Delta County has a population of 15,000, which includes approximately

Delta County has a population of 15,000, which includes approximately 12 persons per square mile. Two primary care physicians and two nurse practitioner-managed care clinics are available in the area. Delta County has two dentists, but neither accepts Medicare or Medicaid. The closest hospital is 60 miles away. Two nurses from the Health Department provide some health care services for the county, primarily maternal-infant health care services (i.e. well-child visits). Tanya is a 35 year old African American living in Delta County. She has lived in Delta County since she was a child, having grown up on her parents 100 acre soybean farm. Tanya has four small children - a 2 year old girl, a 6 year old boy, and 9 year old boy twins. Tanya is a housewife. Her husband, Bill, is trying to get a permanent job but for now he does seasonal farm work. Tanya and Bill cannot afford private health insurance and do not qualify for Medicaid or Sooner Care. Tanya was recently diagnosed with Type 2 Diabetes, but she cannot afford the medications recommended by the nurse practitioner. Use this case study to answer the following questions: 1) Is Delta county a rural, urban or frontier community? Why? 2) What barriers can contribute to Tanyas familys difficulties to accessing health care? 3) Which model would be most effective for Tanyas family: the case management model or community-oriented primary care model? Why?

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