1. hobbies and interests
2. arts and crafts
3. pottery

CLAY COUNTY
2005
Health Needs Assessment
Prepared by:
Health Planning Council of Northeast Florida, Inc.
900 University Blvd. North, Suite 110
Jacksonville, Florida 32211
TABLE OF CONTENTS
LIST OF TABLES AND FIGURES................................................................................ ii
INTRODUCTION..............................................................................................................1
CLAY COUNTY PROFILE .............................................................................................3
I.
Introduction ...........................................................................................................3
II. Population Characteristics.....................................................................................3
III. Socio-Economic Profile ........................................................................................4
HEALTH STATUS............................................................................................................7
I. Mortality Indicators ................................................................................................7
II. Infectious Diseases...............................................................................................21
III. Maternal and Child Health...................................................................................22
IV. Social and Mental Health.....................................................................................27
V. Behavioral Risk Factor Surveillance Survey .......................................................29
ACCESS TO CARE/HEALTH CARE RESOURCES.................................................31
I.
Introduction .........................................................................................................31
II. Health Coverage..................................................................................................31
III. Primary Care .......................................................................................................33
IV. Health Care Professionals...................................................................................34
V. Health Care Facilities..........................................................................................34
VI. Other Health Care Services .................................................................................39
COMMUNITY COMMENTS ........................................................................................41
I. Focus Groups........................................................................................................41
II. Community Surveys..............................................................................................45
KEY ISSUES AND RECOMMENDATIONS...............................................................53
I. Introduction ...........................................................................................................53
II. Key Issues and Recommendations........................................................................53
APPENDICES
Appendix A-1 Executive Summary, Florida Youth Substance Abuse Survey
Appendix A-2 2002 County Behavioral Risk Factor Surveillance Survey
Appendix B Clay County Health Resources
Appendix C-1 Focus Group Instrument
C-2 Survey Instrument
C-3 Other Survey Comments
i
LIST OF TABLES AND FIGURES
TABLES
Clay County Profile
Table 1 Population Trends 2000-2015...............................................................................3
Table 2 Clay County Population by Race, 2003................................................................4
Table 3 Per Capita and Median Household Income, 2001 ................................................4
Table 4 Estimates of Persons and Families in Poverty, 2000 ............................................5
Table 5 Families on Public Assistance, 2000-2004 ...........................................................5
Table 6 Unemployment Rates, 1998-2003 ........................................................................5
Table 7 Students Receiving Reduced Price or Free Lunch, 2003......................................6
Health Status
Table 8 Population by Race, 2003 .....................................................................................7
Table 9 Death Rates for Leading Causes of Death, 2001-2003.........................................9
Table 10 Reported AIDS and HIV Cases, 2001-2003......................................................21
Table 11 Sexually Transmitted Diseases, All Races, 2001-2003 .....................................21
Table 12 Total Births and Birth Rates by Race, 2001-2003 .............................................22
Table 13 Female Pop of Childbearing Women Age 15-44 by Race, 2001-2003 .............22
Table 14 Domestic Violence Offenses, 2003 ...................................................................27
Table 15 Arrests by Offenses, 2004..................................................................................29
Access to Care
Table 16 Health Insurance Coverage, 2004......................................................................31
Table 17 Medicaid Enrollees, 2000-2004.........................................................................32
Table 18 KidCare Enrollment, 2004.................................................................................33
Table 19 Medicare County Enrollment and Aged and Disabled Enrollment, 2003 .........33
Table 20 Adult Discharges, Clay County Residents, 2004...............................................36
Table 21 Pediatric Discharges, Clay County Residents, 2004..........................................36
Table 22 Free Standing Community Nursing Homes, 2004.............................................38
FIGURES
Clay County Profile
Figure 1 Estimates of Population by Age Group, 2003 ......................................................3
Figure 2 Household Income Levels, 2001 ..........................................................................4
Figure 3 High School Graduates, 2003-04 .........................................................................6
Health Status
Figure 4 Heart Disease Death Rates, All Races, 1997-2003 ..............................................9
Figure 5 Heart Disease Death Rates by Race, 2001-2003 ..................................................9
Figure 6 All Cancer Death Rates, All Races, 1997-2003 .................................................10
Figure 7 All Cancer Death Rates by Race, 2001-2003.....................................................10
Figure 8 Lung Cancer Death Rates, All Races, 1997-2003..............................................11
Figure 9 Lung Cancer Death Rates by Race, 2001-2003.................................................11
ii
Figure 10 Breast Cancer Death Rates, All Races, 1997-2003 ..........................................12
Figure 11 Breast Cancer Death Rates by Race, 2001-2003..............................................12
Figure 12 Stroke Disease Death Rates, All Races, 1997-2003.........................................13
Figure 13 Stroke Disease Death Rates by Race, 2001-2003 ............................................13
Figure 14 C.O.P.D. Death Rates, All Races, 1997-2003 .................................................14
Figure 15 C.O.P.D. Death Rates by Race, 2001-2003......................................................14
Figure 16 Unintentional Injuries, All Races, 1997-2003..................................................15
Figure 17 Unintentional Injuries by Race, 2001-2003......................................................15
Figure 18 Motor Vehicle Accident Death Rates, All Races, 1997-2003..........................16
Figure 19 Motor Vehicle Accident Death Rates by Race, 2001-2003 .............................16
Figure 20 Diabetes Death Rates, All Races, 1997-2003...................................................17
Figure 21 Diabetes Death Rates by Race, 2001-2003 ......................................................17
Figure 22 Influenza & Pneumonia Disease Death Rates, All Races, 1997-2003 .............18
Figure 23 Influenza & Pneumonia Disease Death Rates by Race, 2001-2003.................18
Figure 24 Alzheimer’s Disease Death Rates, All Races, 1997-2003 ...............................19
Figure 25 Alzheimer’s Disease Death Rates by Race, 2001-2003 ...................................19
Figure 26 Liver Disease Death Rates, All Races, 1997-2003...........................................20
Figure 27 Liver Disease Death Rates by Race, 2001-2003 ..............................................20
Figure 28 Gonorrhea, Chlamydia, & Infectious Syphilis Rates, All Races, 1997-2003 ..21
Figure 29 Infant Mortality Rates, All Races, 1997-2003..................................................23
Figure 30 Infant Mortality Rates by Race, 2001-2003 .....................................................23
Figure 31 Low Birthweights, All Races, 1997-2003 ........................................................24
Figure 32 Low Birthweights by Race, 2000-2002............................................................24
Figure 33 Births to Mothers Under 18, All Races, 1997-2003.........................................25
Figure 34 Births to Mothers Aged 15-17 by Race, 2001-2003.........................................25
Figure 35 Percent of Pregnancies Receiving First Trimester Prenatal Care, All Races,
1997-2003 .........................................................................................................26
Figure 36 Percent of Pregnancies Receiving First Trimester Prenatal Care by Race,
2001-2003 .......................................................................................................26
Figure 37 Births to Mothers Who Smoked During Pregnancy, All Races, 2001-2003....27
Figure 38 Suicide Death Rates for All Races, 1997-2003 ................................................28
Figure 39 Suicide Death Rates by Race, 2001-2003 .........................................................28
Access to Care
Figure 40 Hospital Utilization of Clay County Residents, 2004 .....................................35
Figure 41 Orange Park Medical Center, ER Visits, 1997-2004 ......................................37
Figure 42 Orange Park Medical Center, Inpatient Hospital Admissions, 1997-2004 .....37
iii
INTRODUCTION
The Clay County Health Department, Orange Park Medical Center, and the Clay County
Chamber of Commerce spearheaded an initiative to conduct a comprehensive, countywide health needs assessment. The Health Planning Council of Northeast Florida was
asked to facilitate this community initiative.
The Clay County Health Assessment Task Force, comprised of representatives from local
medical and behavioral health providers, social service agencies, civic organizations, and
minority and faith-based groups, was formed. Information collected during the needs
assessment process was presented to the Clay County Health Assessment Task Force at
community meetings that were held at the Clay County Chamber of Commerce in Orange
Park from January through July of 2005.
Components of Clay County’s needs assessment included an analysis of demographics,
health statistics, and access to health care indicators for county residents. Community
input was obtained from six focus group interviews with special populations: elderly,
Hispanics, recovering substance abusers, and rural residents. A community-wide survey
that examined the community’s opinion on health care services and quality of life issues
was also distributed to gain additional feedback from Clay County residents. Detailed
information summarizing each of these components is included in this report.
At the final two community meetings, members of the Clay County Health Assessment
Task Force made recommendations of key health issues based on data obtained from the
various components of the needs assessment. A summary of their key issues and
recommendations is included in the final section of this report.
1
2
CLAY COUNTY PROFILE
I. INTRODUCTION
The characteristics of a community, including the age, gender, ethnic background, and economic
characteristics, influence the community’s health care needs and the design of delivery of services to
meet those needs. This section provides an overview of the demographics and socio-economic
characteristics of Clay County in comparison to the state.
II. POPULATION CHARACTERISTICS
Table 1 shows Clay’s population trends and projections between 2000-2015. It is projected that Clay
County will experience a 47% population growth during this period, while Florida is projected to
increase by 31%.
Table 1
Population Trends, 2000-2015
Area
Clay
Florida
2000
141,266
16,072,832
Population
2005
2010
165,877
186,941
17,844,137 19,478,414
2015
% Population Change 2000-2010
207,637
47.0%
21,080,569 31.2%
Source: July 1 Population Estimates, Office of Governor, October 2004
Figure 1 summarizes the age groups of Clay County residents with comparison to Florida.
Clay County is comprised of a younger population with respect to many other counties in the state.
The highest percentage of its residents are in the 25-44 age group, accounting for nearly 30% of the
county’s population. Elderly residents over the age of 65 make up only 10% of the total population.
Figure 1
Estimates of Population by Age Group, 2003
30
25
20
15
10
5
0
0-14
15-24
25-44
45-64
Clay
Florida
Source: July 1 Population Estimates, Office of Governor, 2004
3
65+
Race and Ethnicity
Table 2 shows the racial composition of Clay County with comparison to Florida. Only 10.4% of the
population in Clay County is non-white. The “Other” race category includes American Indians,
Asians, and Hawaiian/Pacific Islanders.
Table 2
Clay County Population by Race, 2003
Clay
Race
Population Percentage
White
140,860
89.5%
Black
11,671
7.4%
Other
4,794
3.0%
Total
157,325
100%
Florida
Population Percentage
14,012,002
81.9%
2,690,405
15.7%
417,761
2.4%
17,120,168
100%
Source: Population Estimates from the Executive Office of the Governor, 2004
III. SOCIO-ECONOMIC PROFILE
Income
Clay County had a per capita income of $22,249 in 2001, which slightly exceeded Florida’s per
capita income of $20,199 (Table 3). At $49,821, Clay County had a higher median household
income than the state’s average of $37,307.
Table 3
Per Capita and Median Household Income, 2001
Clay
Florida
Per Capita Income Median Household Income Per Capita Income Median Household Income
$22,249
$49,821
Source: ESRI Marketing Systems, 2002
$20,199
$37,307
With regard to household income levels, 29% of Clay County households had incomes between
$25,000 - $49,000 and 35% of residents had incomes between $50,000 - $99,000 (Figure 2).
Figure 2
Household Income Levels, 2001
35.0
30.0
Percent
25.0
20.0
15.0
10.0
5.0
0.0
< $15K
$15K -$24K
$25K-$49K
$50K-$99K
$100K-$149K
$150K
Clay
10.4
10.6
29.2
35.3
9.8
4.8
Florida
17.6
14.5
31.6
26.6
6.2
3.4
Source: ESRI Marketing Systems, 2002
4
Poverty
The estimated percentage of all persons living in poverty in Clay County was 6.8%, nearly half of the
percentage of those living in poverty in Florida (Table 4).
Table 4
Estimates of Persons and Families in Poverty, 2000
All Persons
Children 0-17
Total
County Population Number Percent
Percent
Clay
139,162
9,437
6.8
2.6
Florida 15,605,367 1,952,629 12.5
4.0
18-64
65+
Percent
3.5
6.9
Percent
0.7
1.6
Source: 2000 US Census Bureau
Note: 2000 US Census Poverty status refers to the 1999 poverty income level.
Public Assistance
National welfare reform and the initiation of Florida's WAGES program in 1996 dramatically
reduced the number of families enrolled in the State Public Assistance Program. Table 5 summarizes
the number of clients and families receiving public assistance from 2000-2004.
Table 5
Families on Public Assistance 2000-2004
2000
Families
Clients
Persons Receiving Cash Assistance
2001
2002
2003
Families
Clients
Families
Clients
Families
Clients
2004
Families
Clients
Area
282
527
274
510
271
472
299
533
293
Clay
142,476 57,676
122,955 58,877
125,251 58,535
124,217 57,020
Florida 64,829
Note: June TANF enrollment figures provided
Source: Economic Self-Sufficiency Services, Florida Department of Children and Families, 2004.
502
118,666
20002004
%
Change
Clients
-4.7%
-16.7%
Labor Force, Employment, and Industry
According to the Florida Department of Labor and Employment Statistics, there was an average of
76,025 persons employed in the civilian workforce in Clay County. Between 1998-2004, Clay
County’s unemployment rate showed an increase of 55% (Table 6). Florida experienced an increase
of 7% during this same time period; however Clay County’s unemployment rate is still below the
state average.
Table 6
Unemployment Rates, 1998-2004
% Unemployment
Area
1998 1999 2000 2001 2002 2003 2004 % Change 1998-2004
Clay
2.7
2.6
2.7
3.8
4.7
4.3
4.2
55%
Florida 4.3
3.9
3.6
4.8
5.5
5.1
4.6
7.0%
Source: Florida Agency for Workforce Innovation, Labor Market Statistics, Local Area
Unemployment Statistics Program, 2004
5
Education
Total enrollment in Clay County public schools (pre kindergarten - grade 12) during the 2003-04
school year was 31,368. The high school graduation rate and drop out rates are shown in Figure 3.
Figure 3
High School Graduates, 2003-04
100.0
73.8
71.6
80.0
60.0
40.0
20.0
0.0
2.9
1.9
Clay
Florida
Graduation Rate
Drop Out Rate
Source: Bureau of Education information and Accountability Services. Florida Dept of Education, Florida School
Indicator Report; Profiles of School Districts, 2003-04
Graduation rate is defined as % of students who graduate from high school within 4 years after entering 9th grade for the
first time.
Table 7 summarizes the number of students receiving free or reduced lunch. Clay County had a lower
number of elementary and middle school students receiving free or reduced lunch with comparison to
Florida.
Table 7
Students Receiving Free or Reduced Price Lunch, 2003
Area
Clay
Florida
Type of School
Middle
25.8%
48.0%
Elementary
30.5%
53.5%
Source: Florida School Indicators Report, 2003-04. Total percentage of students in enrolled in public schools receiving
free or reduced lunches. Students whose family incomes are < 130% of the federal poverty guidelines are eligible for free
lunch and students whose family incomes are between 131-185% are eligible for the reduced price lunch program. High
schools students are not included in these figures
6
HEALTH STATUS
I. MORTALITY INDICATORS
Mortality rates can be key indicators of the state of health of a community. This section will
compare mortality rates for Clay County with Florida mortality rates, as well as three other
counties in Northeast Florida, including Baker, Bradford, and Nassau Counties.
