GIS Review of Health Professions in a Hispanic Community Kathleen Urbansky Christine Aguilar, MD MPH Roberto Villarreal, MD MPH The University of Texas Health Science Center at San Antonio South Texas Health Research Center
The Issues: Throughout the US ethnic and racial health disparities exist in minority communities. The Hispanic population is the fastest growing population in the US. Minority healthcare providers are decreasing in the US.
What Research Says: Minority Health Professionals (MHP) are more likely to serve minority and medically underserved populations MHP are well suited to overcome cultural and health belief barriers A report of the Sullivan Commission on Diversity in the HealthCare Workforce. Missing Persons: Minorities in the Health Professions. (Sep. 2004)
Why Bexar County? Bexar County is located in South Central Texas and is home to San Antonio, the 2 nd largest city in the state 56% of the total population of Bexar County is Hispanic (primarily Mexican American) Bexar County has one of the largest and fastest growing Hispanic communities in Texas
El Paso Dallas Fort Worth Austin Houston Bexar County, Texas Laredo
Bexar County Demographics Category Population Estimate 2000 Population Estimate 2005 % Difference Total Population 1,392,931 1,476,351 6% Hispanic 54% 56% 4% White (non-hispanic) 36% 34% -5% Black 7% 7% 0% Other 3% 2% -3%
Texas Ethnicity 2004 Other 4% Hispanic 35% White 50% Black 11% Bexar County Ethnicity 2004 Other 3% Hispanic 56% White 34% Black 7%
Projected Bexar County Population by Race and Ethnicity 2000 to 2020 1,200,000 1,000,000 Population 800,000 600,000 400,000 200,000 0 2000 2005 2010 2015 2020 Year NH White African American Hispanic Other
Research Questions: How is Bexar County currently positioned in terms of MHP? What are the issues affecting MHP accessibility? What are the factors that affect MHP hiring, recruitment, and retention?
Methodology: Quantitative analysis of state and county data on active health professionals Qualitative analysis of health care administrator responses to open-ended ended interviews Spatial analysis of clinics, health professionals, and population
Results: Quantitative analysis shows Bexar County has more Hispanic health professionals per capita than the state of Texas. Interviews indicate local clinics need bilingual Hispanic physicians and nurses, and retaining quality minority staff is difficult. Spatial analysis helps resolves the difference between data and healthcare administrators experiences.
Medical Profession to Population Ratios for 2004 Medical Bexar Texas % Diff Profession Ratio per 100,000 Ratio per 100,000 Bexar vs. Texas Physician (Primary + Direct Care) 268 223 20% Physician Assistant 21 14 53% Registered Nurse 822 624 32% Licensed Vocational Nurse 364 273 33% Pharmacist 87 74 18%
Physician Ethnicity for Texas and Bexar County 100 Percent 80 60 40 20 0 66.5 61.9 24.5 17.9 11.3 10.5 3.1 4.4 White Black Hispanic Other Bexar County Texas
Population to Primary Care Physician Ratios Ratio Type Bexar County State of Texas Tot Pop / Physician 523:1 645:1 Tot Pop / Hisp. Physician 2,278:1 5,747:1 Tot Hisp. Pop / Hisp. Physician 1,275:1 1,994:1 Federal HPSA Designation population to physician ratio is 3500:1
Results: Quantitative analysis shows Bexar County level of Hispanic health professionals is higher than state levels Interviews indicate local clinics need bilingual Hispanic physicians and nurses, and retaining quality minority staff is difficult. Spatial analysis helps resolves the difference between data and healthcare administrators experiences.
Interview Results: Clinics Primary Needs Hispanic HP Nurses Physicians Allied Health Translation Spanish Speaking Spanish Reading Spanish Writing Training Cultural Beliefs Language Prof. Dev. Employee Recruitment & Retention Competitive Salaries Qualified Candidates
Interview Results: Primary Barriers Competitive Salary Language Skills Unqualified Minorities Distance to Work Barriers Insufficient Minority Health Professionals Lack of Training or Experience Cultural Beliefs
Results: Quantitative analysis shows Bexar County level of Hispanic health professionals is higher than state levels Interviews indicate local clinics need bilingual Hispanic physicians and nurses, and retaining quality minority staff is difficult. Spatial analysis helps resolves the difference between data and healthcare administrators experiences.
Conclusions: Data suggests Hispanic healthcare professionals in Bexar County exceed state levels, but clinics experience indicates a lack of qualified MHP. Spatial analysis explains this difference by showing care providers are not in close proximity to Hispanic communities. GIS is a strong analytical and communication tool for public health issues. The maps make the information more meaningful.
Thank You!
Percent 70 60 50 40 30 20 10 0 Projected Bexar County Population by Percent Race and Ethnicity 2000 to 2020 2000 2005 2010 2015 2020 NH White African American Hispanic Other
Population to Total Physician Ratios Ratio Type State of Texas Bexar County Tot Pop / Physician 448:1 373:1 Tot Pop / Hisp. Physician 3,731:1 1,623:1 Tot Hisp. Pop / Hisp. Physician 1,295:1 909:1