Category Archives: Chronic Diseases

Providing Behavioral Health Care in a Primary Care Setting

Extensive barriers to accessing behavioral health care exist in the United States – affordability, access to a behavioral health provider, fear of stigma. Each of these barriers can be eliminated or reduced by folding behavioral health services into the primary care setting, or “integrating care.” A national survey published by the Mental Health Association found that 32% of undiagnosed, asymptomatic adults would likely turn to their primary care physician if mental health concerns arose while only 4% would seek care from a mental health specialist.

Flipping the coin over, a strong case can also be make for integrating primary care into the mental health treatment setting. 68% of those living with mental illness in the United States also suffer from a chronic physical condition such as diabetes, hypertension and/or heart disease. The life expectancy of adults living with mental illness is reduced by over ten years due to their chronic conditions – not their mental illnesses. Thus those who regularly consult a psychiatrist or other provider regularly for counseling or medication management for their mental illnesses stand to benefit from the opportunity to obtain affordable primary care during the same visit.

Tarzana Treatment Centers in Southern California, serves as an example of successful integration. Dr. Jose Salazar of Tarzana explains, “Patients typically report higher satisfaction rates with health services that are fully integrated as opposed to those that are not,” while benefits to the provider include improved patient adherence and increased follow up to care.  Additionally, “many fully integrated care programs see their patient emergency department utilization reduce by 20%-30% [or higher],” lending our general healthcare system additional benefits from full integration.

The transition to an integrated care system is not without its challenges, particularly relating to an organization’s limited financial and human resources. Dr. Salazar explains that full integration of behavioral and medical care adds a valuable care component that may not be fully or even partially covered by third party reimbursement, such as case management and care coordination. Having undergone this transition already, staff members at Tarzana recognize now that “it is also important to change the culture and mindset of providers via training and development to operate in this new model, which has its own set of principles, values, and communication approaches.”

The transition to integrated care is a seismic shift in the way health care is considered and delivered. Through holistic care approaches – primary care integrating behavioral health and vice versa – these innovative organizations are ensuring that no patient is defined by a single diagnosis, but rather is understood and respected as a sum of his or her parts.

“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.



AmeriCares Global Medical Assistance – Ecuador

AmeriCares has been sending medical aid to Ecuador since 1987.

I have heard a lot of wonderful things about Ecuador — a popular vacation and adventure travel destination for students, backpackers and families. But, during my time interning at AmeriCares, I have also learned that when you look beneath the surface, Ecuador is a nation whose people struggle with chronic poverty and its accompanying consequences.

About one-third of the world’s population does not have access to needed medicines and basic health services, mainly in developing countries such as Ecuador. The country’s health care institutions often lack the necessary medicines and supplies to provide their patients with life-saving and life-sustaining treatments, resulting in deaths from treatable diseases and handicaps from chronic conditions, such as heart disease and diabetes.

One of the leading causes of death in Ecuador is heart disease — although malnutrition, respiratory disease, malaria and diabetes persist in remote regions where access to healthcare is limited.  This is where AmeriCares makes its impact. In addition to supplying in-country partners with ongoing aid to support health care, AmeriCares responds to natural disasters in the region, including the severe floods in 2008 that affected eight of the nation’s provinces. AmeriCares delivered medicines and supplies to support medical camps, and relief items including blankets and other necessities to help people living in shelters.

From 1987 to June, 2011, AmeriCares provided over $24 million in medical assistance including medical aid to support more than 1 million patient visits per year, ranging from primary and maternal care to pediatrics and mental health, improving the overall well-being of the community.

AmeriCares work in Ecuador is part of its Global Medical Assistance Program. Through Global Medical Assistance, AmeriCares delivers essential medicines and supplies to medical facilities and partner organizations in underserved communities worldwide, including prescription and over-the-counter medication, nutritional supplements, surgical and wound care supplies, hospital supplies, and diagnostic and laboratory supplies. AmeriCares’ well-established partnerships and networks around the world include over 2,000 hospital, clinics, outpatient programs, hospice and rehabilitation centers and homes for children and the elderly.

Find out more about AmeriCares in Ecuador here.

Chronic Disease Initiative Helps Patients in Need

Luis uses a spirometer to help better manage his asthma.

Tom is constantly feeling fatigued, extremely thirsty, and gets a tingling sensation in his extremities. What should he do?

The answer seems simple: Go to the doctor. Unfortunately, Tom is one of the 50 million Americans who do not have health insurance or a way to pay for medical attention.

Eventually his disease gets so unmanageable that Tom has to take a day off work to go to the free clinic. At the free clinic he is diagnosed with type 2 diabetes, a chronic but manageable disease. But once again Tom has an issue because he can’t afford his medicine and there is no easy way to get his medicine for free. So now what?

AmeriCares Chronic Disease Initiative helps people like Tom who are living with a chronic illness, but are unable to access the information and medicines necessary to manage their condition. AmeriCares is currently accepting applications from its partner network of 400 safety net clinics for the second enrollment period of the initiative. Four chronic illnesses are being targeted: Diabetes, hypertension, high cholesterol, and chronic respiratory disease.

Thirteen clinics will be selected as recipients of the initiative. The recipient clinics will benefit with support from AmeriCares for a specific chronic illness that affects their patients.  The support includes patient educational materials about the illness, prioritized assistance with donations of targeted medications, as well as a two year license for a web-based software system to expedite and simplify the applications for Patient Assistance Programs (PAP) a program by which pharmaceutical companies donate medicines directly to the patients in need.

The Chronic Disease Initiative helps clinics better serve their community, and also helps patients like Tom learn more about their disease and provides them with access to medications needed for management. This initiative is just one of the many ways that AmeriCares works here in the U.S. and around the world with “A passion to help. The ability to deliver.”


  • Visit Free Clinics TodayExternal Link, AmeriCares online resource guide for America’s free clinics and nonprofit health centers.
  • Partner clinics can order medicines and supplies on the AmeriCares U.S. Access website; the medicines are shipped within six days.
  • Icon PDF 2Download the special reportAddressing Resource Gaps in the U.S. Health Care Safety Net—the first nationwide study of free clinic resource needs.