Table 8 summarizes the population by race. Clay County’s minority population is lower than
Florida as well Bradford and Baker Counties.
Table 8
Population by Race, 2003
Area
Baker
Bradford
Clay
Nassau
Florida
Race
Total
White
Black
Other
Total
White
Black
Other
Total
White
Black
Other
Total
White
Black
Other
Total
White
Black
Other
Population
23,457
19,829
3,386
242
27,060
21,050
5,655
355
156,951
140,345
11,750
4,856
63,425
58,119
4,681
625
17,134,945
14,012,002
2,690,405
432,538
Race as % of
Population
100%
84.5%
14.4%
1.0%
100%
77.8%
20.9%
1.3%
100%
89.4%
7.5%
3.1%
100%
91.6%
7.4%
1.0%
100%
81.8%
15.7%
2.5%
Source: July 1 Population Estimates, Office of the Governor, 2004
A significant number of Clay County deaths are premature and preventable. Behavior
modification and risk reduction can reduce the mortality rates of many of the lading causes of
death, especially those attributed to heart disease, stroke, diabetes, lung cancer, and motor
vehicle accidents. Individuals may improve both the length and quality of their lives by simply
following a healthy lifestyle and receiving regular medical care.
Table 9 summarizes age-adjusted death rates for several of the leading causes of deaths for all
races. Overall, Clay County exceeded Florida’s death rates for the other leading causes of death.
7
Table 9
Death Rates for Leading Causes of Death, 2001-2003
Area
Baker
Bradford
Clay
Nassau
Florida
Heart
Disease
313.9
220.2
239.9
254.3
217.9
Age-Adjusted Death Rates, All Race, Per 100,00 Population
Cancer
Stroke
COPD Diabetes Pneumonia/ Liver Disease
Influenza
221.2
62.8
84.1
47.8
48.8
20.6
199.3
58.1
47.1
36.9
29.1
11.9
223.9
62.6
60.9
28.0
18.7
11.1
214.2
68.3
61.5
19.4
25.2
10.1
178.7
44.7
39.4
21.1
14.4
10.9
Note: Three-Year Average, Age Adjusted
Source: Florida Department of Health, Office of Planning, Evaluation & Data Analysis, 2004
The remainder of this section will explore the leading causes of death for Clay County in
comparison with Baker, Bradford, and Nassau Counties as well as Florida. Age-adjusted death
rates for all races from the period of time between 1997 – 2003 will be presented, as well as age
adjusted death rates by race from 2001 – 2003. Unless otherwise noted, all tables in this section
compare three-year rolling averages using age-adjusted death rates from the Florida Department
of Health’s CHARTS website which can be found at
http://www.floridacharts.com/charts/chart.aspx
Mortality rates for the following indicators are included in this section:
• Heart Disease
• All Cancers
• Breast Cancer
• Lung Cancer
• Stroke
• Chronic obstructive pulmonary disease (C.O.P.D.)
• Unintentional injuries
• Motor vehicle accidents
• Diabetes
• Influenza and pneumonia
• Alzheimer’s disease
• Liver Disease
In addition, this section will review infectious disease rates, maternal and child health and social
and mental health indicators as well as results of the 2002 Behavioral Risk Factor Surveillance
System Survey.
8
Heart Disease
Heart disease remains the nation’s leading cause of death. Figure 4 shows age-adjusted heart
disease death rates for the period of time between 1997 – 2003. Clay County has shown a decline
in heart disease deaths during this time period, however still remains slightly higher than Florida.
Non-white deaths from heart disease in Clay County were lower than deaths in the white
population (Figure 5).
Figure 4
Heart Disease Deaths, All Races, 1997-2003
400
300
200
100
0
Baker
Bradford
Clay
Nassau
Florida
1997-1999
324.1
278.2
305.2
298.3
250.7
1999-2001
309.8
237.1
276
313.2
238
2001-2003
313.9
220.2
239.9
254.3
217.9
Figure 5
Heart Disease Death Rates By Race, 2001-2003
400.0
300.0
200.0
100.0
0.0
Baker
Bradford
Clay
Nassau
Florida
All Races
313.9
220.2
239.9
254.3
217.9
W hite
320.5
225.1
243.9
245.6
212.2
Non-W hite
250.4
203.4
167.7
359.9
263.4
9
Cancer
Cancer ranks second only to heart disease as the leading cause of death in the United States.
Age-adjusted deaths from all types of cancer in Clay County remained fairly stable between
1997-2003 (Figure 6). Cancer deaths in the non-white population of Clay County were lower
than the white population (Figure 7).
Figure 6
All Cancer Death Rates For All Races, 1997-2003
300.0
200.0
100.0
0.0
Baker
Bradford
C lay
Nassau
Florida
1997-1999
257.8
214.5
219.2
232.3
193.5
1999-2001
280.4
219
227
204.8
187.2
2001-2003
221.2
199.3
223.9
214.2
178.7
Figure 7
All Cancer Death Rates By Race, 2001-2003
300.0
200.0
100.0
0.0
Baker
Bradford
Clay
Nassau
Florida
All Races
221.2
199.3
223.9
214.2
178.7
W hite
225.4
207.2
228.2
214.8
177.3
Non-W hite
188.2
149.3
164.5
214.7
191.6
10
Lung Cancer
Clay County showed an increase in age-adjusted lung cancer deaths between 1997-2003 (Figure
8). Lung cancer deaths in the non-white population were less than the white population in Clay
County as well Florida and Baker, Bradford, and Nassau Counties (Figure 9).
Figure 8
Lung Cancer Death Rates, All Races, 1997-2003
120.0
100.0
80.0
60.0
40.0
20.0
0.0
Baker
Bradford
Clay
Nassau
Florida
1997-1999
98.9
67.1
67.9
77.9
57.8
1999-2001
90.6
71.4
76.1
66.7
56.0
2001-2003
61.2
70.4
81.6
66.3
53.6
Figure 9
Lung Cancer Death Rates By Race, 2001-2003
100.0
80.0
60.0
40.0
20.0
0.0
Baker
Bradford
Clay
Nassau
Florida
All Races
61.2
70.4
81.6
66.3
53.6
W hite
65.0
73.4
84.0
67.7
54.5
Non-W hite
27.9
44.5
46.8
52
44.3
11
Breast Cancer
Clay County showed a slight decrease in the number of breast cancer deaths from the period of
time from 1997-2003 (Figure 10). There was a higher number of deaths in the white in Clay
County than the non-white population (Figure 11).
Figure 10
Breast Cancer Death Rates, All Races, 1997-2003
20.0
15.0
10.0
5.0
0.0
Baker
Bradford
Clay
Nassau
Florida
1997-1999
17.0
10.1
14.8
16.4
14.1
1999-2001
17.5
8.6
14.7
9.7
13.2
2001-2003
17.7
10.8
13.1
14.2
12.5
Figure 11
Breast Cancer Death Rates By Race, 2001-2003
20.0
15.0
10.0
5.0
0.0
Baker
Bradford
C lay
Nassau
Florida
All Races
17.7
10.8
13.1
14.2
12.5
W hite
16.8
11.3
13.5
14.0
12.1
Non-W hite
27.3
6.0
9.2
13.3
15.2
12
Stroke
Stroke is a cardiovascular disease that affects the blood vessels supplying blood to the brain.
Stroke is the third leading cause of death in the United States. As shown in Figure 12, Clay
County’s rate of deaths from strokes remained stable from 1997-2003. There was little
difference in stroke deaths among racial groups in Clay County as shown in Figure 13.
Figure 12
Stroke Disease Death Rates, All Races, 1997-2003
100.0
80.0
60.0
40.0
20.0
0.0
Baker
Bradford
Clay
Nassau
Florida
1997-1999
82.8
69.9
68.7
66.9
50.2
1999-2001
73.1
68.8
66.3
65.4
48.8
2001-2003
62.8
58.1
62.6
68.3
44.7
Figure 13
Stroke Disease Death Rates By Race, 2001-2003
120.0
100.0
80.0
60.0
40.0
20.0
0.0
Baker
Bradford
C lay
N assau
Florida
All R aces
62.8
58.1
62.6
68.3
44.7
W hite
60.9
59.4
62.1
68.7
41.7
Non-W hite
73.4
54.2
67.5
67.4
73.8
13
Chronic Obstructive Pulmonary Disease (C.O.P.D.)
Chronic bronchitis, emphysema, and asthma all fall within the category of C.O.P.D. There was a
spike in C.O.P.D. death rates from 1999-2001 in Clay County, however the death rate declined
from 2001-2003 (Figure 14). C.O.P.D appears to disproportionately affect the white population
in Clay County, with death rates over twice as high than the non-white population (Figure 15).
Figure 14
C.O.P.D. Death Rates For All Races, 1997-2003
120.0
100.0
80.0
60.0
40.0
20.0
0.0
Baker
Bradford
Clay
Nassau
Florida
1997-1999
94.2
67.3
65.0
64.4
41.0
1999-2001
73.8
53.5
71.8
80.6
41.2
2001-2003
84.1
47.1
60.9
61.5
39.4
Figure 15
C.O.P.D. Death Rates By Race, 2001-2003
100.0
80.0
60.0
40.0
20.0
0.0
Baker
Bradford
Clay
Nassau
Florida
All Races
84.1
47.1
60.9
61.5
39.4
W hite
87.5
53.4
62.7
64.9
40.2
Non-W hite
46.1
0.0
27.1
27.9
27.0
14
Unintentional Injuries
Unintentional injuries include motor vehicle crashes, drowning, fires, fall, and other home and
recreation injuries. Unintentional injuries have shown a slight increase in Clay County from
1997-2003 (Figure 16). The white population in Clay County had over twice an many deaths
from unintentional injuries in comparison to the non-white population (Figure 17).
Figure 16
Unintentional Injuries Death Rates, All Races, 1997-2003
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
Baker
Bradford
Clay
Nassau
Florida
1997-1999
61.0
43.2
35.8
54.3
35.3
1999-2001
60.1
41.0
39.0
51.8
37.9
2001-2003
58.5
64.8
40.6
43.5
41.6
Figure 17
Unintentional Injuries Death Rates By Race, 2001-2003
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
Baker
Bradford
Clay
Nassau
Florida
All Races
58.5
64.8
40.6
43.5
41.6
W hite
59.4
69.9
43.4
46.0
43.5
N on-W hite
61.0
64.7
15.5
19.8
33.7
15
Motor Vehicle Accidents
Half of all unintentional injury deaths are due to motor vehicle crashes and motor vehicle
accidents. Age-adjusted motor vehicle accidents in Clay County showed a slight increase from
1997-2003 (Figure 18). The majority of deaths in Clay County were in the white population,
with very few deaths in the non-white population (Figure 19).
Figure 18
Motor Vehicle Accident Death Rates, All Races, 1997-2003
50.0
40.0
30.0
20.0
10.0
0.0
Baker
Bradford
Clay
Nassau
Florida
1997-1999
32.0
28.6
14.5
26.7
17.0
1999-2001
34.8
27.3
12.7
21.2
16.3
2001-2003
45.6
40.2
17.3
26.5
18.4
Figure 19
Motor Vehicle Accident Death Rates By Race, 2001-2003
50.0
40.0
30.0
20.0
10.0
0.0
Baker
Bradford
Clay
Nassau
Florida
All Races
45.6
40.2
17.3
26.5
18.4
W hite
45.7
43.7
18.9
28.5
19.0
50
38.7
2
6.9
17.2
Non-W hite
16
Diabetes
Diabetes is a chronic metabolic disease that affects millions of Americans and is the sixth
leading cause of death in the United States. Clay County’s age-adjusted death rate from diabetes
remained stable during the period from 1997 – 2003 (Figure 20). Clay County had a significantly
higher number of deaths from diabetes in the non-white population, with over double the number
of deaths than the white population (Figure 21).
Figure 20
Diabetes Disease Death Rates For All Races, 1997-2003
60.0
40.0
20.0
0.0
Baker
Bradford
Clay
Nassau
Florida
1997-1999
40.7
28.7
30.4
24.6
20.7
1999-2001
41.8
41.1
30.6
19.0
21.7
2001-2003
47.8
36.9
28.0
19.4
21.1
Figure 21
Diabetes Disease Death Rates By Race, 2001-2003
60.0
40.0
20.0
0.0
Baker
Bradford
Clay
Nassau
Florida
All Races
47.8
36.9
28.0
19.4
21.1
W hite
46.5
33.3
25.8
17.3
18.7
Non-W hite
54.9
64.6
58.7
43.6
45.8
17
Influenza and Pneumonia
Influenza and pneumonia deaths together constitute the seventh leading cause of death in the
United States. Figure 22 illustrates the trend in age-adjusted death rates from influenza and
pneumonia from 1997-2003. Clay County showed a slight decrease during this period of time.
The death rate from influenza and pneumonia was higher in the non-white population in Clay
County, as shown in Figure 23.
Figure 22
Influenza & Pneumonia Disease Death Rates, All Races, 1997-2003
50.0
40.0
30.0
20.0
10.0
0.0
Baker
Bradford
Clay
Nassau
Florida
1997-1999
42.8
40.5
22.2
32.6
18.8
1999-2001
35.5
43.8
23.3
30.7
15.6
2001-2003
48.8
29.1
18.7
25.2
14.1
Figure 23
Influenza & Pneumonia Disease Death Rates by Race, 2001-2003
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
Baker
Bradford
Clay
Nassau
Florida
All Races
48.8
29.1
18.7
25.2
14.1
W hite
47.1
27.6
18.0
26.1
13.6
Non-W hite
64.4
41.3
28.7
18.6
17.2
18
Alzheimer’s Disease
An estimated 4.5 million Americans have Alzheimer’s disease. Clay County showed a sharp
increase in the number of deaths from this disease during the period of time from 1997-2003
(Figure 24). Clay County has a higher number of nursing beds and assisted living facilities than
many of its surrounding counties, which may be a contributing factor. There were very few
deaths in the non-white population from Alzheimer’s disease in Clay County, as well as Florida,
Baker, Bradford and Nassau Counties, as shown in Figure 25.
Figure 24
Alzheimer’s Disease Death Rates, All Races, 1997-2003
40.0
30.0
20.0
10.0
0.0
Baker
Bradford
Clay
Nassau
Florida
1997-1999
16.7
14.1
15.7
16.1
10.0
1999-2001
9.9
27.7
37.5
22.7
15.1
2001-2003
29.3
24.9
39.3
18.4
17.0
Figure 25
Alzheimer’s Disease Death Rates By Race, 2001-2003
50.0
40.0
30.0
20.0
10.0
0.0
Baker
Bradford
Clay
Nassau
Florida
All Races
29.3
24.9
39.3
18.4
17.0
W hite
32.8
25.8
40.5
19.9
17.3
0.0
17.5
16.0
6.2
13.0
Non-W hite
19
Liver Disease
Among the numerous diseases that affect the liver, cirrhosis accounts for most of the cases of
liver disease and death associated with liver failure. As shown in Figure 26, death rates from
liver disease showed a slight increase in Clay County from 1997-2003. Liver disease appears to
disproportionately affect the white population in Clay County as shown in Figure 27.
