortage of physicians in the area, particularly specialists. Physicians blamed the problem on reimbursement rates and managed care. The nature of a rural community appeals to some potential providers, but not others. There were varying perceptions of practice in a rural setting - escape from some urban health problems balanced by lack of access to high profile teaching and research institutions. ⁴⁰ At the time of this study, of fourteen Internal Medicine physicians in the area, seven were taking new patients, none of who have offices in Putnam. Of twenty Family Practice physicians in the area, six were accepting new patients, two with offices in Putnam. All four OB/GYN physicians and two Certified Nurse Midwives in the area were accepting new patients, all with offices in Putnam. There are only three psychiatrists in the area and none are accepting new patients. There are five Psychologists in the area, all five were accepting new patients, but only one has an office in Putnam. ⁴¹

Footnotes

34. Interviews, focus groups.
35. Focus groups, interviews, parent surveys
36. Day Kimball Hospital, the Bristol Group, 10/1/99 to 3/31/00.
37. Interview
38. CDM Program Summary Report, 2000.
39. Interviews focus groups, interviews
40. survey of providers in the area,
41. Interviews.