Lindsay O'Brien

Lindsay is head of U.S. Medical Assistance Program at AmeriCares

Why 107 Hot Showers Matter

In one morning alone, 107 men living outside St. Mary’s Dining Room (a full health and social services agency near San Francisco) had come to take hot showers. And what do showers have to do with health? Everything.

I traveled to St. Mary’s Dining Room in Stockton, California recently to visit our free clinic partner as part of the regular visits to clinics that receive our donations of medicines or that are part of our clinic programming. At St. Mary’s, the need is immediately visible. Rows of tents and tarps line the street leading up to the facility. Living inside these tents are many of the patients who rely on a myriad of services provided by St. Mary’s. While the organization has its roots in a soup kitchen opened in 1955, it has evolved into a full service primary care clinic (the Virginia J. Gianellli Medical Clinic), dental office and operatory, social service organization, clothing distributer and shower provider. As Mary Anne Soria, Director of Medical Services explained, “We are more than just a meal.” That’s an understatement.

CA-clinic-with-shower-program-for-homeless-lores

What St. Mary’s offers is more than services: it provides dignity. The staff at St. Mary’s intimately understands the critical concept of social determinants of health: that health is profoundly affected by the conditions in which we live and goes well beyond clinic walls. Examples of social determinants include not only access to health care services, but also availability of educational and job opportunities, social support, transportation options and cultural offerings. Good health is achieved by more than a diagnosis and a prescription; it is obtained by treating the whole person, beginning with the means to manage the daily reality of their lives.

St. Mary’s addresses poverty by feeding the hungry, addressing health concerns, and as Ms. Soria explains, “Restoring human dignity” to over 700 individuals each day, one shower at a time.

Learn more about our partner, St. Mary’s Dining Room, and their history of “restoring human dignity since 1955.”

When a 10-Minute Drive is an Ocean Away

Last week I paid a visit to the University of Miami’s Pediatric Mobile Clinic (UMPMC). The 40-foot bus was parked outside the Center for Haitian Studies in Miami’s Little Haiti neighborhood as usual – the big blue bus took over the parking lot, with staff, interns, residents and volunteers providing care both in the mobile unit and throughout the Community Center. The services provided to the children visiting the clinic are highly integrated and holistic, ranging from sports physicals and immunizations to specialty care in cardiology, dermatology, endocrinology, hematology and nutrition. How does one mobile clinic possibly provide this breadth and depth of care?

Telemedicine. And an innovative medical director committed to serving her young patients with the highest level of continuous care.

The Pediatric Mobile Clinic provides live interactive videoconferencing consultations in which young patients and/or their care givers interact directly with a specialist off site. As Dr. Lisa Gwynn, clinic director explained, “There are major barriers to the 10-minute drive to the closest hospital, from transportation costs and cultural barriers to fear of a bill and inability to pay.” Telemedicine removes those barriers by bringing a specialist right into the clinic with a portable videoconferencing tool that allows patients to interact directly with a provider in the comfort and convenience of their medical home. Gwynn notes she saw the clinic’s patient compliance rate sky-rocket with the integration of this technology in 2013, with 35% of her patients following through and meeting with their specialists to now over 90% of her patients meeting with their specialists.

The neighborhood of Little Haiti is home to one of the largest populations of Haitian immigrants in the country, with the majority of its residents of Haitian origin or descent. It is also an area of high levels of poverty and a lack of primary care providers. 45% of the residents of Little Haiti earn less than $12,000 a year and 40% of its residents have no insurance, compared to 16% of all Floridian residents that live below the poverty line and 20% across the state that have insured.  These demographics and a shortage of providers make it the ideal neighborhood for the Pediatric Mobile Clinic, which rolls out of its parking spot at the University of Miami 5 days a week to park in different high need neighborhoods throughout the city.