Figure 26
Liver Disease And Cirrhosis Death Rates For All Races, 1997-2003
25.0
20.0
15.0
10.0
5.0
0.0
Baker
Bradford
C lay
Nassau
Florida
1997-1999
10.2
10.3
9.3
11.0
11.1
1999-2001
23.6
6.1
8.2
10.6
11.0
2001-2003
20.6
11.9
11.1
10.1
10.9
Figure 27
Liver Disease And Cirrhosis Death Rates By Race, 2001-2003
25.0
20.0
15.0
10.0
5.0
0.0
Baker
Bradford
Clay
Nassau
Florida
All Races
20.6
11.9
11.1
10.1
10.9
W hite
20.1
11.9
11.5
9.6
11.5
Non-W hite
22.0
16.2
6.4
17.9
7.5
20
II. INFECTIOUS DISEASES
HIV/AIDS represents the eleventh leading cause of death among Floridians. Clay County had a
significantly lower average rate of HIV and AIDS cases than Florida (Table 10). The number of
HIV and AIDS cases by race is not available in counties where the total number of cases are less
than three, due to confidentiality issues.
Table 10
AIDS And HIV Cases, 2001-2003
Area
Baker
Bradford
Clay
Nassau
Florida
HIV Cases
Average # of
Rate per
Cases
100,000
4.0
17.3
2.6
10.0
13.6
9.1
5.0
8.1
6,299.3
37.6
AIDS Cases
Average # of
Rate per 100,000
Cases
2.3
10.1
4.6
17.5
11.3
7.5
6.3
10.3
4,985.3
29.7
Sexually Transmitted Diseases
The Sexually Transmitted Disease (STD) rate in Clay County experienced an increase from
1997-2003 (Figure 28) however, still remains lower than the state’s rates for gonorrhea and
chlamydia as shown in Table 11.
Figure 28
Gonorrhea, Chlamydia & Infectious Syphilis Rates, All Races, 1997-2003
500.0
400.0
300.0
200.0
100.0
0.0
Baker
Bradford
Clay
Nassau
Florida
372.5
216.6
155.9
151.8
315.3
1999-2001
469
467.9
225.6
205.8
354.5
2001-2003
408.9
438.3
219.5
212.3
368.8
1997-1999
Table 11
Sexually Transmitted Diseases, All Races, 2001-2003
Gonorrhea
Area
Baker
Bradford
Clay
Nassau
Florida
Ave # of Cases
23.0
40.3
80.0
35.0
20,617.7
Chlamydia
Rate per 100,000 Ave # of Cases
99.7
71.3
151.5
76.3
53.0
250.3
56.9
95.7
122.9
40,688.3
21
Rate per 100,000
309.2
286.8
165.8
155.5
242.6
III. MATERNAL AND CHILD HEALTH
Birth Rate
Population growth in a community is a combination of natural increase (more births than deaths)
and migration (more people moving into the area than leaving).
The birth rate for Clay County was 13.0 births per 1,000 for all races, slightly higher than the
state’s rate of 12.4 births per 1,000 (Table 12). The rate of non-white births in Clay County was
16.0 births per 1,000 population, which was similar to state’s non-white birth rate of 17.7 births
per 1,000 population.
Table 12
Total Births and Birth Rates by Race, 2001-2003
All Races
White
Area
Ave
Rate
Ave
Rate
Number
Number
Baker
349
15.1
302
15.5
Bradford
296
11.1
233
11.3
Clay
1,968
13.0
1,715
12.7
Nassau
700
11.4
637
11.3
Florida 207,874
12.4
153,717
11.2
Nonwhite
Ave
Rate
Number
47
13.3
63
10.6
252
16.0
64
12.1
53,821
17.7
Female Population of Childbearing Age by Race
The percentage of women of childbearing age (15- 44 years) in Clay County represented
approximately 20 % of the total population as shown in Table 13. The majority of women of
childbearing age in Clay County were white (88%).
Table 13
Female Population of Childbearing Women Age 15-44 by Race, 2001-2003
Area
Total Childbearing
White
Black
Population
Ave
%
Ave
%
Ave
%
Number
Number
Number
Baker
4,682
20.0
4,058
86.7
586
12.5
Bradford
4,496
16.6
3,682
81.2
768
17.1
Clay
32,236
20.5
28,393
88.1
2,733
8.5
Nassau
12,237
19.3
11,122
90.8
982
8.0
Florida 3,310,435
19.3
2,571,422
77.7
638,128
19.3
22
Other
Ave
Number
38
46
1,121
133
100,885
%
0.8
1.0
3.5
1.1
3.0
Infant Mortality
Infant mortality includes the deaths of babies from birth to 364 days. The leading causes of
infant deaths in Florida were perinatal conditions, congenital anomalies, low birth weight, and
sudden infant death syndrome.
Infant mortality rates from 1997-2003 are provided in Figure 29. Clay County experienced a
decline in infant deaths during this period of time. As shown in Figure 30, Clay County had a
higher non-white infant mortality rate with comparison to the white population.
Figure 29
Infant Mortality Rates, All Races, 1997 – 2003
15.0
10.0
5.0
0.0
Baker
Bradford
Clay
Nassau
Florida
1997-1999
7.8
12.3
8.3
5.0
7.2
1999-2001
4.6
9.5
6.9
7.2
7.2
2001-2003
7.6
10.1
7.5
7.1
7.4
Figure 30
Infant Mortality Rates By Race, 2001-2003
15.0
10.0
5.0
0.0
Baker
Bradford
Clay
Nassau
Florida
All Races
7.6
10.1
7.5
7.1
7.4
White
7.7
10.0
6.6
6.8
5.7
Non-White
7.1
10.6
13.2
10.5
12.3
23
Low Birth Weight
Babies born less than five and a half pounds, or 2500 grams, in weight are termed "low birth
weight" births. The highest rates of these births occur to teen and minority mothers. These
vulnerable babies have an increased risk of morbidity and mortality and consume a
disproportionate share of health care resources during the first year of life and early childhood
years.
Clay County’s low birth rate remained stable from 1997– 2003 and was close to the state’s low
birthweight rate (Figure 31). Clay County’s low birthweight rate of non-white mothers was
slightly higher than white mothers (Figure 32).
Figure 31
Low Birthweights For All Races, 1997-2003
10.0
8.0
6.0
4.0
2.0
0.0
Baker
Bradford
Clay
Nassau
Florida
1997-1999
6.4
8.3
7.2
8.4
8.1
1999-2001
7.4
8.1
7.4
7.9
8.1
2001-2003
8.4
9.6
7.0
7.9
8.4
Figure 32
Low Birthweights By Race, 2001-2003
16.0
12.0
8.0
4.0
0.0
Baker
Bradford
Clay
Nassau
Florida
All Races
8.4
9.6
7.0
7.9
8.4
White
7.6
8.1
6.7
7.0
7.0
Non-White
13.6
14.8
9.5
16.8
12.3
24
Adolescent Births
Babies born to young mothers under the age of 18 are more likely to experience poor birth
outcomes than those born to older mothers. Birth outcomes are also closely tied to the education,
economic outlook, and family relationships of the mother. Births to teenage mothers in Clay
County showed a steady decrease from 1997-2003 (Figure 33). There was a higher rate of births
to non-white teenage mothers than white mothers in Clay County as shown in Figure 34.
Figure 33
Births To Mothers Under 18, All Races, 1997-2003
25.0
20.0
15.0
10.0
5.0
0.0
Baker
Bradford
Clay
Nassau
Florida
1997-1999
22.6
18.8
9.1
10.5
13.0
1999-2001
18.4
14.1
7.5
9.8
11.0
2001-2003
16.1
11.3
5.6
8.1
9.4
Figure 34
Births To Mothers Ages 15-17 By Race, 2001-2003
50.0
40.0
30.0
20.0
10.0
0.0
Baker
Bradford
Clay
Nassau
Florida
All Races
40.9
27.4
14.4
20.2
24.0
W hite
42.2
25.8
13.8
19.6
19.2
Non-W hite
33.8
33.1
19
26.1
37.8
25
Early Prenatal Care
Prenatal care begun during the first trimester of pregnancy can have a profound effect on birth
outcomes. Figure 35 illustrates the percentage of pregnancies receiving early prenatal care for
all races from 1997-2003. Clay County remained stable, exceeding the state. A higher percentage
of white mothers received early prenatal care in Clay County than non-white mothers (Figure
36).
Figure 35
Percent of Pregnancies Receiving First Trimester Prenatal Care, All Races, 1997-2003
100.0
90.0
80.0
70.0
60.0
50.0
Baker
Bradford
Clay
Nassau
Florida
1997-1999
85.3
82.8
89.8
90.5
83.8
1999-2001
86.1
82.1
89.1
91.2
83.9
2001-2003
86.2
82.1
90.0
90.8
85.1
Figure 36
Percent of Pregnancies Receiving First Trimester Prenatal Care By Race, 2001-2003
100.0
90.0
80.0
70.0
60.0
50.0
Baker
Bradford
Clay
Nassau
Florida
All Races
86.2
82.1
90.0
90.8
85.1
W hite
87.2
86.3
90.8
91.5
87.7
Non-W hite
79.5
66.3
84.5
82.9
77.8
26
Other Birth Risk Factors
It is estimated that at least 11% of women in the U.S. smoke during pregnancy. Smoking during
pregnancy can lead to complications and health problems in newborns. Smoking nearly doubles
woman’s risk of having a low birthweight baby. In Clay County, nearly 15% of births occurred
to mothers who smoked which was double the state’s percentage (Figure 37).
Figure 37
Births to Mothers Who Smoked During Pregnancy, All Races, 2001-2003
25.0
Percent
18.4
19.4
18.6
20.0
14.6
15.0
8.6
10.0
5.0
0.0
Baker
Bradford
Clay
Nassau
Florida
Note: Resident Live Births to Mothers Who Smoked During Pregnancy
IV. SOCIAL AND MENTAL HEALTH
Domestic Violence
Domestic violence is a widespread social problem that affects families on all socio-economic and
demographic levels. A high number of domestic violence offenses in a community can be used
as an indicator to estimate the number of persons in a population who may potentially have
serious mental illness conditions or substance abuse problems and are in need of mental health
treatment programs. Clay County showed a decrease in domestic violence from 2002- 2003, as
shown in Table 14.
Table 14
Domestic Violence Offenses, 2003
Total Domestic
Rate Per
Total
Violence
% Change
100,000
Rate Change
Area
Population
Offenses
2002-2003^
Population
2002-2003^
Baker
23,383
51
-22.7
218.1
-24.0
Bradford
26,972
169
-12.0
626.6
-13.5
Clay
156,011
902
-6.4
578.2
-10.1
Nassau
63,062
326
-34.5
517.0
-36.6
Florida
17,071,508
120,697
-0.9
707.0
-3.2
Note:^ Percent changes in the number and should be interpreted with caution, due the fact that in small counties, a
small increase in crime can produce a large percent change. Source: FDLE. Crime in Florida, Florida Uniform
Crime Report, Florida Statistical Analysis Center, 2003
27
Suicide
Suicide is a terrible potential outcome of mental illness and disorders such as panic, depression,
and schizophrenia. Clay County showed a slight increase in suicide rates between 1997-2003
(Figure 38). There were no deaths in the non-white population (Figure 39).
Figure 38
Suicide Death Rates, All Races, 1997-2003
25.0
20.0
15.0
10.0
5.0
0.0
Baker
Bradford
Clay
Nassau
Florida
1997-1999
8.1
20.1
15.0
12.4
13.1
1999-2001
12.0
6.4
14.8
10.7
12.8
2001-2003
12.7
9.5
16.6
14.7
13.1
Figure 39
Suicide Death Rates by Race, 2001-2003
20.0
15.0
10.0
5.0
0.0
Baker
Bradford
Clay
Nassau
Florida
All Races
12.7
9.5
16.6
14.7
13.1
W hite
15.0
10.8
18.2
14.9
14.7
0.0
3.6
0
14.1
4.7
Non-W hite
28
Adolescent Substance Abuse
Teen-age drinking and drug use is a growing concern in many counties throughout Florida, as
well as the nation. In 2004, 20% of all arrests in Clay County from drug offenses were among
juveniles with comparison to 9% statewide. In addition, Clay County had a higher percentage of
youth liquor law violations than Florida, with 22% of total arrests from juveniles compared to
only 4% in the state. Table 15 summarizes the total arrests from drug and alcohol related
offenses in Clay County and Florida for juveniles and adults.
Table 15
Arrests by Offenses, 2004
Offenses
Clay County Offenses
Drug Arrests
Driving Under Influence (DUI)
Liquor Law Violations
Juvenile Arrests
Number
Percent
Total Arrested
577
295
65
Florida Offenses
Drug Arrests
150,334
Driving Under Influence (DUI) 55,805
Liquor Law Violations
35,692
Adult Arrests
Number
Percent
113
3
14
20%
1%
22%
464
292
51
80%
99%
78%
14,134
480
1,419
9%
0.1%
4%
136,200
55,325
34,273
91%
99%
96%
Source: Office of the Sheriff, Clay County, Annual Arrests Report, 2004
Florida Department of Law Enforcement, Crime in Florida, 2004 Florida Uniform Crime Report
The Florida Youth Substance Abuse Survey (FYSAS) is an annual, statewide school-based
survey effort that measures the prevalence of alcohol, tobacco and other drug use and delinquent
behaviors as well as the risk and protective factors related to these behaviors. The 2004 FYSAS
was administered to 1,112 Clay County students in grades 6 – 12 in the spring of 2004. Key
findings revealed that alcohol was the most commonly used drug among Clay County students.
The Executive Summary of this report is included as Appendix A-1. A full copy of Clay’s report
can be found at http://www.dcf.state.fl.us/mentalhealth/publications/fysas/county04/clay04.pdf
V. BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY
The Centers for Disease Control and Prevention began the Behavior Risk Factor Surveillance
System Survey (BRFSS) in the early 1980’s in a handful of states and today, all states participate
in the survey.
BRFSS data have been widely used to monitor health behavior and health status at the state and
national levels, however, due to small sample sizes, statewide BRFSS results cannot provide
accurate and reliable data at the county level for public health program planning and evaluation.
Therefore, with support from county health departments and other health agencies, the Florida
Bureau of Epidemiology designed and implemented the county BRFSS to provide data on
behavioral risk factors and chronic disease conditions for every one of Florida’s 67 counties.
