Friday, July 18, 2014
In a time when health care is such a moving target, it is an extremely difficult arena for the working poor and uninsured to receive preventive and primary care services. East Cooper Community Outreach (ECCO) and the MUSC College of Nursing have responded to this overwhelming need by opening “Partners in HealthCare,” a nurse practitioner-managed clinic that focuses on the care of uninsured patients with diabetes, hypertension and associated conditions of hyperlipidemia, obesity and tobacco usage.
The clinic, which opened in June, serves the uninsured residents of East Cooper without a medical home on Wednesday evenings by appointment only. Appointments are scheduled through ECCO by calling 843-416-7145 or by emailing ytolton@ECCOcharleston.org.
This unique practice emphasizes continuity of care, health education, lifestyle coaching and care coordination. MUSC nurse practitioners are the primary providers. ECCO's Prescription Assistance program assists with securing needed medications for enrolled patients.
Dianne Schuler, ECCO board member and retired registered nurse says, “One of our biggest focuses is helping ECCO clients to better understand their conditions and prescribed medications.” It's true. When you're poor, medications are rarely taken as prescribed. It's a common occurrence when our Health and Wellness manager discovers a patient is taking half of their dosage a day or has compromised the formula in some way.
Frequent reasons for failure to take medication include miscommunication or poor understanding of the disease and prescribed medications, lack of funds for medications prescribed, or medication side effects. The ongoing, real-time support provided by the health coaching offered at Partners in HealthCare strives to address these barriers in addition to promoting healthy lifestyles. Dr. Deborah Williamson, associate dean at MUSC's College of Nursing, said, “Our team of nurse practitioners strives to engage the clients through building relationships and trust which is a key component of the health-coach model.” Health coaching has been shown to improve outcomes in chronic disease management.
Last year, South Carolina and several southern states chose not to receive federal funding for Medicaid which is a vital component to the Affordable Care Act. This created a huge gap for the working poor. Purchasing personal health insurance is not affordable for someone making minimum wage. The Post and Courier reported on June 22 that in South Carolina, 194,000 residents fall into this gap and remain uninsured.
Uninsured individuals are especially susceptible to poor outcomes associated with chronic conditions such as high blood pressure and diabetes. These individuals are less likely to be aware they have the condition, less likely to be under control and more likely to use an emergency room as their usual source of care. These factors contribute to fragmented care delivered at a high cost with worse health outcomes than the insured. Partners in HealthCare hopes to demonstrate a reduction in emergency room visits by providing a system of care that engages the client in self management to reduce poor health outcomes.
Chronic diseases such as diabetes and high blood pressure, if uncontrolled, can result in significant complications such as stroke, amputations, vision loss and kidney disease. The loss of productive years of life due to these complications is why Partners in HealthCare is so critical. As Schuler says, “Our goal is to improve the health of our community – one patient at a time.”
Jack Little is executive director of East Cooper Community Outreach.