Breaking down barriers to care

RPAP student Andy Mulder, Class of 2007, listened carefully during the young Latino woman's appointment with a diabetes management nurse at the Willmar clinic. Afterward he asked the patient how the health-care system might better serve her.

What would help her follow the diabetes management program? A Spanish-speaking nurse? Access to translators? More information about diet?

No, she said—what she really needed was a ride to the clinic, since she didn't always have access to a car.

For Mulder, that was an "aha" moment. "Several of the people I talked to had transportation issues—they lived in a one-vehicle household, or they didn't drive at all," he says. The conversation was just one of many experiences that helped him realize that Latino patients confront a multitude of barriers to health care, and that some challenges, like transportation, are both easy to address and easy to overlook.

For his RPAP community health assessment project, Mulder spent several months last fall and winter studying diabetes care among Latino patients in Willmar (population 18,918), which has a large and growing Latino population. As Mulder knew, Latinos as a group have a higher incidence of diabetes than the general population.

With the help of Deb Lippert, clinical coordinator at the Rice Diabetes and Nutrition Center (RDNC), Mulder had access to a wide range of statistics and other nonconfidential data. He was also able to meet with Latino patients so he could talk with the people behind the numbers.

RPAP is seen as fundamental to the continued successful evolution of the Medical School curriculum. For a lot of students, it's the reason they apply to the program.

Macaran (Mac) Baird, M.D., an early RPAP participant in Wabasha, Minnesota, who is now head of the Department of Family Medicine and Community Health, which oversees RPAP

Based on his research, Mulder made several recommendations to the RDNC. Some of his suggestions, like providing transportation vouchers and calling patients a day in advance to remind them about appointments, have already been implemented, says Lippert. Others, such as training interpreters in diabetes management, may be incorporated in long-term plans. "Andy's [research] is very much part of our ongoing quality-improvement process," she says. "It's wonderful to be able to tap into a resource like that."

Mulder, who starts a preliminary surgery residency later this year at the University, says his project helped him gain not only an appreciation for the challenges Latinos face in getting diabetes care but also for the meaningful changes—both large and small—that can improve their care. "Some of the barriers to health care that Latino patients face aren't readily apparent," he says. "But just putting up signs in Spanish that explain where to register or where to get prescriptions can make a difference."

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