29
The 2002 County Behavior Risk Factor Surveillance System Survey (BRFSS) was conducted in
September 2002 through January 2003. Approximately 500 adults (age 18 and older) were
randomly selected and interviewed in each county. The purpose of this telephone survey was to
obtain county-level estimates of the prevalence of personal health behaviors that contribute to
morbidity and mortality.
Data obtained from the BRFSS county report can be used to make comparisons between counties
and the state overall on a variety of health-related issues. Data can also be used to: (1) prioritize
health issues and identify populations at highest risk for illness, disability, and death; (2) plan
and evaluate prevention programs; (3) educate the community and policy makers about disease
prevention; (4) support community policies that promote health and prevent disease.
A summary of the 2002 County BRFSS is provided as Appendix A-2. Clay County is compared
the state, as well as other surrounding counties in the area including Baker, Bradford and Nassau
Counties. A full copy of the report can be found on the Bureau of Epidemiology’s website at
http://www.doh.state.fl.us/disease_ctrl/epi/index.html.
Some of the findings from Clay County revealed poor health behaviors among its residents.
Nearly 35% of Clay County residents reported being overweight and 26% reported being obese.
In addition, 26% reported that they did not engage in any leisure time physical activity, while
over half reported they did not engage in any regular moderate exercise. Another 23% reported
that they were current smokers.
30
ACCESS TO CARE/HEALTH CARE RESOURCES
I. INTRODUCTION
Access to health care is the key to achieving a healthy community and is a primary goal of health
policy in Florida. This section will review health coverage of Clay County residents, health care
providers practicing in the county, as well as review health care facilities and licensed health care
services and other community resources in Clay County.
II. HEALTH COVERAGE
Very few individuals have the means to pay the full cost of health care services. The majority of
individuals rely on insurance coverage to spread the risk and financial cost of treatment. Most
have health coverage through an employer (their own or their spouse's) or receive benefits
through Medicaid or Medicare. Among the uninsured are full-and part-time employees whose
employers do not offer health insurance benefits, low-income persons who do not qualify for
Medicaid, early retirees, and numerous others who simply cannot afford the costly premiums of
adequate coverage. Uninsured persons experience reduced access to health care and are less
likely to have a regular source of care or use preventive services. As a result, uninsured are more
likely to require both avoidable hospitalizations and emergency hospital care.
According to the 2004 Florida Health Insurance Study, the geographic area that includes Clay
County had a total uninsured rate of 20.7%, an increase from 18.9% in the 1999 Florida Health
Insurance Study.
A listing of health insurance coverage by major providers can be found in Table 16. These
figures represent enrollments in Medicare, Medicare HMO, Medicaid, Medicaid HMO, and
Commercial HMO insurance programs. Significant numbers of insured residents are not reported
because commercial insurance enrollment figures are not available and the number of employees
covered by self insurance is unknown.
Table 16
Health Insurance Coverage, 2004
Percent of Population by Type of Health Coverage
*Medicare
Medicare HMO
Medicaid
Medicaid HMO Commercial HMO
2003
Area Population Enrollment % Enrollment % Enrollment % Enrollment % Enrollment
%
Clay
9,691
157,325
17,752 11.2
18
0.01
6.2
0
0
28,278
18.0
Florida 17,134,945
2,920,971 17.1 551,025
3.2 2,144,417 12.5 755,332 4.4 2,404,001
14.0
* Medicare Enrollment, Centers for Medicare & Medical Services (CMS) as of July 1, 2003
Source: Department of Insurance Quarterly HMO Enrollment Reports and AHCA Monthly Medicaid Enrollment
Reports as of December 31, 2004
Clay County had a lower percentage of residents enrolled in Medicare and Medicaid with
comparison to the state. There are no Clay County residents enrolled in the Medicaid HMO and
very few in the Medicare HMO. Commercial HMO enrollment in Clay County was 18%,
exceeding the state’s enrollment at 14%.
31
Florida’s Medicaid program currently services over 2.1 million Floridians, with about half of
those being children and adolescents under the age of 21. While children are the bulk of the
beneficiaries, most of the costs arise from providing services to seniors, especially nursing home
care, and people with disabilities who have significant medical costs.
There are four categories of Medicaid eligibility for adults in Florida, which include low income
families, pregnant women, emergency medical assistance for non-citizens, and Medicaid for the
elderly and disabled. Eligibility for each of those programs is based on specific income criteria.
The number of Medicaid enrollees in Clay County increased by 36% during 2000-2004 while the
number of enrollees in the state increased by 21.5% (Table 17).
Table 17
Medicaid Enrollees, 2000-2004
2000
Area
Clay
Florida
7,111
1,734,389
Number of Medicaid Enrollees
2001
2002
2003
7,917
1,844,275
8,078
2,012,548
8,876
2,113,820
2004
9,691
2,106,951
2000-2004
% Change
36.3%
21.5%
Source: Agency for Health Care Administration, July enrollment figures for 2000 – 2004.
Federal government provisions for children’s health coverage include Medicaid and Title XXI of
the Social Security Act. The states use Title XXI block grants to fund child health care coverage
through an expansion of the Medicaid program, health insurance, or a combination of the two.
In Florida, the KidCare Act of 1997 expanded Medicaid eligibility and the Healthy Kids
Program, and initiated the MediKids program for children ages 0-5. The Healthy Kids program
provides medical coverage for children ages 5 up to 19 in households whose income is between
100 – 200% of the federal poverty level (FPL). Children’s Medical Services covers children
from birth through 18 who have special behavioral or physical health needs or chronic medical
conditions.
MediKids covers children age 1 –5 whose income is between 133-200% of the federal poverty
level. Medicaid is the fourth KidCare program for children birth though 18 years and eligibility
is based on the age of child and household income. Children less than age 1 are covered if the
household income is below 200% of FPL, children ages 1-5 if household income is less than
133% of FPL, and children ages 6 up to 19 if household income is below 100% of FPL.
32
KidCare enrollment figures for the four programs are provided in Table 18.
Table 18
KidCare Enrollment, 2005
Area
Healthy Kids
1,291
Clay
199,986
Florida
Source: Healthy Kids, as of February, 2005
*AHCA as of January 2005
KidCare Program Enrollment
CMS
MediKids
58
119
7,935
20,986
*Medicaid
5,972
1,211,658
Nationally, Medicare beneficiaries make up 14% of the population. In Florida, the percentage of
Medicare beneficiaries comprise 17% of the state’s population. Medicare provider coverage for
people age 65 or older, some people under the age of 65 with disabilities, and people with EndStage Renal Disease. Table 19 summarizes Medicare enrollment by county for aged and disabled
by hospital insurance (HI) and supplemental medical insurance (SMI).
Table 19
Medicare County Enrollment and Aged and Disabled Enrollment, 2003
Aged
Area
Clay
Florida
Disabled
Total
Aged & Disabled
HI
HI &/or
HI &/or
&/or
SMI
HI
SMI
HI
SMI
SMI
HI
SMI
SMI
15,021
14,983
14,459
2,731
2,731
2,732
17,752
17,714
16,831
2,558,145 2,545,289 2,482,092 362,826 362,627 329,160 2,920,971 2,907,916 2,811,252
Source: Medicare Enrollment, Centers for Medicare & Medicaid Services (CMS) as of July 1, 2003
Aged and Disabled Enrollment, Centers for Medicare & Medical Services (CMS), as of March, 2004
III. PRIMARY CARE
Primary care providers (PCP) give routine medical care for the diagnosis, treatment, and
prevention of common medical conditions. Primary care is the entry point into the health care
system for non-emergent services. PCPs refer patients requiring additional care to specialists for
treatment. In this way, primary care providers serve as gatekeepers for the health care system
and play an important role in the coordination of care in today's managed care environment.
Family practitioners, internists, pediatric and general medicine physicians, obstetricians and
gynecologists nurse midwives, physician assistants, and nurse practitioners are all considered
primary care providers. Additionally, public health nurses and school nurses provide primary
care services to designated populations.
The Department of Health and Human Services (HHS) considers a primary care physician-topopulation ratio of 1:3,500 persons adequate for most communities. In areas where more than
20% of the population lives in poverty, the ratio is increased to 3,000 persons per primary care
physician.
33
HHS uses physician/population ratios to determine Health Professional Shortage Areas (HSPA)
and eligibility for the development of federally funded primary care programs and placement of
National Health Service Corps personnel. Primary care HPSA designation is based on the
described ratio, the availability of care in nearby areas, infant mortality, birth rates, and poverty
level. Keystone Heights is the only area of Clay County that was given a primary care HPSA
designation, with a primary care physician-to-population ratio of 1:3,661.
IV. HEALTH CARE PROFESSIONALS
There are 63 family practice, general practice and internal medicine physicians in Clay County,
12 Ob/gyn’s and 17 pediatricians. Specialty physicians generally practice in the Orange Park
area at Orange Park Medical Center (OPMC). A summary of primary care and specialty care
providers is found at the beginning of “Clay County Health Resources” included as Appendix B.
Other health care professionals, including dentists and chiropractors, are also listed.
V. HEALTH CARE FACILITIES
Acute Care
Acute care hospitals play a key role in the delivery of health care services in a community. In
addition to providing traditional inpatient services, hospitals also provide extensive diagnostic
and treatment services on an outpatient basis.
The three hospitals located in or near Clay County are described below:
Orange Park Medical Center
Orange Park Medical Center (OPMC) is a 230 bed facility serving residents of Clay County,
West Jacksonville, Baker County and other areas in proximity to Orange Park.OPMC provides
broad service medical and surgical care for adults, geriatric, and oncology patients as well as
providing for patients who require cardiac monitoring, peritoneal dialysis or ventilator care.
OMPC features a Level II Emergency Department, Medical/Oncology Unit, Ortho-Surgical Unit
and departments of Telemetry, Pulmonary, Neurology and Intensive Care. Other areas of
specialization include a Cardiac Cath Lab and Urology Control Center.
OPMC also provides a wide range of outpatient services, including diagnostic testing, surgical
preparation and treatment programs, as well as rehabilitation. Other services include respiratory
care and diabetic education.
Kindred Hospital – North Florida
Kindred Hospital North Florida is a 60-bed acute care hospital located in Green Cove Springs
that offers a full range of services for long-term, catastrophically ill patients. As a regional
referral center, the hospital specializes in managing medically complex, resource-intensive
patients who require extended lengths of stay. Kindred Hospital North Florida delivers nearly all
levels of care, including intensive care. Specialized services offered include pulmonary services,
critical care, renal dialysis, cardiac telemetry, blood bank, laboratory, pharmacy, EKG,
34
radiology, nutritional support, speech, physical and occupational therapy, surgery, wound care
management, outpatient GI services and comprehensive outpatient ultrasound.
Naval Hospital- Jacksonville
Naval Hospital Jacksonville is a general medical and surgical hospital offering both inpatient and
outpatient care to active duty military men and women and their families as well as military
retirees and their families. Naval Hospital Jacksonville is located in Duval County on the banks
of the St Johns River, very close to the Clay County border. The hospital has the Navy's largest
Family Physician Training program and also provides internal medicine, surgery, obstetrics,
gynecology, psychiatry, radiology, opthamology, pediatrics, neurology, orthopedics and many
other specialty areas. The hospital also has an emergency room for all eligible beneficiaries.
Hospital Utilization
Many residents of Clay County receive hospital care at Orange Park Medical Center. Residents
living in the Keystone Heights, Green Cove Springs, Middleburg areas of Clay County must
travel a far distance to Orange Park for hospital care. As a result, many of these residents seek
care at hospitals in neighboring counties. A lack of public transportation in Clay County can
make this a barrier for many western residents who are geographically isolated.
Figure 40
Hospital Utilization of Clay County Residents, 2004
Shands Jax
4.5%
St Luke's
3.6%
Shands at UF
2.8%
All Others
9.8%
Memorial HospitalJax
4.4%
Baptist Medical
Center
9.6%
OPMC
53.8%
St Vincent's
11.5%
Source: AHCA Hospital Discharge Data Files, 2004
Note: Excludes discharges from Naval Hospital
Figure 40 shows the hospital utilization rates by Clay County residents in 2003. Of the 16,661
total inpatient discharges, over 50% of Clay County residents received inpatient care at Orange
Park Medical Center. Another 11.5% received care at St. Vincent’s Medical Center and 9.6% at
Baptist Medical Center, both facilities located in Duval County.
35
Table 20 illustrates Clay County’s top ten hospital discharges by diagnostic related groups
(DRGs) for adults. Normal deliveries lead the list, followed by psychoses and heart failure and
shock related conditions.
Table 20
Adult Discharges, Clay County Residents, 2004
Adult Top 10 DRG's (Adults age 18 and over)
Vaginal Delivery W/O Complicating Diagnoses
Psychoses
Heart Failure & Shock
Simple Pneumonia & Pleurisy With Complicating Conditions (CC)
Cesarean Section W/0 CC
Major Joint & Limb Reattach Procedures of Lower Extremity
Percutaneous Cardiovascular Procedure with Drug-Eluting Stent W/O AMI
Uterine & Adnexa Procedures for Non-Malignancy W/O CC
Chest Pain
Chronic Obstructive Pulmonary Disease (COPD)
Total Top 10 DRG’s
Total
1,029
773
463
438
399
368
359
357
343
339
4,868
% of Top
10 DRG's
21.1%
15.9%
9.5%
9.0%
8.2%
7.6%
7.4%
7.3%
7.0%
7.0%
100%
Source: AHCA Hospital Discharge Data Files, Calendar Year 2003
Table 21 illustrates the leading pediatric discharges in Clay County. Normal newborns lead the
list, accounting for 65% of the top 10 discharges.
Table 21
Pediatric Discharges, Clay County Residents, 2004
Pediatric Top 10 DRG's (Children age 0-17 years)
Normal Newborn
Neonate With Other Significant Problems
Full Term Neonate With Major Problems
Psychoses
Prematurity W/O Major Problems
Bronchitis & Asthma, 0-17 years
Vaginal Delivery Without Complicating Diagnosis
Esophagitis Gastrent & Misc Digest Disorders, Age 0-17
Neonates, Died or Transferred to Other Acute Care Facility
Prematurity With Major Problems
Total Top 10 DRG’s
Total
1,326
231
115
100
75
46
43
41
38
35
2,050
% of Top
10 DRG's
64.5%
11.2%
5.6%
4.9%
3.7%
2.2%
2.1%
2.0%
1.9%
1.7%
100%
Source: AHCA Hospital Discharge Data Files , Calendar Year 2003
Emergency Room Care
Local hospital emergency room utilization is a good indicator of the availability and accessibility
of area health care services. Many appropriate visits to an emergency room do not result in
36
hospital admissions. Figure 41 depicts the number of emergency room visits from Orange Park
Medical Center during 1997 – 2004.
Figure 41
Orange Park Medical Center, ER Visits, 1997-2004
60,000
N u m b er o f E R V isits
50,000
40,000
36,125
37,227
1997
1998
39,795
41,753
45,536
49,292
55,829
54,559
30,000
20,000
10,000
0
1999
2000
2001
2002
2003
2004
Source: AHCA Discharge Hospital Data, Calendar Year 2003
Figure 42 illustrates total inpatient hospital admissions and the number of hospital inpatient
admissions through the emergency room at Orange Park Medical Center from 1997-2004. The
number of total hospital inpatient admissions increased by 34% during this period of time. In
2004, 75% of total hospital inpatient admissions came through the emergency department.
