Helen Peake-Godin MN RN University of Southern Maine College of Science, Technology, and Health School of Nursing

Transcription

1 Helen Peake-Godin MN RN University of Southern Maine College of Science, Technology, and Health School of Nursing

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3 History of Sagamore Village Health Center Brief Overview The Sagamore Health Center, developed in 1992, initially functioned as a community health clinical site for nursing students. In this public housing community, residents soon saw the health center as a resource for health screening, information, and support. As the needs of the community residents were identified, there was an obvious need for primary care services. We sought financial support from the hospital / medical center. Our goal in seeking funding was not to ask the medical center to provide a nurse practitioner, but to request funding to allow us to hire a nurse practitioner. Services to Sagamore residents remain free. This was and continues to be important as the Health Center belongs to the residents and the School of Nursing. Each year we submit an annual report to the medical center and receive funding. The Housing Authority continues to provide a separate housing unit for the Health Center, plus utilities. Both graduate and undergraduate students have primary care and community health practice experiences at this nurse managed health

4 Beginning Steps Initial contact was with a resident, who was President of the Village Tenants. At this meeting were an USM faculty member and the Director, Public Health Department, City of Portland. Focus was on listening to this lead resident and to agree on a plan to address health needs with a focus on women s health and need to further analyze the community needs.

5 Beginning Steps Commitments by Portland Public Health and USM Nursing Faculty to: 1. Initiate a well-child clinic (once day / month) in the community 2. Assign two graduate students to conduct a comprehensive community assessment over a period of 2 semesters 3. Two nursing faculty to meet weekly with self selected group of community women. 4. Open communication with on-site Portland Housing Authority s project director and residents services coordinator.

6 Be visible and listen and keep eyes and ears open for opportunities.

7 Clinic Visit / Learning Together

8 Community Health Assessment 1. Two graduate nursing students utilized a participatory action approach to assessment. 2. Multiple methodologies 3. Triangulation 4. Data / findings brought back to the community for their interpretations.

9 Initial Programs. 1. Cardiovascular reduction classes need documented by community assessment and emphasized as an appropriate first community program. 2. Parenting Group* identified as a need via focus groups and individual interviews. *Initiated by students, continued for almost 2 years after students completed their graduate community health clinical.

10 Immediate Impact Project manager and residents ask USM not to leave. Space provided in the community center. Undergraduate nursing students begin to make home visits to families referred by the residents, the project manager, and the City of Portland Public Health Nurses Students held health fairs based on residents requests, which identified additional needs and potential families to visit. Collaboration with school nurse at local elementary school (source of referrals)

11 Meeting Women s Health Needs Identified as a need at the initial meeting Referrals made when nurses approached by residents However, women continue to express need for on-site health care (supported by evidence of frequent lack of annual pap / breast exams, lack of follow-up for abnormal exams, and increasing number of teen pregnancies. Child care, transportation, and fear identified as major barriers

12 Next Step in Collaboration Meeting with small community hospital with a request for funding to hire a nurse practitioner, i.e., money would come to the School of Nursing, who would hire the nurse practitioner. (Rationale: Community via USM to have control over hiring and assignment) This funding continued after smaller hospital purchased by Medical Center. Annual report submitted each year with Medical Center continuing to fund (with 2 increases since 1996)

13 Population Served 500 residents living in public housing community 200 families 14 ethnic groups

14 Health Care Services Initial focus on women s health care and then evolved into acute episodic and chronic disease management Key medical partners were (are) the outpatient clinics at the Medical Center. Initial contact and developing relationships with clinic triage nurses, nurse practitioners, and physicians International Clinics Private practices Mental health providers

15 Overview of Services The Health Center is unique in that our goal was not to become the primary care provider (PCP) or medical home for residents of the Sagamore Village Public Housing Community. The goal was to provide primary care services in collaboration with primary care providers (PCPs) in the Portland area. This has created a strong collaborative partnership with established health providers, including medical specialties, mental health providers, and social services.

