This mixed-methods study reports on an outreach clinics program designed to deliver genetic services to medically underserved communities in Wisconsin.
We show the geographic distribution, funding patterns, and utilization trends for outreach clinics over a 20-year period. Interviews with program planners and outreach clinic staff show how external and internal constraints limited the program’s capacity. We compare clinic operations to the conceptual models guiding program design.
Our findings show that state health officials had to scale back financial support for outreach clinic activities while healthcare providers faced increasing pressure from administrators to reduce investments in charity care. These external and internal constraints led to a decline in the overall number of patients served. We also find that redistribution of clinics to the Milwaukee area increased utilization among Hispanics but not among African-Americans. Our interviews suggest that these patterns may be a function of shortcomings embedded in the planning models.
Planning models have three shortcomings. First, they do not identify the mitigation of health disparities as a specific goal. Second, they fail to acknowledge that partners face escalating profit-seeking mandates that may limit their capacity to provide charity services. Finally, they underemphasize the importance of seeking trusted partners, especially in working with communities that have been historically marginalized.
There has been little discussion about equitably leveraging genetic advances that improve healthcare quality and efficacy. The role of State Health Agencies in mitigating disparities in access to genetic services has been largely ignored in the sociological literature.
This material is based upon work supported by the National Institute of Food and Agriculture, United States Department of Agriculture, under ID number MSN136524 and by the National Human Genome Research Institute of the National Institutes of Health, under award number 1K01HG006441-01A1. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the United States Department of Agriculture or the National Institutes of Health.
The authors thank Rozalynn Klaas for creating the maps that appear in Figs. 3 and 4 and Jessica von Reyn, Phil Brown, Michelle Kempf-Weibel, Rachael Lee, Michael Shields, Berit Lindell, Lauren Nicoll, John Auerbach, and two anonymous reviewers for comments on a draft version of this chapter. The authors also thank Pilar Ossorio and Daniel Kleinman at the University of Wisconsin-Madison and Deb Franko at Northeastern University for their support and mentorship in the execution of this research.
Senier, L., Kearney, M. and Orne, J. (2015), "Using Public-Private Partnerships to Mitigate Disparities in Access to Genetic Services: Lessons from Wisconsin", Genetics, Health and Society (Advances in Medical Sociology, Vol. 16), Emerald Group Publishing Limited, Bingley, pp. 269-305. https://doi.org/10.1108/S1057-629020150000016010
Emerald Group Publishing Limited
Copyright © 2015 Emerald Group Publishing Limited