Figure 42
Orange Park Medical Center Inpatient Hospital Admissions, 1997 – 2004
13,248
1 4 ,0 0 0
11,547
N um ber of A dm issions
1 2 ,0 0 0
1 0 ,0 0 0
11,001
10,175
9,896
10,998
7,228
8 ,0 0 0
6 ,0 0 0
5,572
5,836
10,672
7,372
11,130
9,968
8,325
8,685
6,668
4 ,0 0 0
2 ,0 0 0
0
1997
1998
1999
Total Inpatie nt Admis s ions
2000
2001
2002
2003
2004
Total Inpatie nt Admis s ions through ER
Source: AHCA Discharge Hospital Data, Calendar Year 2003
37
Long-Term Care
Long-term care is defined as "those services designed to provide diagnostic, preventive,
therapeutic, rehabilitative, supportive, and maintenance services for individuals who have
chronic physical and/or mental impairments, in a variety of settings ranging from home to
institutional settings, to ensure the quality of life."
Long-term care includes nursing home care. Medicaid is the primary funding source of nursing
home care, paying for 66% of all nursing home days. Medicaid typically pays for long-term care
while Medicare provides funding for short-term care following hospital discharge. Many
nursing homes limit the number of dedicated Medicaid beds in their facilities in order to control
the number of low-reimbursing, long-term Medicaid patients admitted.
Clay County has a ratio of 57.0 community nursing home beds per 1,000 residents age 65+,
exceeding Florida’s ration of 26.6 community nursing home beds per 1,000 residents. Table 22
summarizes the number of nursing home beds and occupancy rates of the nine facilities in Clay
County. Seven of the nine nursing homes are located in Orange Park. Occupancy rates are
rapidly approaching full capacity and no new beds will be approved until July 2006.
Table 22
Free Standing Community Nursing Homes, 2004
Licensed
Beds
120
Total
Census
Days
2004
39,397
Total
Census
Days
2000
38,105
Occupancy
Rate 2004
89.7%
Medicaid
Rate
2004
77.2%
Medicare
Rate
2004
11.1%
78.6%
14.3%
26.3%
74.2%
27.8%
17.8%
50.3%
47.4%
27.3%
26.9%
0.0%
0.0%
56.2%
26.6%
55.1%
21.2%
Facility Name
Doctors Lake of Orange Park
Governor's Creek Health and
Rehab (Green Cove Springs)
120
42,089
36,316
95.8%
Heartland Health Care Center –
Orange Park
120
39,089
38,977
89.0%
HQM of Orange Park
105
35,186
36,431
91.6%
Life Care Center at Wells
Crossing (Orange Park)
120
41,332
40,533
94.1%
Life Care Center of Orange Park
180
63,647
62,015
96.6%
Pavilion For Health Care (Penney
Farms)
40
13,630
11,469
93.1%
Tandem Health Care of Orange
Park
120
40,627
42,271
92.5%
The Terrace at Fleming Island *
(Orange Park)
108
Total
1,033
314,997
306,117
93.0%
Source: HPCNEF
Note: *Licensed January 18,2005
No Certificate of Need (CON) for additional nursing home beds shall be approved until 7-1-06
Assisted Living Facilities
Assisted Living Facilities (ALFs) provide a residential setting where a group of older or disabled
persons unable to live independently receive room, meals, and variety of personal supportive
services. ALF fees vary greatly depending on the location, amenities, size of the units and
38
services provided. Because neither Medicaid nor Medicare pays for ALF care, the vast majority
of ALF residents use private funds to pay for their care.
There are a total of nine ALFs in Clay County, including six in Orange Park (Absolutely
Assisted Living, Allegro at Fleming Island, Jabot’s Assisted Living, Quality Care of Florida,
Queen of Angels, and Village Oaks at Orange Park); one in Green Cove Spring (Magnolia
Manor); one in Keystone Heights (Park of Palms); and one in Middleburg (Pine Crest Manor).
VI. OTHER HEALTH CARE SERVICES
Appendix B includes a list of health care services and agencies in Clay County, including home
health, EMS, mental health, urgent care, and volunteer medical clinics.
39
40
COMMUNITY COMMENTS
I. FOCUS GROUPS
Introduction
In the Spring of 2005, the Health Planning Council of Northeast conducted six focus groups for the
Clay County health needs assessment. The purpose of these focus groups was to better understand
the views and opinions of Clay County residents about the quality of life in their community. This
report will outline the focus group methodology, demographics of participants as well as a summary
of key themes identified in the focus group discussions.
Focus Group Methodology
A set of questions was developed for the focus groups to explore how residents felt about the
quality of life in Clay County. The focus group instrument was used in similar health needs
assessments in surrounding counties. A copy of the focus group questions that were used are
included as Appendix C-1.
Focus groups were scheduled by staff at the Clay County Health Department and Health Planning
Council through the assistance of members from the Clay County Community Health Assessment
Task Force. Efforts were made to target existing groups that were already meeting throughout the
county.
Six focus groups were conducted from March – May of 2005. The size of the focus groups ranged
from 6 – 26 participants, with a total of 70 participants. A list of the focus group locations, as well
as the number of participants in each group is summarized below:
1.
2.
3.
4.
5.
6.
Clay Behavioral Health, Middleburg: 9 participants
Hispanic Group, Orange Park: 26 participants
Parent Group, Keystone Heights: 6 participants
Council on Aging, Green Cove Springs: 9 participants
Shepherd’s Center of Orange Park: 11 participants
Clay Hill Community Association, Clay Hill: 9 participants
Focus groups were moderated by a staff member from the Health Planning Council and handwritten
notes were taken during each of the groups to ensure that no comments were missed. Notes were
carefully reviewed to explore participants’ comments and discover whether similar concerns and
opinions were voiced by Clay County residents. A summary of common themes each of the focus
groups discussions is included in this section.
Demographics
The majority of focus group participants were female. Approximately 50% were non- white,
providing excellent representation from the minority community in the focus group discussions.
With regard to age, there was representation from each of the age groups. Over a third of the
participants worked full-time and nearly 30% were retirees.
41
The majority of participants reported having health insurance through their job or member’s job or
had Medicare. A large number of focus group participants from the Hispanic group reported not
having health insurance of any kind. More detailed demographic information is included below.
DEMOGRAPHICS OF FOCUS GROUP PARTICIPANTS
ZIP CODE
32068
32065
32073
32043
32003
32050
32656
Not Available
Total
Total Responses
16
11
17
13
3
1
6
3
70
Percent
22.9%
15.7%
24.3%
18.6%
4.3%
1.4%
8.6%
4.3%
100%
AGE GROUP
18 – 25
26 – 39
40 – 54
55 – 64
65 – 74
75+
Total
Total Responses
3
19
21
8
8
11
70
Percent
4.3%
27.1%
30.0%
11.4%
11.4%
15.7%
100%
GENDER
Male
Female
Total
Total Responses
23
47
70
Percent
32.9%
67.1%
100%
RACE/ETHNICITY
African American/Black
Asian/Pacific Islander
Caucasian/White
Hispanic/Latino
Native American
Mixed
Total
Total Responses
3
0
36
28
2
1
70
Percent
4.3%
0
51.4%
40.0%
2.9%
1.4%
100%
EMPLOYMENT STATUS
Working Full-Time
Working Part-Time
Student
Unemployed
Home Maker
Retired
Other (Please describe)
Total
Total Responses
25
6
0
11
7
20
1
70
Percent
35.7%
8.6%
0
15.7%
10.0%
28.6%
1.4%
100%
42
HOW IS HEALTH CARE COVERED: (check all that apply)
Health insurance offered from your job or a family member’s job
Health insurance you pay for on your own
Medicare
Medicaid
Veteran’s Administration
Military Coverage
I don’t have health insurance
Other
Total
Responses
27
9
17
4
3
5
22
2
Summary of Focus Group Discussions
A summary of each of the six focus group discussions is provided below:
Clay Behavioral Health, Middleburg
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Clay good place to raise kids, very good school system, but quality of schools depended on region of
the county
There aren’t enough activities for teenagers in Clay, but it is no different here than other counties
Teenage drinking is a problem
Schools need to offer more physical education and limit students being permitted to purchase
unhealthy snacks from vending machines
There are not enough corporate businesses and job opportunities in the county, must commute
outside Clay for work
Limited rental options in Middleburg
Mixed feelings about safety in the community, depended on participant’s specific neighborhoods
Lack of accessible public transportation in Clay County is a major issue for many participants in this
group
There is a need for teenage pregnancy crisis center in the community
People don’t know what resources are available in the community, but awareness is increasing about
the services at Clay Behavioral Health
Several participants felt there are very good doctors in Clay County
Majority of participants were uninsured and had no where to go for health care
Majority of participants go to Jacksonville for hospital care
Feel Clay County should have similar program for the uninsured as Shands Jacksonville,it is unfair
that Shands won’t accept them into their program because they are not Duval residents
Hispanic Group, Orange Park
•
•
•
•
•
•
Overall, Clay County is a good place to live, but the language barrier for Hispanics residents is a
major issue.
School system, county health department, Orange Park Medical Center, health care providers, and
city and government offices need to be more culturally sensitive to Spanish speaking residents; make
more of an effort to have bilingual staff and offer patient education materials in Spanish.
Many Hispanic residents are not aware of services and resources available in the community.
There needs to be improved collaboration among members of the Hispanic community with local
churches, schools, and the county health department.
Many Hispanics are unemployed and uninsured due to their immigration status.
Health care services and prescriptions are not affordable for many Hispanics, even for those who do
have health insurance.
43
Parent Group, Keystone Heights
•
•
•
•
•
•
Great place to raise children.
Long commute to work, but feel it is worth it because of the quality of life and great schools in
Keystone Heights
All participants go to Gainesville for all their health care needs – primary care, specialty care, and
hospital care (none use providers in Clay or go to OPMC).
“I would never want to live anywhere else!”
Feel the schools should do more health screenings, offer the students more PE.
Parents would like to have a community CPR class offered at the ball field.
Clay Hill Community Association
•
•
•
•
•
•
•
•
•
•
•
•
•
Overall, good place to raise a family
Good public school system in Clay County
Lack of public transportation a major concern; if their own cars are not functioning, they are
dependent on family or friends for assistance
Easy to find housing or assistance with housing
Concern about drugs in their community; some participants felt their neighborhoods were unsafe
Financial need is a major issue in this community; many residents of Clay Hill live “payday to
payday” due to minimum wage earning. Unable to afford health insurance even if it is offered by
their employer.
Several participants feel that the welfare system needs to be formed. Some have tried to apply for
Medicaid but felt they were unjustly disqualified, feel the government encourages people to quit
working and collect a check
Lack of affordable dental care services a major concern in this community
Many participants are concerned about improper drainage/flooding problems due to increased
development
Current road systems are inadequate to increasing population growth
Some participants would like to see another hospital open in Clay County, there is some distrust of
Orange Park Medical Center
Many parents in Clay Hill greatly rely on the school health program (screenings, shots, exams) for
their children due to lack of health care coverage
Group would like to see more parks and sidewalks in the Clay Hill area
Council on Aging, Green Cove Springs
•
•
•
•
•
•
•
•
Good place to raise a family.
Very safe, elder-friendly community.
COA provides a great deal of services and resources for the local elderly.
Overall, the COA’s van meets most of their transportation needs (with the exception of picking up
their medications at the pharmacy).
Churches help residents in the GCS community.
Majority have primary care physicians in GCS; all go to Orange Park or Jacksonville for specialists
or hospital care.
Many elderly weren’t aware of services available at health department
Transportation to pick up prescriptions is a frequent problem for eldery in Green Cove. Mayhugh’s
Pharmacy delivers, but has limited hours. Group interested in other prescription delivery services
that could be made available in GCS.
44
Shepherd’s Center of Orange Park
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Very good school system in Clay County.
Not enough activities for teenagers.
Concern that schools will become overcrowded with all the homes being built, the infrastructure
can’t support it.
Good place to grow old, this is a very friendly community.
Would like to see a multi-level care facility in Clay, similar to Cypress Village.
Overall, feel this is a very safe community.
Majority of participants were able to drive, so public transportation wasn’t an issue, but they were
very concerned about elderly who cannot drive as well as when they are no longer able to drive.
Heavy traffic in Orange Park is an ongoing problem, trying to walk to places can be dangerous,
recommended ‘walk-overs’ at busy intersections on Blanding.
Churches are a great resource in the community.
Several participants go to physicians outside the county while many have doctors in Clay.
Majority go to OPMC for hospital care—very satisfied with care they receive.
There are limited urgent care centers (after-hours centers) in the community.
Some participants reported getting their prescriptions from Canada to save on the cost of their
medications.
Several were military retirees and were very satisfied with their health care plan.
There was an interest in seeing an organic health food store or restaurant come to the area; strong
interest in alternative medicine (acupuncture, herbal medicines, etc).
Great deal of pride at the Shepherd’s Club, would like others in the community to know about the
resources they offer elderly.
II. COMMUNITY SURVEY
Survey Design and Distribution
The purpose of the survey was to capture the opinions and concerns from Clay County residents
about the health of their community. Existing community surveys were reviewed that incorporated
the MAPP Model (Mobilizing for Action through Planning and Partnerships). MAPP is a
community-wide strategic planning tool for improving community health and assists communities
prioritize public health issues and identify resources for addressing them. The Clay County Health
Department selected a MAPP survey that was used by other local communities during previous
needs assessments. The survey was then revised to specifically address the needs of Clay County. A
copy of the survey instrument in included as Appendix C-2.
Surveys were distributed throughout the county in February 2005 and continued to be circulated
through March 2005. Surveys were collected at the Clay County Fair, county health department
centers, local churches, Orange Park Medical Center, Clay County public offices, Chamber of
Commerce, Clay Electric, Wal-Mart, and local parks and churches. In addition, surveys were filled
out by elected officials, local community leaders and other Clay County residents. An online
version of the survey was advertised in the local newspapers and public libraries for those residents
with Internet access. A total of 1,116 surveys were collected and analyzed.
45
Demographics of Survey Respondents
The majority of the respondents who completed the surveys were females. Approximately 22% of
survey respondents were age between the ages of 26-39 and another 38% of respondents were
between the ages of 40-54, which represent the largest age groups of Clay County. Approximately
10% of survey respondents were over the age of 65, which matches Clay County’s elderly
population. 86% of survey respondents were white and 14% were non-white, which closely
matched Clay County’s population demographics of race (90% white, 10% non-white). With regard
to ethnicity, 4.5% of survey respondents were Hispanic, which closely matched the county’s
Hispanic population of 4.3%.
Geographically, there was a wide range of participants living throughout Clay County, including
good representation from Orange Park, Middleburg, Green Cove Springs and Keystone Heights.
