NHCW 2016: Meeting Patients Where They Are

Monday, August 08, 2016

Spend enough time in a community health center, and you’re bound to pick up on a common refrain used in conversation, in literature, in staff memos: “meeting people where they are.”

Many community clinic patients, according to Gene Biggs, “haven’t been treated with respect or decency, haven’t had the best experience with medical care." Trauma, fear, and mistrust, says Gene, also mean that this patient population is less willing or able to commit to ongoing primary care. Meeting patients where they are becomes an essential approach to not only getting them the care they need now, but getting them ready to continue receiving the care they'll need moving forward.

Gene is the Clinic Care Coordinator at Central City Concern's Bud Clark Clinic, which, like many other community health centers, provides acute care—care for episodic or urgent health needs—for those who are homeless and marginally housed. Bud Clark Clinic, however, is unique in two distinct ways: how they meet vulnerable people where they are, and their end goal.

The Bud Clark Clinic is located within Home Forward’s Bud Clark Commons, which consists of a daytime resource center run by Transition Projects, Inc. (TPI) and permanent supportive housing (the Apartments at Bud Clark Commons) provided by Home Forward. In this sense, the clinic meets patients where they are, literally.

"For marginally housed patients, the idea of getting on a bus or walking the city blocks to a big clinic with lots of providers and a lot of people to get care can be too much," Gene says. "It's much easier for them to come to a place where they're already going to spend time." That place, of course, is the TPI daytime center, just adjacent to them exam room.

Residents of the Apartments at Bud Clark are served by a second clinic exam room upstairs. Even still, their trauma histories can make traveling down the hall for care too difficult or overwhelming. In those cases, care providers visit patients in their rooms.

Gene has found that setting up operations where patients already are provides, perhaps unsurprisingly, significant benefits to providing care.

"Being here every day, consistently, is a huge part of our care—a consistency that, in their situation, they don't have. Sometimes people just come and want to talk. Being immersed in the community has helped. "

Gene sees their everyday presence as a way to engender trust in and a feeling of safety with Bud Clark Clinic that helps patients believe that the clinic is there to help them, giving them an entryway to provide acute care. But the Bud Clark Clinic is concurrently oriented toward helping their patients become more comfortable with the idea of receiving ongoing care from a primary care provider.

"We can build on that relationship to get them to the next level of care [beyond acute care] that can offer more and ongoing medical services Bud Clark Clinic isn't set up to provide," Gene explains. "The big point of Bud Clark Clinic is to bridge the gap between getting people the care they need now and trying to get them care that's better suited for them in the long run."

At each visit, Gene and other care providers bring up the topic of primary care. Do you have a primary care provider? How do you feel about going to a primary care clinic? What are your reservations?

"We feed off the type of language use about it," Gene says. "We don't push, we don't force. We engage. Like a wading pool before the deep end of primary care."

Until a patient does feel ready to dive into a primary care medical home, Gene and the Bud Clark Clinic remain steadfast in meeting patients where they need to be met. Sometimes that might mean walking or riding in a cab with a patient to their next care site. Other times it might mean tracking down a patient who ended up in the hospital and visiting them.

That flexibility, Gene emphasizes, "is the Bud Clark Clinic. We let them know that we’re here to support them as much as we can. However and whatever it takes."

For Gene, his commitment to the people he sees at the clinic is just as much personal as it is professional.

"I’ve had some times of struggle personally, and family who have struggled with addiction who would be homeless if they had no one to rely on. If I didn’t have the family that I do, I could be here as well."

Meeting patients where they are can happen in a physical sense or a relational sense. Combine the two, like at the Bud Clark Clinic, and patients receive a depth of care that both honors where they are while seeking to propel them toward more sustained care.

"We want to get them to that next level of care. In the meantime, we're not done with their care once they leave the door."

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