by Gina Foianini
Public health graduate student
Health Promotion Advocate (HPA) Intern, 2010-2011

As a health promotion advocate (HPA), one of my main goals is to connect patients with primary care providers. Many of the patients in the pediatric emergency department (ED) do not have a regular provider and, as a result, end up using ED services for non-urgent needs.

Although I make appointments for patients both at Boston Medical Center (BMC) and community health centers, adolescent patients don’t always keep their appointments.  In fact, approximately two thirds of adolescents don’t make it to the primary care appointments made for them by HPAs at the hospital.  Below are five potential barriers that stand in the way of adolescents receiving primary care:

1. Lack of Transportation
   Many adolescents in Boston don’t have access to a car or money to take public transportation to an appointment. This is especially a problem for adolescents whose parents are less involved in their lives.
2. Forgetfulness
   Forgetting to write down the details of the appointment or forgetting the appointment all together.
3. Ambivalence
   Feeling ambivalent is common with adolescents. When they are no longer sick and requiring immediate care, adolescents may feel ambivalent about seeing a primary care doctor when it no longer feels “necessary” to do so, even though they think it could be helpful.
4. Insurance Issues
   Lack of insurance is a major barrier to accessing care for adolescents. (Most patients without insurance at BMC are enrolled in MassHealth but there are still obstacles that make this process difficult.)
5. Communication Barriers
   Many adolescents are difficult to reach by phone. Using someone else’s phone, having a full voice mailbox, or screening incoming calls from unfamiliar hospital phone numbers all make contacting patients even more difficult.

While considering these barriers, my goal is to find solutions for each patient that will create a more direct link between the emergency department and the doctor’s office.

Edited by Llaen Coston-Clark