Approximately 67% of participants were employed full-time and 4.4% reported being unemployed,
which closely matched the county’s unemployment rate of 4.2% in 2004. One-third reported having
a high school diploma or GED as their highest level of education completed and 23% reported
having a 4 year college degree. Another 19% reported household incomes under $20,000 and onethird reported household incomes between $50,000 - $99,000. A detailed summary of information
obtained from the demographic section of the survey is included in this report.
Survey Analysis
A total of 1,116 surveys were entered into an electronic database software program. Descriptive
statistics were used to summarize the survey questions and data tables with frequencies and
percentages are included in this section. A summary of all other written in comments by survey
respondents is included as Appendix C-3. The following section summarizes the top 5 selections for
Clay County residents.
1. How do you rate your overall health? (check one selection)
Clay County
Excellent
Good
Fair
Poor
Don’t Know
Total
Not Available
Total Responses
207
649
165
23
5
1,049
67
Percent (%)
19.7
61.9
15.7
2.2
0.5
100
2. Check up to 5 selections you feel are the most important features of a healthy community:
Top 5
Access to healthcare
Clean and healthy environment
Good education
Low crime rates/safe neighborhoods
Good place to raise kids
Total Responses
763
652
576
572
506
46
All other responses, based on the total number of responses for each category
Category
Access to churches or other places of worship
Good jobs, healthy economy
Access to parks and recreation
Affordable and/or available housing options
Preventative health care (annual check-ups)
Good place to grow old
Access to public transportation
Absence of discrimination
Quality child care
Access to social services
Available cultural events
Adequate handicapped parking/accommodations
Skipped This Question
Total Responses
498
476
351
286
250
171
160
142
141
134
97
87
15
3. Check up to 5 of the health problems that you feel are the most important in Clay County:
Top 5
Obesity
Cancers
Addiction – alcohol or drug
Heart disease and stroke
Smoking/tobacco use
Total Responses
543
450
433
374
360
All other responses, based on the total number of responses for each category
Category
Child abuse/neglect
High blood pressure
Diabetes
Domestic violence
Mental health problems
Teenage pregnancy
Motor vehicle crash injuries
Asthma
End of life care (nursing homes, hospice)
Respiratory/lung disease (COPD, emphysema)
Contagious diseases (flu, pneumonia)
HIV/AIDS/Sexually Transmitted Diseases
Dental problems
Rape/sexual assault
Environmental health, sewers, septic tanks
Firearm-related injuries
Suicide
Infant death/premature birth
Skipped This Question
Total Responses
308
293
280
260
225
221
191
188
184
176
171
171
164
91
85
34
33
24
28
4. Check up to 3 behaviors you are most concerned about in Clay County:
Top 5 Category
Being overweight
Alcohol abuse
Drug abuse
Lack of exercise
Tobacco use
Total Responses
474
439
407
333
329
47
All other responses, based on the total number of responses for each category
Category
Dropping out of school
Teen sexual activity
Unlicensed and/or unsafe drivers
Poor eating habits
Unsafe sex
Not using birth control
Not getting shots to prevent disease
Discrimination
Skipped This Question
Total Responses
308
269
245
237
144
86
81
80
17
5. What health care services are difficult to obtain in your community?
Top 5 Category
Emergency room care
Dental/oral care
Specialty MD care
Mental health/counseling
Substance abuse services (drug and alcohol)
Total Responses
343
232
228
223
208
All other responses, based on the total number of responses for each category
Category
Total Responses
Alternative therapy (herbals, acupuncture)
X-rays/mammograms
Inpatient hospital
Primary care (family doctor or walk-in clinic)
Prescriptions/medications/medical supplies
Lab work
Vision care
Preventative care (annual check-ups)
Physical therapy/rehab therapy
Family planning/birth control
OB/pregnancy care
Ambulance services
Chiropractic care
There are no health services difficult to obtain
205
187
159
155
131
138
125
123
96
94
67
50
48
259
6. How do you rate the quality of health services in Clay County?
Clay County
Excellent
Good
Fair
Poor
Don’t Know
Total
Not Available
Total Responses
54
571
349
64
51
1,089
27
Percent (%)
5%
52.4%
32%
5.9%
4.7%
100%
7. What do feel are barriers for you in getting healthcare?
Top 5 Barriers
Long wait for appointments
Lack of evening and week-end services
Can’t pay doctor/hospital visits
Can’t find providers that accept my insurance
Don’t know what types of services are available
Total Responses
408
347
281
197
160
48
All other responses, based on the total number of responses for each category
Other Barriers
Have no regular source of health care
Lack of transportation
Don’t like accepting government assistance
Afraid to have health check-up
Health care information is not kept confidential
None of these apply, I don’t have any barriers getting healthcare
Not available
Total Responses
108
103
44
37
35
310
30
8. When you need to use prescription medications for an illness, do you (check all that apply)
Category
Have your prescription filled at the drugstore or supermarket
Buy over-the-counter medicine instead
Go without medicine
Use herbal remedies instead
Use leftover medication prescribed for a different illness
Get medications from sources outside the country
Use medication of friends or family
Got to the hospital emergency room
Use pet medicines instead
Not Available
Total Responses
959
185
140
71
65
59
57
49
3
40
9. How is your health care covered? (check all that apply)
Category
Health insurance offered from your job or a family member’s job
I can’t afford health insurance
Military coverage/VA
Medicare
Health insurance that you pay for on your own
Medicaid
I don’t need health insurance (no health insurance coverage)
Other
Not Available
Total Responses
722
142
137
113
113
73
3
17
15
10. Where would you go if you are sick? (check one)
Total
Responses
774
103
89
54
43
37
1,100
16
Categories
Your doctor’s office
Hospital emergency room in Clay County
Hospital emergency room outside the county
The local health department
Other
No where – I don’t have a place to go when I get sick
Total
Not Available
49
Percent (%)
70.4%
9.4%
8.1%
4.9%
3.9%
3.4%
100%
11. Where would you go if your children/dependents are sick? (check one)
Total
Responses
641
179
79
67
38
31
7
1,044
72
Categories
Their doctor’s office
Don’t have children/dependents
Hospital emergency room in Clay County
Hospital emergency room outside the county
The local health department
Other
No where – we don’t have a place to go when we get sick
Total
Not Available
Percent (%)
61.4%
17.1%
7.6%
6.4%
3.6%
3%
0.7%
100%
DEMOGRAPHICS
CITY/TOWN
Clay Hill
Fleming Island
Doctor’s Inlet
Green Cove Springs
Middleburg
Orange Park
Keystone Heights
Lake Geneva
Penny Farms
Other
Total
Not Available
Number
9
50
9
216
244
380
160
4
6
10
1,088
28
Percent (%)
0.8%
4.6%
0.8%
19.9%
22.4%
34.9%
14.7%
0.4%
0.6%
0.9%
100%
AGE GROUPS
Less Than 18
18-25
26-39
40-54
55-64
65-74
75+
Total Respondents
Not Available
Total Responses
0
110
244
422
213
69
45
1,103
13
Percent (%)
0%
10%
22.1%
38.3%
19.3%
6.3%
4.1%
100%
GENDER
Female
Male
Total Respondents
Not Available
Total Responses
792
271
1,063
53
Percent (%)
74.5%
25.5%
100%
RACE/ETHNICITY
Black/African American
Hispanic
Native American
White/Caucasian
Asian/Pacific
Other
Total
Not Available
Total Responses
70
49
12
948
13
8
1,100
16
Percent (%)
6.4%
4.5%
1.1%
86.2%
1.2%
0.7%
100%
50
EDUCATION
Elementary/Middle School
High School Diploma or GED
Technical/Community College
4 Year College/Bachelor’s Degree
Graduate/Advanced Degree
Total Respondents
Not Available
Total Responses
34
377
266
252
164
1,093
23
Percent (%)
3.1%
34.5%
24.3%
23.1%
15%
100%
EMPLOYMENT STATUS
Employed Full-Time
Employed Part-Time
Unemployed
Retired
Home Maker
Student
Other
Total Respondents
Not Available
Total Responses
741
97
49
113
77
8
18
1,103
13
Percent (%)
67.2%
8.8%
4.4%
10.2%
7%
0.7%
1.6%
100%
HOUSEHOLD INCOME
Less Than $10,000
$10,000 - $20,000
$21,000 - $30,000
$31,000 - $50,000
$50,000 - $99,000
$100,000 or more
Total Respondents
Not Available
Total Responses
80
121
149
209
346
139
1,044
72
Percent (%)
7.7%
11.6%
14.3%
20%
33.1%
13.3%
100%
51
52
KEY ISSUES AND RECOMMENDATIONS
I. INTRODUCTION
The Clay County Health Assessment Task Force meetings were held from January – July of
2005 as part of the Clay County health needs assessment. Information provided in the previous
chapters of this report was presented to members of the Clay County Health Assessment Task
Force, including chronic disease death rates, infectious disease rates, and maternal and child
health indicators. In addition, hospital utilization data of Clay County residents was presented as
well as the availability of health resources and services in the county. Community input from
Clay County residents was obtained through focus groups and surveys.
The Clay County Health Assessment Task Force identified key health issues as a result of the
health assessment process. These included smoking, alcohol use/abuse, dental care availability,
access to mental health services, availability of health services in west and south Clay county,
availability of bi-lingual health services (Spanish) and obesity including the diseases that it
contributes to such as heart disease and diabetes.
II. KEY ISSUES/RECOMMENDATIONS
The Clay County Health Assessment Task Force identified key health issues which included
smoking, alcohol use/abuse, dental care availability, access to mental health services, availability
of health services in west and south Clay county, availability of bi-lingual health services
(Spanish) and obesity including the diseases that it contributes to such as heart disease and
diabetes. Task Force members then prioritized these issues and developed recommendations and
action steps. The task force believed these recommendations should be incorporated in the work
of existing community groups such as the Clay Action Coalition or the “Healthy Clay” initiative
and report on the progress of these recommendations through the Clay County Health
Department Director on a quarterly basis.
Recommendation 1: Reduce teen drug and alcohol use
Activity Steps
1) Develop community awareness campaign in order to change community
norms targeting both parents and teens.
• Seek grant funding/ county assistance in the development of
campaign.
• Partner with the schools, law enforcement, churches, health
professionals and community groups to disseminate awareness
campaign.
2) Encourage police to strongly enforce teen drinking violations.
3) Develop teen center/community center in Green Cove Springs (possibly
partner with the YMCA).
53
Referred to:
Clay Action Coalition
Clay Action Coalition
Clay Action Coalition
Recommendation 2: Reduce obesity and enhance chronic disease prevention
Activity Steps
Referred to:
1) Develop worksite wellness programs at businesses, schools
and the
Chamber of Commerce,
hospital in conjunction with the “Healthy Clay” initiative.
Orange Park Med.
Center
2) Provide safe recreational activities/parks for children in older, established County Govt.
neighborhoods.
Health Dept.
• Develop fact sheet of children’s recreational and sport activities
available in the county.
Healthy Clay, schools
• Distribute fact sheet thru Healthy Clay businesses, schools and
community groups.
3) Provide affordable fitness options as well as transportation to and from
YMCA
fitness centers.
Recommendation 3: Expand mental health services
Activity Steps
1) Form mental health task force to determine what services are available,
the capacity of these programs, gaps in services and referral processes.
2) Educate providers and community of resources available.
Referred to:
Clay Behavioral Health,
OPMC, NAS Hospital
Clay Behavioral Health,
OPMC
Recommendation 4: Improve access to health services in west and south Clay County.
Activity Steps
Referred to:
1) Expand mobile health services to rural areas of Clay County either
St. Vincent’s, Health
through a partnership with St. Vincent’s Mobile Health Ministry or the
Dept.
Clay County Health Dept.
2) Explore opportunity with Family Medical and Dental Centers to open a
Health Dept.
satellite federally qualified community health center in the target areas.
54
APPENDIX A-1
EXECUTIVE SUMMARY
T
he Florida Legislature’s 1999 Drug Control Summit recommended the establishment of an annual, multi-agencydirected, statewide school-based survey effort, combining several survey instruments, with specific variations in
odd and even years. The Florida Youth Substance Abuse Survey (FYSAS), one of these instruments and the focus
of this report, is administered to a county-level sample of students in even years, and a smaller statewide sample in odd
years.
The FYSAS is based on the Communities That Care® Youth Survey, developed from the nationally recognized work of
Dr. J. David Hawkins and Dr. Richard F. Catalano. It not only measures the prevalence of alcohol, tobacco and other
drug use and delinquent behavior, but also measures the risk and protective factors related to these behaviors.
The 2004 FYSAS was administered to 1,112 Clay County students in grades 6 through 12 in the spring of 2004. The
results supply a valuable source of information to help reduce and prevent the use of alcohol, tobacco and other drugs by
school-aged youth.
Key Survey Results
Strengths to Build on
•
Surveyed students reported a substantial reduction in past-30-day cigarette use. The rate dropped from 20.3% in
2000 to 14.5% in 2004.
•
No respondents reported past-30-day usage of heroin.
•
Relatively few students reported that they would be seen as “cool” by their peers if they drank alcohol regularly
(13.7%), smoked cigarettes (6.8%) or smoked marijuana (11.2%).
•
A substantial proportion of students indicated that it would be “wrong” or “very wrong” for someone their age to
smoke cigarettes (74.3%), smoke marijuana (78.7%) or use other illicit drugs (94.0%).
•
A majority of respondents reported that each of the following behaviors poses a “great risk” of harm: smoking a
pack or more of cigarettes per day (68.5%) and regular use of marijuana (63.8%).
•
Students reported a particularly low percentile score for one risk factor scale that is directly associated with
alcohol, tobacco and other drug use: Low Perceived Risks of Drug Use (37).
•
Prevalence rates for Carrying a Handgun (5.0%), Attempting to Steal a Vehicle (3.8%) and Taking a Handgun to
School (1.5%) are all 5.0% or less.
Opportunities for Improvement
•
With overall prevalence rates of 61.0% for lifetime use and 35.1% for past-30-day use, alcohol is the most
commonly used drug among Clay County students.
•
Binge drinking (defined as the consumption of five or more drinks in a row within the last two weeks) is more
prevalent than past-30-day tobacco, marijuana and other illicit drug use.
2004 Florida Youth Substance Abuse Survey - Clay County Report
APPENDIX A-2
Summary Report from 2002 County Behavior Risk Factor Surveillance System Survey
Bureau of Epidemiology, Florida Department of Health
The 2002 County Behavior Risk Factor Surveillance System Survey (BRFSS) was conducted in
September 2002 through January 2003. Approximately 500 adults were randomly selected and
interviewed in each county. The purpose of this telephone survey was to obtain county-level estimates of
the prevalence of personal health behaviors that contribute to morbidity and mortality. These estimates
might differ slightly from estimates obtained through the 2002 Florida State BRFSS because sampling
methods of the two surveys were different. Data in this report can be used to make comparisons between
counties and the state overall on a variety of health-related issues. These data can also be used to: (1)
prioritize health issues and identify populations at highest risk for illness, disability, and death; (2) plan
and evaluate prevention programs; (3) educate the community and policy makers about disease
prevention; (4) support community policies that promote health and prevent disease.
