title: Unmet need for chronic disease and end-of-life care at urban family health centers in the Bronx, NY.
abstract: OBJECTIVE
  With population demographic shifts and as people live longer with progressive incurable illnesses, there will be a growing need for community-based chronic disease and end-of-life care services. Family practice sites could be strategic community-based settings in which to offer chronic disease and end-of-life care. This study determined whether two urban family health centers were meeting the chronic disease and end-of-life care needs of health center users, their families, and the local community.
  
  
  METHODS
  Using a brief structured interview instrument, we interviewed a convenience sample of 218 patients at two hospital-affiliated family health centers in the Bronx, NY, about their recent experiences with serious illness and death of immediate family members. In addition, we developed geographically defined medical service areas for each health center and compared the age distribution of residents of the geographic areas with that of actual health center users.
  
  
  RESULTS
  Of 218 health center users, 18% (n=39) had experienced the death of an immediate family member in the past year, of whom only 8% (n=3) stated that their family member had received end-of-life/chronic disease care at the health center, and only 23% (n=9) knew that their family member could have received such care. Of 26% (n=56) of study subjects who reported having an immediate family member who was currently seriously ill, 18% (n=10) stated that their family members were receiving care at the health center, and 23% (n=13) knew that their family members could have received such care. Eighty percent (n=174) of study subjects stated that they themselves would be interested in receiving end-of life/ chronic disease care at the health center in the event that they needed such care. The age distribution of health center users significantly differed from that of the residents of the geographically defined medical service areas, with an underrepresentation of people over the age of 75 among the health center users.
  
  
  CONCLUSIONS
  We identified a potential unmet need for chronic disease and end-of-life care among families of health center users and the larger community served by two family health centers in the Bronx, NY. Despite the frequent occurrence of serious illness and recent death among close family members, relatively small proportions of these family members had received care at the health centers, and few actual users were aware that such services could be provided there. Moreover, there was a significant demographic mismatch in age distribution between health center users and the surrounding community. These findings signal an important opportunity for the discipline of family medicine and its training programs to define and respond to the chronic disease and end-of-life care needs of patients and their families in community-based settings.
authors.affiliation: Department of Family Medicine and Community Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Leah
authors.initials: L
authors.lastname: Zallman
authors.forename: John
authors.initials: J
authors.lastname: Sanchez
authors.forename: Hyunok
authors.initials: H
authors.lastname: Choi
authors.forename: Peter
authors.initials: P
authors.lastname: Selwyn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003151:Community Health Centers; D005260:Female; D006301:Health Services Needs and Demand; D017051:Hospice Care / Q000458:organization & administration; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009518:New York; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000458:organization & administration; D014504:Urban Health