Learning Objective #1: Evaluate the relationship between geospatial indicators of safety net status and access to care

Learning Objective #2: Propose recommendations for research related to further understanding the care-seeking behaviors by vulnerable and underserved populations

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Objectives: This paper will report on the safety net status of six academic nurse-managed centers using a geospatial approach. The objective of this study was to differentiate between the services that may be offered in the geographic location of the vulnerable population and the location of the safety net clinic where clients access services. Design: The study used a longitudinal design over a five year period. Population: The population in the study included uninsured adults and children in two communities. Methods: Chart data were collected from 1998 to 2003 from five nurse-managed school clinics in one community and one primary care clinic primarily serving adults. Variables were the percent of children on free and reduced price lunch, percent of children with special needs, percent of adults without any third party reimbursement, geographic location of the nurse-managed clinics and geographical residence of the clients. Geomaps were constructed using the geographic residential areas of clients, clinics and other health care services near client residential areas. Findings: Geomapping indicated that while all clients in the study were underserved, only two clinics were wholly located in medically underserved areas. The others were located in partially medically underserved areas or areas that were not underserved. Not all clients lived in medically underserved areas or economically distressed census tracts. Those clients sought services from the nurse-managed clinics when other services were in closer proximity. Conclusions: Findings suggest that academic nurse-managed centers provide access to care for underserved populations that extends beyond geographic boundaries of medically underserved areas. The health care delivery system does not seem to meet these clients' needs for access to care. Implications: Academic nurse-managed centers play an important role in the safety net for vulnerable populations. Future research should address factors that contribute to clients decisions to seek care in these clinics.