Addressing Challenges to Providing Health Care in a Short Term Medical Mission: Diabetes Outcomes in Migrant Farmworkers

Abstract

The Farmworker Family Health Program (FWFHP), a nurse led mobile migrant health clinic, provides health care to Hispanic migrant farmworkers in an annual two week service learning trip. The FWFHP shares many similarities with international programs where care is provided to underserved populations in resource poor areas called short term medical missions (STMMs). Questions have been raised concerning the effectiveness of these venues due to lack of outcome evaluations and failure to address challenges to providing clinically and culturally competent, sustainable and accountable care. Nurses frequently contribute their time and expertise in STMMs but few outcomes studies emanate from the discipline. A mixed methods case study framed by the Quality Health Outcomes Model was employed to describe how the nurse led FWFHP addresses challenges to providing care and to provide an analysis of outcomes of diabetes (DM) care given during the 2012 FWFHP. The FWFHP was found to have multiple structures in place which promote clinical and cultural competencies, sustainability and accountability resulting in both quantifiable and perceived benefits in the community served. Sixty-four percent (288/447) of adult patients had one or more risks for DM. Seventy-six percent (219/288) of those with risk received risk reduction education. Seventy-seven (77/288, 26.7%) individuals with risk received referral for follow up; 19.5% (15/77) of those sought follow-up after being seen at the FWFHP. Blood glucoses (BG) were significantly lower at follow-up compared to initial levels at the FWFHP (p=0.008, n=8). There were no significant statistical differences in comparisons of initial and follow-up blood pressure, weight or body mass index (BMI). The nurse led FWFHP effectively targets DM and provides risk information which has been previously proven to increase adoption of healthy behaviors. Reduction of BG levels found at follow-up could be a measure of positive behavioral changes resulting from FWFHP activities. The FWFHP model can be adapted for use by STMM organizers in structuring their programs in a variety of domestic and international settings. Findings concerning the small number of farmworkers who followed up have relevance for all STMMs. Even though follow-up may be facilitated, barriers to follow- up access likely persist after mission providers depart. Factors affecting access to follow- up care such as distance, cost and transportation should be considered when planning all STMM health care. Strategies for removing these barriers as well as ongoing research on whether patients receive appropriate care over time are needed.