Area
Baker
Bradford
Clay
Nassau
Florida
Area
Baker
Bradford
Clay
Nassau
Florida
Population
22,259
26,088
140,814
57,663
15,982
Population Size and Health Status
Number of adults surveyed
Health Status is Fair or Poor
503
24.0%
573
20.3%
507
16.0%
503
18.4%
34,551
16.7%
No leisure time
physical activity
34.5%
32.5%
26.1%
25.2%
26.4%
Risk Factor: Physical Activity
No regular moderate
No regular vigorous
physical activity (1)
physical activity (2)
60.9%
81.9%
61.1%
79.7%
52.3%
72.4%
54.9%
79.0%
55.1%
75.6%
(1)
People who do not engage in regular moderate physical activity (at least 30 minutes a day and 5 days a week) or
regular vigorous physical activity (at least 20 minutes a day and 3 days a week).
(2)
People who do not engage in regular vigorous physical activity (at least 20 minutes a day and 3 days a week).
Area
Baker
Bradford
Clay
Nassau
Florida
(3)
Overweight (3)
30.8%
30.8%
35.1%
37.7%
35.1%
Risk Factor: Overweight and Nutrition
Obese (4)
Less than 5-A-Day (5)
25.5%
82.0%
30.7%
81.1%
25.8%
72.0%
26.9%
76.6%
22.3%
74.3%
People with a Body Mass Index (BMI) between 25 and 30.
People with a Body Mass Index (BMI) equal to or greater than 30.
(5)
People who consume less than 5 servings of fruits and vegetables a day.
(4)
APPENDIX A-2
Area
Baker
Bradford
Clay
Nassau
Florida
(6)
Risk Factor: Tobacco and Alcohol Use
Current Smoker (6)
Ever quit smoking in Engage in heavy or binge
the past 12 months
drinking (7)
29.2%
51.9%
13.4%
22.7%
48.7%
17.1%
23.2%
50.5%
14.7%
19.5%
57.0%
12.7%
17.6%
55.3%
16.4%
People who have smoked at least 100 cigarettes in their lifetimes and who also smoked some days or every day in
the past month.
(7)
People who have consumed 5+ drinks at one occasion in the past month (binge drinker) or men who have 2+
drinks every day or women who have 1+ drinks every day (heavy drinker).
Area
Baker
Bradford
Clay
Nassau
Florida
Area
Baker
Bradford
Clay
Nassau
Florida
Area
Baker
Bradford
Clay
Nassau
Florida
Risk Factor: Health Care Coverage and Access
No health care
No personal health
Unable to get medical
coverage
care provider
care in past 12 months
20.5%
18.7%
8.2%
19.7%
21.4%
10.1%
11.9%
18.4%
5.5%
18.1%
18.6%
8.2%
18.7%
23.9%
8.7%
Visit a dentist
within past year
60.2%
60.8%
67.2%
74.2%
70.2%
Oral Health
No teeth removed
39.6%
42.5%
56.1%
46.0%
46.7%
Had teeth cleaned within
past year
60.7%
56.5%
67.0%
67.0%
70.5%
Chronic Health Conditions: Hypertension and Weight Control
Had high blood
Now taking HBP
Received advice about
pressure (HBP)
medication, if had
weight in past year
HBP
31.7%
78.3%
16.4%
38.2%
69.4%
24.3%
25.4%
76.0%
20.9%
29.4%
65.9%
21.1%
27.7%
76.0%
21.1%
2
APPENDIX A-2
Area
Baker
Bradford
Clay
Nassau
Florida
Area
Baker
Bradford
Clay
Nassau
Florida
Area
Baker
Bradford
Clay
Nassau
Florida
Area
Baker
Bradford
Clay
Nassau
Florida
Chronic Health Conditions: High Cholesterol
Ever had blood
If yes, cholesterol
Blood cholesterol is high
cholesterol checked
checked in past 2
years
79.4%
91.8%
34.3%
81.2%
91.2%
31.1%
84.6%
90.0%
32.3%
84.6%
92.2%
39.2%
83.1%
91.8%
35.2%
Chronic Health Conditions: Asthma & Diabetes
Ever had asthma
If yes, still have
Have diabetes
asthma
13.6%
73.7%
15.4%
11.6%
67.6%
8.8%
12.8%
73.1%
6.0%
13.8%
81.4%
7.4%
10.7%
60.4%
8.2%
Chronic Health Cardiovascular Disease Prevention
Being advised by a health professional to…
Eat fewer higher fat
Eat more fruits and
Be more physically active
or cholesterol food
vegetables
23.0%
30.3%
26.9%
16.5%
22.4%
22.5%
20.8%
21.3%
25.8%
20.6%
26.2%
29.9%
21.0%
27.9%
28.0%
Preventive Health Behaviors: Annual Flu and One-Time Pneumonia Shot
Received flu shot
Received flu shot at
Ever had a pneumonia
within past 12
county health dept
shot
months
22.4%
4.4%
20.4%
29.9%
2.5%
20.6%
26.0%
1.1%
18.8%
23.7%
1.5%
18.6%
26.2%
1.2%
22.7%
3
APPENDIX A-2
Area
Baker
Bradford
Clay
Nassau
Florida
Area
Baker
Bradford
Clay
Nassau
Florida
Area
Baker
Bradford
Clay
Nassau
Florida
Preventive Health Behaviors: Mammograms & Pap Smear Tests
For women age 40+:
All adult Women:
All Adult Women:
Had mammogram
Ever had Pap smear
Had Pap smear test in
in past 2 years
test
past 2 years
68.0%
97.2%
77.9%
83.6%
94.8%
87.6%
84.0%
97.6%
87.7%
75.3%
97.0%
82.0%
79.0%
93.5%
82.2%
Preventive Health Behaviors: Colorectal Screening
For respondents 50 years and older…
Ever had blood stool Had blood stool test in Ever had sigmoidoscopy
test
past 2 years
45.0%
38.1%
60.4%
49.1%
30.1%
48.1%
36.8%
25.4%
52.2%
44.3%
32.9%
51.8%
44.4%
33.5%
52.6%
Preventive Health Behaviors: HIV/AIDS Tests
For respondents 64 years and younger…
Ever been
If yes, the test was
In the past 12 months, health
tested for HIV
done in the past 2
professional talked to you about
years
preventing sexually transmitted
diseases through condom use.
49.8%
66.9%
14.9%
47.7%
75.1%
15.8%
45.0%
59.5%
8.1%
42.4%
51.0%
12.3%
47.7%
65.6%
16.3%
4
APPENDIX B
CLAY COUNTY HEALTH RESOURCES
Family Practice
Al-Awady, Murchid, MD/ Luciano, Christina, MD
Alessandria, Marc, MD/ Thomas, William, MD
Bass, Rhonda, MD
Battle, Miguel, MD/ Nazario-Vidal, Uriel, MD
Bernard, Gary, MD (Pointe Medical Services,inc)
Bultman, Richard, MD/ Biggerstaff, James, MD/ Khadour, Luna, MD/ Sessions, Herman, MD
Boyd, Dale, MD
Castiel, Alberto, MD
Choisser, William, MD/ Rocha, Lilly, MD/ Harris, Gene, DO
Cruikshank, Barbara, MD/ Wilson, Kathleen, DO
Harris, Gene, DO/ Braeutigam, Kent, DO/ Goh, Benjamin,MD
Hardin, Micheal, DO
Garcia, Teddy MD
* Griffin, E. Rawson, MD
Javier, Agrapino, MD
Johnson-Bennett, Linda, MD
Mendhi, Mohammed, MD/ Parghi, Anjan, MD/ Thompson, William, MD
Moshiree, Massoud, MD/ Ruedas, Bethoven, MD
Patel, Jitendra, MD
Platt, George, MD/ Lloyd, Sharon, ARNP
Pulwers, Patricia, MD
Shekar, Jaya, MD
Schueler, Arthur, DO
Stephens, Hinson, MD
Tilak, Mel, MD/ Johnson, Jon, ARNP
Williston, Shaila, MD
Pediatrics
M. Hassan Aboushaar, MD/T.Michael Hardin DO /Lanie Willis, ARNP
Charles Dellinger, MD/Richard Gehret, MD/ * Shiree Sauer, MD/ Rhonda Woolwine, MD/ Dan Spearman, MD/ Khalil
Shelly Hall, MD/ Amy Garrett, MD/Susan Kugewicz, MD
Maria Mora, MD
Patricia Pulwers, MD
* Sue Tilak, MD/ Mel Tilak, MD
Maris Valdes, MD
* Clorinde Miller, MD/ Donna Richardson, ARNP
Internal Medicine
Arnold, John, MD/ Phillips, Charles, MD/ Stawara, Mark, MD/ Tew, Douglas, MD/ Bryner, Charles, MD
Bielawaski, Regina, MD/ Chesler, Jeffrey, MD/ Rocha, LillyMD
Delrosario, Eufrocina, MD/ Gatien, Lionel, DO/ Awan, Rasheed, DO/ Matias, Annabelle, MD
Juba, Daniel, MD/ Yasay, Leon, MD/ Ramey, Thomas, MD
Koe, Antionette, MD/ Koe, Robert, MD
Padmanabhan, J.MD
Pitocchi, Peter, MD
Porcelli, James, MD
* Pulwers, Jack, Jr. MD
*Salehi, Susan, MD
Mattingly, Larry DO
* Part-Time
APPENDIX B
Ob/Gyn
Bernard, Teresa, MD
Bridgewater, Richard, MD
Hyler, David MD
Krebs, Curtis, MD/ Lin, M., MD/ McCauley,R.A., MD/ Shah, Arjav, MD/ Powers, R.R., DO/ Jones, Sharron, ARNP/
Aultman, Kathi, MD/ Klima, Susan, ARNP/ Roberts, Sandra, ARNP (gyn only)
Wilson, Charles, MD
Roberts, Norma, MD
* Davis, Reginald, MD/ Groff, Catherine CNM
Redfearn, Mary, ARNP/ Blankle, Carlene ARNP
SPECIALTISTS
Anesthesiology
Campbell, Christopher, MD
King, Tiffany, MD
Miller, Deevid, MD
Valachovic, Anthony, MD
Zapp, John, MD/ Zapp, Mark, MD
Cardiology
* Ashchi, Majdi, DO, FACC, FCCP, FSCAI
Chow, Leon, MD
* Constantin, Jonathan, DO
Dajani, Omar, MD
Ramezani, H., MD, FACC
Taylor, Garry, MD
*Bednarzyk, Paul, MD
*Haery, Cameron, MD
*Khatib, Yazan, MD
*Leon, Carlos, MD
* Phillips, Ernest, MD
Waller, David, MD
Colon/ Rectal Surgery
* Fatemi, Amir, MD
Dermatology
* Brown, Robert, MD
Charneco, Dale, MD
Eaglstein, Fred, DO/ * Paley, Bruce, DO
O'Leary, Joan, MD
* Robins, Douglas, MD
* Schiavone, Frank, MD
* Shvartzman, Leonard, MD
Endocrinology & Metabolism
* Silva, Ricardo, MD
Gastroenterology
Madhok, Dinesh, MD
* Merrell, Dale, MD
APPENDIX B
General Surgery
Gilligan, Michael, MD
Stankard, Charles, MD
Hematology/ Oncology
Goldstein, Kenneth, MD
Marsland, Thomas, MD
Sylvester, Linda, MD
Trent, Kelly Ann, MD
Infectious Disease
Ionescu, Mihaela, MD
Nephrology
Michal, David, MD
Neurology
Spatola, Mark, MD
Dewey, Dennis, MD
Hudgins, Robert, MD, PA
* Maquera, Victor, MD/ * Nealis, James, MD
Optometry/ Ophthalmology
Bowden, Frank, MD/ Reed, Joanne, OD/ King, Colleen, OD
Blalock, Jeffrey, OD/ * Estrada, Miguel, OD/ * Taylor, Jamie OD
Brown, Nichole, OD
Donovan, John, MD/ Harris, C.M., MD/ Wilcox, John, MD/ Javier, Melanie, OD/ Green, David,OD
Hoffman, James, OD/ Abshire, Kyle, OD/ Nolan, Dana, OD/ Bowman, Christina, OD
Hite, Hilda, OD
Hunter, Gregory; OD
* Jones, Vernon, MD
Minesinger, James, OD (Keystone Heights)
Swinehart, Alan, OD
Orthopedic Surgery
Albert, Henry, MD
Cohen, Jack, DO
Hutton, Patrick, MD
Otolaryngology/ Otohinolaryngology (ENT)
Carreno, Octavio, MD
Fetchero, John, DO, PA
Mosberg, David, MD
* Ruggiero, Joseph, MD
Pain Management
* Florez, Gerardo, MD
Hunt, John, MD/ Trescot, Andrea, MD/ Rehman, Arkam, MD
Jacobs, William, MD
APPENDIX B
Physical Medicine & Rehabilitation
* Collier, Frantk R., MD
* Oteyza, Carlos, MD
Pham, Bao, DO
Smith, Lewis Alan, MD
* Tan, Jackson, MD
Plastic Surgery
* Ong, Francis, MD
Weiss, Eric, MD
Podiatry
*Concha, Jose, DPM
Efron, Barry, DPM
*Friedman, Michael, DPM/ * Greenhut, Steven, DPM
* Herbst, Bradley, DPM/ * Lapkowicz, Cara, DPM
* Johnson, Richard, DPM
*Lagoutaris, Emanuel, DPM/ *Lagoutaris, Efstratios, DPM
*Matey, Mark, DPM
* Militello, James, DPM
* Tellam, George, DPM
* Weed, Jerry, DPM
Psychiatry
Findley, Russel S., MD
Sushas, Joshi, MD
Larson, James, MD
* Martinez, Emanuel, MD
Boger, Patricia, PhD
Crane, Carole, PhD
Prewett, Nicholas, PhD
Pulmonology
Antonio-Miranda, Maria, MD
Millstone, Stuart, MD
Radiologist
Simmons, Dwelvin, MD
Wells, John, MD
Estner, Michael, MD
Rheumatology
Oza, Meera, MD
Urology
* Antar, Mohamed, MD
Blasser, Marc, MD
* Homra, Mark, MD
Kaelin, James, MD
* Marino, Rober, MD
McBroom, Stacy, MD
*Samara, David, MD
APPENDIX B
Vascular Surgery
Rifkin, Kerry, MD
OTHER HEALTH PROFESSIONALS
Dentists
Aiosa, Lori, DDS
Archambault, Gregory, DDS
Arias, Miguel, DDS
Batel, Steven, DDS
Boitet, Dayn, DDS
Brown, Andrew, DDS
*Bunyi, Daniel, DDS
Campbell, Jack, DDS
Caputa, Lewis, DDS
Cioffi, Gerald, DDS
Clark, Phillip, DDS
*Coleman, J.Rutledge, DDS
Crovatto, Steven, DDS/ Edwards, Megan, DDS
Elrod, Ken, DDS
Federico, Roland, DDS
Fraser, Maria, DDS
Fields, Robert, DDS
Haeussner, T.A., DDS/ Haeussner, T.D., DDS
Harrington, John, DDS
Hein, Elizabeth, DDS
Huaman, Kevin, DDS
Hudgins, Charles, DDS
Johns-Stoutamire, Laurie, DDS
Keller, Pamela, DDS
Klement, Betty, DDS
Lessig, Margaret, DDS
Linder, Jerry, DDS
Lindhardt, Vagn, DDS
Macleod, Peter, DDS
Mahajan, Jila, DDS
Mapp, Stephanie, DDS
Martinez, Elaine, DDS
Mate, Shannon, DDS
McCabe, John, DDS
*Myers, Donnie, DDS/ Myers, Gary, DDS
Nipper, William, DDS
O'Brien, David, DDS
Patel, Bhari, DDS
Patel, Rashmikant, DDS
*Patel, Niatel, DDS
Pearson, Marilyn, DDS/ Pearson, Richard, DDS
Peden, John, DDS
Prieto, Jeffrey, DDS
Ramsey, Thomas, DDS
Roessler, DDS
Rosenblum, Robert, DDS
Santiago, Carlos, DDS
APPENDIX B
Dentists (Cont'd)
Scales, Douglas, DDS
Scarlett, Gary, DDS
Sevetz, Edward, DDS
Sherman, Micheal, DDS
Single, Jason, DDS
Skaggs, Danny, DDS
Small, Larry, DDS
Standish, Curtis, DDS
Stratton, Michael, DDS
Verville, John, DDS
Weaver, Gerald, DDS
Young, Kirk, DDS
Chiropractors
Allen, Iris Cynthia
Baird, Thomas W
Brunson, Leslie
Buchanan, Michael
Burke, Kristen T
Dautel, James
Fiore, Tim
Garver, Gordon
Hutchinson, Bob
Monahan, Marty
Moore, John
Musa, Joseph
Musa, Mary Ann
Morris, Clifford
Nickels, Steven
Orlando, Jason
Rosenstein, Scott
Schertell, Keith
Smith, Anthony
Starkey, Beth
Starkey, David B.