16 Primary Goals To provide community-based primary care services to a community of public housing residents, who are considered vulnerable and at risk. To increase access to existing health services in collaboration with other area providers. To avoid the duplication of services. (The goal has never been to duplicate or compete for services).

17 Other PCPs (in the Portland area), including both NPs and physicians, look to the nurse practitioner and students, as partners which allows their patients to receive comprehensive care. Last year nearly 1,000 visits were made to the nurse practitioner with an additional 1,100 home visits made by nursing students. This is a truly collaborative model of care.

18 Additional Goals In addition to providing primary care services, the Health Center provides traditional public health and home nursing care to individuals, families, and the community. These latter services are provided by both undergraduate and graduate nursing students, which include 8-12 students per week during fall, spring, and summer semesters.* *Initially nursing faculty provided services during the summer months. The nurse practitioner is on a 12 month contract.

19 Why This Community-Based Model? Majority of residents initially identified a primary care provider Community Assessment by graduate students identified that many residents only accessed primary care for acute episodic care and less often for management of chronic disease and preventive care. School of Nursing lacked resources to establish a full service primary care service (24 /7) Political climate not supportive

20 Note: At the time the Sagamore Center was established, Nurse Practitioners practiced under physician supervision in Maine. Initially community physician provided supervision at no cost. In 1997, Maine Nurse Practice Law changed to allow Nurse Practitioners to practice independently after 2 years of supervision.

21 Financial Support Space (housing unit) and utilities provided by Portland House Authority. Maine Medical Center provides limited funding to the School of Nursing for the nurse practitioner s salary and limited supplies. Medical Center provides interpreting phone line and funding to hire an on-site interpreter. School of Nursing provides in-kind support in terms of supporting clinical faculty on-site. Graduate assistants (5 hours / week) provided by University Office of Graduate Studies

22 Primary Care Services Provided 8 10 hours each week By Nurse Practitioner / Advanced Practice Nurse (Adjunct Faculty) All services are provided free of charge Majority of patients are women (Teens to the elderly) Collaboration with local nurse practitioners and physicians, including medical specialists

23 Sagamore Heath Clinic Activities Annual physical examinations Blood work as requested by private providers and MMC Clinics Follow-up care of residents with chronic illnesses Acute episodic care (e.g., diagnosis and treatment of acute respiratory infections) Interpreting Pregnancy tests Pap smears and breasts exams Contraceptive counseling and prescriptions, including depo provera injections every 12 weeks for individual clients Scheduling of mammograms Referrals to other providers and agencies Immunizations, including flu shots Pacemaker checks Telephone triage Collaboration with providers, including MMC outpatient staff

24 Assumptions 1. Primary care can only be as effective as the community that supports its utilization 2. Primary care cannot replace the need for public health and community-based services. 3. Gaps in access to primary care and traditional public health services is related to multiple causes. 4. Community partnerships between communities, health care organizations, and academia can help bridge these gaps. 5. Primary health care requires the inclusion of primary medical care with traditional public health and community-based health programs.

25 Impact* of Communication with PCPs / Other Providers Acute illness a. Chest pain a. Referral to cardiologist by PCP; M.D. home visit b. Infections: UTI, bronchitis, cellulitis c. Toothache b. Antibiotics prescribed c. Pain medication, antibiotic, and search for and referral to dental health center

26 Communication (cont.) Chronic Illness a. Pacemaker check b. Thyroid lab work a. Sent to cardiolo- gist; pacemaker turned back on b. Results to endocri- nologist; medication adjusted c. Hypertension d. Diabetes c. Reports to PCP; meds. adjusted; newly diagnosed: initial Rx. and PCP found for client d. Newly diagnosed: referred to PCP; monitoring and teaching with non-english speaking client

27 Communication (cont.) e. Chronic pain e. Monitoring and referral to pain clinic; education; advocacy f. Mental health f. Reported changes in behavior and affect, medication changes by psychiatrist; dementia evaluation report to PCP for medication; home safety evaluation and teaching

