10/15/13 — Patient census steady

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Patient census steady

By Steve Herring
Published in News on October 15, 2013 1:46 PM

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Family Nurse Practitioners Rebecca Hunt-Hawley, left, and Faye Warren review patient records at the Wayne County Health Department on Monday. They work primarily with maternity patients seen by the clinic.

The struggling economy does not appear to be driving more people to the Wayne County Health Department, officials say.

Rather, the number of client visits this year is consistent with last year's, Health Department Director Davin Madden said.

Madden said he has seen a slight decease in numbers in some programs, but a slight uptick in others -- something not unexpected.

"So, across the board with us right now, numbers are pretty much staying about what we have seen over the last year or two, with the kind of anticipated up and down in a few different programs," Madden said. "I don't know if that is really based on a perspective of the demand.

"For example, if a program has been up, you are going to assume that demand has increased for the services. But when one it is down, it is not necessarily that the demand has dropped for us."

Last year, the department had a vacant provider position in one of its programs, he said.

"So, when we have vacant positions, we can't see the full capacity that we normally could if we had that person there," Madden said. "We change our schedule, and we don't schedule as many clients in a given time period. So sometimes you will see a little dip in numbers in regards to that. I think in the big picture we are seeing about the same.

"You have to remember, just because somebody is out of work, that it doesn't mean they will qualify for Medicaid, which means they are not going to have insurance to come to the Health Department for certain services either."

Last year, there were more than 6,200 office visits in the Health Department's maternity clinic. Also, a couple thousand immunizations are given each year.

Madden said the Health Department is seeing about the same numbers this year in both.

"I have noticed across the state that a lot of health departments have seen a slight slip in services and even the (state) Department of Health and Human Services has inquired about that," Madden said.

The Health Department has another challenge -- high no-show rates for its services, Madden said.

For example, he said, the department's dental program has a no-show rate of 40 to 45 percent.

The maternity clinic's no-show rate is about 25 percent, he said.

"But, for a public health clinic, that is actually not a bad rate," Madden said.

Some people may have lost their job and not have money for gas, or may no longer have a vehicle, Madden noted. In those cases, people may rely on public transportation that can interfere with them getting to and from appointments.

A significant problem across the state is an increasing infant mortality rate, he said.

That could indicative of mothers who did not get adequate pre-natal care or who started it later in the pregnancy, or decided against any care, Madden said.

That greatly increases the risk of a "bad outcome" with the pregnancy or a higher rate for infant mortality, he said.

Maternal health clinic numbers are slightly down, but immunization numbers are slightly up, he said. Statistically, that is not important, he said.

"It is like with anything, you have an ebb and flow of people utilizing services," Madden said. "With a health department you are battling with a couple of things.

"One, you are working on your marketing because some people have a somewhat skewed and antiquated view of what a health department is. They look at it as simply a facility that provides health services for STDs (sexually transmitted diseases) and indigent care. But that is not what a health department is. So sometimes people don't use services that they can use fully, being a taxpaying citizen of Wayne County. But they just choose not to, perhaps because of perception. So that does drive some of the utilization of the Health Department."