Stone, Clifford
Towns, J.L.
Tuller, Richard
Yapp, William
Zivkovic, Annette
Zivkovic, Robert
APPENDIX B
HEALTH CARE FACILITES/SERVICES
Home Health Agencies
Alliance Care
Apria Healthcare
Atkinson's Home Health Care
Baycare Home Care
Community Hospice of Northeast FL
Family Life Care, Inc.
Florida First Care D-4
Florida Palliative Home Care
Grannies Nannies, Inc.
Home Instead Senior Care
Interin Healthcare
Kelly Home Care Servoices
Nursefinders
Total Patient Care Home Health
Welcome Homecare
EMS
Advanced Patient Transportation
Clay County Fire Rescue
Hospice
Northeast FL Community Hospice
Rural Health Clinics
Village Doctors, Keystone Heights
Family Medical and Dental Clinc, Keystone Heights
Federally Qualified Health Center (FQHC)
Family Medical and Dental Centers, Keystone Heights
Volunteer Medical Clinics (Indigent/ free care)
We Care Clinic
Volunteers in Medicine (only Clay residents who work in Duval)
St. Vincent's Mobile Van
Mental Health & Substance Abuse
Clay Behavioral Health Center (Outpatient)
Harris, Hope, PhD (Outpatient)
Center for Psychological Services (Outpatient)
Psychiatric Associates (Outpatient)
Presett J Nicholas PhD & Associates (Outpatient)
Rickerson Lee C Eds LMHC (Outpatient)
Orange Park Medical Center (Inpatient)
Ambulatory Surgical Care Centers
Clay Surgery Center
Orange Park Surgery Center
APPENDIX B
Urgent Care Centers
Clay Primary and Family Care Center
Garcia, Teddy, MD
Magnolia Urgent Care
Meadowlands
Solantic
Renal Dialysis Units
Fresenius Medical Center/ Orange Park Kidney Center
Northeast FL Dialysis Center
Adult Day Care Centers
Clay County Council on Aging, Inc.
Magnolia Manor- Kauna Vacation Club
Physical Therapy Centers
Apex Physical Therapy
Baptist Rehabilitation Services
Brooks Rehabilitation Services
Brooks Rehabilitation Outpatient Clinic
Clay Physical Therapy
Cora Rehabilitation Clinic
Healthex Physical Therapy
Healthsouth
Heartland Fleming Island Therapy
Heartland MCR Rehabilitation
Orange Park Medical Center Outpatient Rehabilitation
Physical Therapy and Rehab Clinic
Progressive Step
St. Vincent's Outpatient Rehabilitation and Sports Medicine
The Pain Center
APPENDIX C-1
Clay County
Focus Group Questions
1.
In general, are you satisfied with the quality of life in your community for yourself?
A. Is this a good place to raise children?
a. School quality
b. Day care
c. After school care
d. Recreation
e. Environment
B. Is this community a good place to grow old?
a. Elder friendly housing
b. Transportation
c. Churches
d. Shopping
e. Elder day care
f. Social support organizations and agencies
g. Services and activities
C. Do you feel there is economic opportunity in the community?
a. Locally owned and operated businesses
b. Jobs with career growth and job training
c. Higher education opportunities
d. Affordable housing options
e. Reasonable commute
2.
Do you feel your community is a safe place to live?
a. Safety in the home
b. Workplace
c. Schools and playgrounds
d. Parks
e. Do the neighbors know each other and look out for one another…
3.
Do you believe there is a network of support for individuals and families during times of
stress and need?
a. Medical crisis
b. Mental health and substance abuse
c. Pregnancy
d. Financial
e. Death
f. Services for children with special needs
APPENDIX C-1
4.
Are you satisfied with the health care system in your community?
a. Cost
b. Quality
c. Options
d. Prescription drugs
5.
Are there health services you need that are not available to you?
6.
Are you aware of the public health services that are available in Clay County?
(i.e. Clay County Health Department)
7. What do you see as the school’s role in health?
8. If you could create any type(s) of “health program(s)” for Clay County residents what would
it/they be?
APPENDIX C-2
HOW HEALTHY IS CLAY COUNTY?
The Clay County Community Health Assessment Task Force needs your help in better understanding the community’s
health. Please fill out this survey to share your opinions about healthcare services and the quality of life in Clay County.
The survey results will be presented to the community and made available to the public. The information gathered from
responses to this survey will help make Clay County a better place to live.
1. How do you rate your overall health? (check one selection)
† Excellent
† Good
† Fair
† Poor
† Don’t Know
2. Check up to 5 selections you feel are the most important features of a healthy community:
†Access to churches or other places of worship
†Good place to raise kids
†Access to healthcare
†Good jobs, healthy economy
†Access to parks and recreation
†Good education
†Access to public transportation
†Low crime rates/safe neighborhoods
†Affordable and/or available housing options
†Preventative health care (annual check-ups)
†Available arts and cultural events
†Quality child care
†Clean and healthy environment
†Access to social services
†Absence of discrimination
†Good place to grow old
†Adequate handicapped parking/accommodations
†Other______________________________
3. Check up to 5 of the health problems you feel are the most important in Clay County:
†Asthma
†Addiction – alcohol or drug
† Respiratory/ lung disease (COPD, emphysema)
†Mental health problems
†Cancers
†Child abuse/neglect
†Contagious diseases (i.e. flu, pneumonia)
†Teenage pregnancy
†Diabetes
†Firearm-related injuries
†Heart disease & stroke
†Domestic violence
†HIV/ AIDS/Sexually Transmitted Diseases
†Infant death/ premature birth
†Obesity
† End of life care (nursing homes, hospice)
†High blood pressure
†Environmental health, sewers, septic tanks
†Smoking/tobacco use
†Motor vehicle crash injuries
†Dental problems
†Suicide
†Rape/sexual assault
†Other___________________________
4. Check up to 3 unhealthy behaviors you are most concerned about in Clay County:
†Alcohol abuse
†Lack of exercise
†Tobacco use (i.e. cigarettes, cigars,
†Being overweight
†Not getting “shots” to prevent disease
chewing tobacco)
†Dropping out of school
†Not using birth control
†Unlicensed and/or unsafe drivers
†Drug abuse
†Discrimination
†Unsafe sex
†Poor eating habits
†Teen sexual activity
†Other_________________________
5. What health care services are difficult to obtain in your community? (check all that apply):
† Alternative therapy (herbals, acupuncture)
†Physical therapy, rehab therapy
† Ambulance services
†Prescriptions/medications/medical supplies
†Chiropractic care
†Preventive care (ex. annual check-ups)
†Dental/oral care
†Primary care (family doctor or walk-in clinic)
†Emergency room care
†Specialty M. D. care (ex. heart doctor)
†Family planning/birth control
†Substance abuse services-drug and alcohol
†Inpatient hospital
†Vision care
†Lab work
†X-rays/mammograms
†Mental health/counseling
† Other __________________________
† OB/pregnancy care
6. How do you rate the quality of health services in Clay County?
† Excellent
† Good
† Fair
† Poor
† Don’t Know
TURN OVER
APPENDIX C-2
7. What do you feel are barriers for you in getting healthcare? (check all that apply):
____ Lack of transportation
____ Have no regular source of healthcare
____ Can’t pay for doctor/hospital visits
____ Lack of evening and week-end services
____ Can’t find providers that accept my insurance
____ Afraid to have health check-up
____ Don’t know what types of services are available
____ Long waits for appointments
____ Don’t like accepting government assistance
____ Healthcare information is not kept confidential
____ None of these apply, I don’t have any barriers in getting healthcare
8. When you need to use prescription medications for an illness, do you…(check all that apply)
† Have your prescription filled at the drugstore or supermarket
† Go without medicine
† Buy over-the-counter medicine instead
† Use medication of friends or family
† Use leftover medication prescribed for a different illness
† Use herbal remedies instead
† Get medications from sources outside the country
† Use pet medicines instead
† Go to the hospital emergency room
9. How is your health care covered? (check all that apply)
† Health insurance offered from your job or a family member’s job
† Health insurance that you pay for on your own
† I don’t need health insurance (no health insurance coverage)
† I can’t afford health insurance
† Medicare
† Medicaid
† Military Coverage/VA
† Other:_______________
10. Where would you go if you are sick? (check one selection)
† Hospital emergency room in Clay County
† Your doctor’s office
† Hospital emergency room outside the county
† The local health department
† No where—I don’t have a place to go when I get sick
† Other _____________________
11. Where would you go if your children/dependents are sick? (check one selection)
† Hospital emergency room in Clay County
† Their doctor’s office
† Hospital emergency room outside the county
† The local health department
† No where-we don’t have a place to go when we get sick
† A school clinic
† Don’t have children/dependents
†Other_______________________
12. Name of city/town where you live:________________________
13. Age:
14. Gender:
† less than 18
† Female
†18-25
†26-39
† 40-54
Zip Code: ______________
† 55-64
† 65 –74
† 75+
† Male
15. Race/Ethnicity: Which group do you most identify with? (check one selection)
†Black/African American
†Hispanic
†Native American
†White/Caucasian
†Asian/Pacific
†Other (Please describe)________________
16. Education: Please check the highest level completed: (check one selection)
† Elementary/Middle School
† Technical/Community College
† Graduate/Advanced Degree
† High school diploma or GED
† 4 year College/Bachelor’s degree
17. Employment Status: (check one selection)
†Employed Full-Time
† Employed Part-Time
†Retired
† Home Maker
18. Household Income: (check one selection)
†Less than $10,000
†$21,000 to $30,000
†$10,000 to $20,000
†$31,000 to $50,000
† Unemployed
† Student
†Other_________________
†$50,000 – $99,000
†$100,000 or more
THANK YOU FOR COMPLETING THIS SURVEY!
APPENDIX C-3
Clay County
Survey Results- Other Comments
2. Check up to 5 selections you feel are the most important features of a healthy community:
Other Comments
Responsible parents
Access to outdoors
Promoting/celebrating diversity
Affordable health care
Green belts, nature preserves
Access to affordable mental health and substance abuse treatment (3)
Organic food choices at Publix
Jobs that allow time to exercise
Better water drainage to prevent mold, bacteria, and insects
Get rid of “good old boy” mentality
Community Intervention Treatment (CIT) in the Sheriff’s Dept, reinstating the position of mental
health liaison in Sheriff’s office
Psychosensitive work programs
Lower taxes than surrounding areas
Less crowding in houses and businesses
Good restaurants versus fast food
3. Check up to 5 of the health problems that you feel are the most important in Clay County:
Other Comments
Housing – shelters
Sex offenders
Renal disease
Senior citizens
Chicken fleas from influx of farm animals in neighborhoods
Lack of good quality hospitals
High lung cancer rate
Independent living
Programs for learning disabled kids
Affordable health care for everyone
Pain management
Automobile insurance is very lax in Clay County
We need a place for children who are neglected or abused to go
Child/teen inactivity
Allergies
Trash on highways and yards of homes
No in home help for disabled who are not elderly
Respiratory problems caused by burning of yard material, household trash
I have no idea about the rates of occurrence of the above problems except what I can see
APPENDIX C-3
4. Check up to 3 behaviors you are most concerned about in Clay County:
Other Comments
Sexual Offenders
Acceptance of mean-spirited behaviors towards one another, especially the kids
Misinformation
Too much drive time
No sidewalks where you can walk safely
Not going to the doctor
Over development without proper planning for transportation
Using jails to house persons with mental illness (2)
Underage drinking
5. What health care services are difficult to obtain in your community?
Other Comments
Affordable health care/insurance (11)
All services are far away from the rapid growth we are having
Driver Training
Hospice care (3)
Elderly care (2)
Quality hospital care
A new hospital (1)
Better service hospital (2)
Getting heart checked
Pain management
HIV care
A new hospital
Services are not used
Long wait to see doctor
South of Orange Park-need all types of services
Everything is for the poor or uninsured working class
Disabled services
Dermatologist (2)
Pediatrician
Distance of services—everything is in Orange Park
Financial aid for need families
Transportation
Well care/life skills
Affordable dental care (2)
Homebirth midwife
Emergency mental health care
Reliable, trustworthy doctors and hospitals that are not just wanting to make money
Good family practitioner
Decent responsive emergency service—should be able to be transported to hospital of
choice
Endocrine care
Good emergency room care
Baker Act Facility
You get what you pay for
Heart surgery --other than choices in Clay county (2)
APPENDIX C-3
No problems obtaining prescriptions, medical supplies if you have insurance
Transportation to health appointments (2)
Community transportation for elderly
Access, transportation, quality and choice are limited at best
Case management for persons with mental illness
Health insurance for self-employed
Quality health care
Doctors are too few and too busy.
More athletic facilities to keep healthy
Nutrition education
Medicare HMO