28 Communication (cont.) Women s Health a. Normal paps a. Results to PCPs b. Abnormal paps b. Colposcopies scheduled c. Contraception c. Education and prescriptions d. STI s d. Diagnosis, RX, and education; follow-up for PCP patients e. Pregnancy e. Diagnosis and referral

29 Communication (cont.) Case finding / newly diagnosed a. Established PCP a. Report findings; additional work-up and medication initiated e.g. s, insulin and statin drugs b. No PCP b. Search and find and refer to PCP

30 Communication (cont.) Communication with housing and social services a. Need for handicapped access b. Home safety evaluation c. Transportation a. Client(s) relocated to accessible unit b. Client s home rearranged c. Arranged for medical appointments

31 Categories of Communication with PCPs and Other Providers 1. Acute illness 2. Chronic illness maintenance 3. Mental health changes 4. Women s health care 5. Newly diagnosed and no PCP 6. Information sharing/ clarification 7. Housing and social services

32 Population Served 500 residents living in public housing community 200 families 90% female head of household Primary insurance: Medicaid and Medicare different racial and ethnic groups Initially refugee population was largely Southeast Asian (Vietnamese, Cambodian) Recent increase in number of African countries (Congo, Ethiopia, Sudan)

33 Additional Activities Diabetes group Walking group Health fairs with focus on primary and secondary prevention activities Collaborative activities with local schools, home health agencies, mental health providers, and Portland Public Health

34 TRUST COLLABORATION AND COMMUNITY - BUILDING

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36 Summer 2012 Portland Newspaper The prevailing atmosphere regarding the clinic was described succinctly by a Sagamore resident, while she sat at the clinic s kitchen table sipping her coffee, "I feel like it's a family." Sagamore Village is a microcosm of Portland's ethnic diversity and its successful Sagamore Health Center and Women's Clinic is a family that could serve as a model for others.

37 Personal Testimony Sandra, a resident of Sagamore Village, has been a client at the housing complex's accompanying health clinic for 14 years. She has blood work done and gets some shots there. But even when she doesn't have a medical issue at the forefront, she will come in to visit with the nurse practitioner and volunteer and have a sociable cup of coffee at the round table in the kitchen. Sagamore Health Center and Women's Clinic isn't your typical health center, and it makes Sagamore Village unique in Portland's public housing. In the clinic is an atmosphere of friendship and conviviality. It's obvious that this clinic is truly part of the residents' lives, and a very important part.

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39 Overview of Services The Health Center is unique in that our goal is not to become the primary care provider (PCP) for residents, but to provide primary care services in collaboration with PCPs in the Portland area. Services include providing pap smears, monitoring residents with chronic illness, and treating acute care problems. Other PCPs, including both NPs and physicians, look to the nurse practitioner and students, as a collaborative resource that allows their patients to receive comprehensive care. Last year nearly 1,000 visits were made to the nurse practitioner with an additional 1,100 home visits made by nursing students. This is a truly collaborative model of care.

40 Community Nursing in Sagamore Village Keeping Warm and Healthy: Nursing student and coats on the way to village flu clinic

41 VILLAGE STORYTELLERS

42 Replication of Sagamore Model 1. Stage One: invitation to partner with community 2. Community assessment 3. Review findings with residents 4. Collaborate with other providers 5. Maintain contact with residents; initiate limited services, such as weekly health screenings and health promotion events. 6. Search for funding and develop plan *Include residents in all aspects of planning

43 Student Learning

44 THEMES A. Defining vulnerable B. Acceptance of difference C.Professional role/boundaries D. Empowerment E. Trust

45 STUDENT OUTCOMES Defining professional boundaries Flexible, fluid, going beyond traditional definition. Community building skills Trust, empowerment, collaboration Traditional nursing skills Assessment. Intervention, evaluation Meaning of poor and vulnerable Every day life, history of and cycles of poverty