On my visit last week, I watched as Gwynn photographed the back of an infant’s head on her cellphone. She then uploaded the photo to an app on her phone which pushed the photo to a pediatric dermatologist for her diagnosis. This store-and-forward technology is yet another telemedicine tool used by the clinic to ensure continuity of comprehensive care. “Telemedicine is absolutely critical for compliance,” Gwynn explains. “My main concern is quality care for patients and their safety.”

a telemedicine machine

 

Established in 1992 by the Children’s Health Fund as a response to hurricane Andrew, the UMPMC has provided medical care to uninsured children in need for nearly two decades. Services provided include well-visits, sports physicals, immunizations, management of chronic conditions, urgent care, mental health, and social work. To learn more the Pediatric Mobile Clinic, click here.

“Do you have any questions for me?”

By Lindsay O’Brien, Associate Director, U.S. Programs 

We all know that it’s a good idea to have a list of critical questions ready for our short visits with the doctor in order to maximize those precious few minutes with an expert. (With doctors’ appointments averaging about 18 minutes1,  it makes sense to come prepared). And yet how many of us have given a quick “no” at the end of an appointment when asked, “Do you have any questions for me?” Whether it’s because we’re unprepared or embarrassed, the appointment is ended on an incomplete note, and we may have missed an opportunity to give our care providers an important piece of the puzzle.

The Greater Killeen Free Clinic in Killeen, TX is working to solve this problem.

healthblog3On a visit to the clinic in the spring, I was struck by the impressive health outcomes of the Killeen’s Chronic Care Clinics. These “clinics” are actually year-long education series and wellness visits for individuals suffering from a chronic disease – diabetes, hypertension, heart diseases, asthma or COPD and/or thyroid disorders. (The national statistics on these preventable health problems are staggering: about ½ of all adults in this country have a chronic health condition, and these chronic conditions are the leading cause of death and disability in the U.S.2 These conditions are also notoriously difficult to treat.3) Patients enrolled in the Chronic Care Clinics at Killeen are provided with education on subjects including proper nutrition, exercise regimens and disease and prescription management. They learn effective ways to manage their disease.

Before acceptance into a Chronic Care Clinic at Killeen, patients sign a contract promising to attend mandatory appointments and education sessions. The contract explicitly states the dates and times of quarterly appointments as well as the ramifications of missed appointments. An addendum to Killeen’s Patient Contract is the Pledge of Care. Both patients and Killeen staff pledge to adhere to 14 different standards of care, including mutual “respect, honesty and compassion” and always telling the truth.

healthblog2One pledge really caught my attention: Killeen promises their patients that they will “listen to and answer your questions.” On the flip side, the patient pledges to ask questions when he/she does not understand “until I do understand.” There is an expectation at Killeen that patients will learn everything that they can about their conditions, and they will come to appointments prepared and leave informed. Just as importantly, Killeen staff are committed to ensuring that their patients are empowered with the information to make informed decisions about their care.

Explained by Executive Director Marlene DeLillo, “Patients in the program are wholly committed to improving their health. The Patient Contract clearly explains the program expectations and our commitment to serving as their medical home. And the Pledge ensures that patients know how much we care about them while also demanding participation and honesty. The contract and pledge have definitely enabled the success of the Care Clinics.”

The results of this comprehensive, patient-centered care at Killeen are impressive. Of the 188 diabetic patients participating in Killeen’s clinics, 153 showed an average of 3% point decline in A1C levels over the course of 24 weeks. “One patient’s A1C level dropped from 11.4 to 6.2 in 12 months. We were thrilled,” said Sheila Brooks, clinical supervisor.

When Brooks asks her chronic care patients, “Do you have any questions for me?,” you can bet she doesn’t take no for an answer.

As the nation’s largest provider of donated medical aid to the U.S. health care safety net, AmeriCares works with over 800 free clinics and health centers in all 50 states. Supported by the GE Foundation, the U.S. Programs help partner clinics to increase capacity, provide comprehensive care, improve health outcomes and reduce costs for patients. Our vision is for every person in this country to have access to affordable and high quality health care regardless of their ability to pay. The Greater Killeen Free Clinic in Killeen, TX is one of our safety net partners.

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1 http://www.washington.edu/news/2008/07/14/rx-for-time-crunched-physicians-communication-skills-that-increase-physician-efficiency-and-patient-satisfaction/
2 http://www.cdc.gov/chronicdisease/overview/
3 http://ecp.acponline.org/augsep98/cdm.htm#Note1