Documenting and analyzing the contribution of the gatekeeper strategy for enhancing health care access in a midwestern city

The rising number of uninsured individuals in the United States causes harm to population health and puts considerable strain on local safety nets. Individuals without access to care suffer negative health outcomes. This study examines the efforts of a community coalition to improve access to health services for vulnerable populations in Shawnee County, Kansas. The coalition implemented a community-based, multi-component, system-level intervention (the Gatekeeper strategy) that focused on six components: (1) increasing early identification of vulnerable adults by mobilizing the community to be more aware and take action to refer these individuals; (2) strengthening coordination and efficiency of the safety net by establishing a process for community-wide screening and triage; (3) enhanced linking of individuals to multi-disciplinary organizations through shared assessment and referral protocols conducted by home visitors; (4) establishment of a pharmacy assistance program to leverage external funding from pharmaceutical companies; (5) enhancing charity care efforts to recruit volunteer providers; and (6) enhancing mental health services for seniors and adults in crisis. An empirical case study design was used to examine the effects of the coalition on community and system changes (new or modified programs, policies, and practices) in implementation of the Gatekeeper strategy. The effects of the coalition's efforts on community and system changes (an intermediate outcome) were examined by using repeated measures (over a three year period) for a naturalistic time series design.; The results showed that increased rates of community and system changes were associated with comprehensive strategic planning, capacity building, resource attainment, and implementation of a comprehensive action plan. The intervention was successful in mobilizing community members, expanding charity care services, and increasing access to health services for vulnerable individuals. External assistance leveraged through pharmaceutical companies doubled local prescription-access resources. Preliminary results indicate that the home visitor approach for assessment, referral, and follow-up processes increased client perceptions of social support but not for health perception improvement. Features of this community context, such as community readiness and history of collaboration, may have contributed to the success of this community to improve access to health services.