Rina Ramirez, MD FACP Teresita Lawson, BS Pharm, CDE
Established in 1990 in Dover FQHC since 2004 Serving 4 counties in NW NJ Serving homeless, residents of public housing, farm workers Served 15,000 in 2011, 95% under 200% poverty level, 70% uninsured, and the majority were Hispanic or other ethnic minority. 73% of patients are adults, 6% are seniors (most are residents of public housing)
Open 7 days/week with late hours at most sites, and Saturdays in two sites 24/7 bilingual call coverage Some services provided: Pediatrics ◦ Adult Medicine ◦ Family Medicine ◦ Women’s Health ◦ Ryan White Part A and C ◦ Dental ◦ Dental Screenings for Children ◦ Podiatry ◦ Behavioral Health ◦ Clinical Pharmacy Services ◦ Outreach Services ◦ Patient Navigation ◦ Case Management ◦ 340B Pharmacies ◦ Reach Out and Read ◦ Support Groups ◦
Clinical Pharmacy Services Breast Patient Navigator Pharmacist provides education & Program Uninsured p atients receive free counseling on medication mammograms and f/u studies, management, diseases, nutrition, assistance through system if have lifestyle changes to help patients breast cancer and other conditions with diabetes, high blood pressure, lipids and HIV Patient Centered Medical Healthy Weight Home Collaborative Team working towards NCQA recognition, and improving access MAs and providers review healthy to care, care management, lifestyles including exercise, eating medication reconciliation on habits and the Plate Method transitions of care, patient empowerment and more
Our Morristown office is located 1 block away from a public housing building and 2 blocks away from a large residential complex. During Hurricane Sandy, parked the mobile van outside our center to provide care to patients despite having no power.
Presented with A1C of 10.1% in January 2011 Significant Barriers – isolation, loneliness, low self esteem, social and cultural barriers, denial, low health literacy and medication non adherence Was on multiple oral diabetes medications (metformin, glipizide, januvia, starlix) and did not want to go on insulin What we did to help him…..
For the next two months, met with PCP and clinical pharmacist ◦ Resisted going on insulin- kept avoiding visits ◦ Team did not give up on him - kept calling and rescheduling ◦ Whenever he came: Discussed his situation, built trust with every visit Asked open ended questions, “peeling an onion” - addressing barriers Reviewed all aspects of living with diabetes Used motivational techniques and gave encouragement Reviewed Self Care Behaviors at every visit always building on each accomplishment - monitoring
Started insulin May of 2011 In July 2011, A1C down to 7.8% ◦ Patient sees progress with insulin use ◦ Patient encouraged by not having to take so many pills Set backs due to loneliness and isolation Despite these setbacks and challenges, FP now keeps every appointment he has with the pharmacist and with the provider.
Frequent follow with same provider, clinical pharmacist and staff Consistent “what’s in it for me” motivation Lowering and simplifying his medication load Patient/Team work and collaboration The patient is at the center of his care- ◦ Involved in making decisions ◦ Makes sure that he gets all preventive services ◦ Is 100% adherent with medications Trust Building Listening
Although FP has a monthly income and a place to live, the isolation and the loneliness can be extraordinarily hard to overcome. Sometimes makes choices that are not the best for his health to meet those needs. Constant follow up and trust building, motivation and encouragement are essential for achieving control of his diabetes.
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