The Center for Family Medicine SpartanBurg Regional Hospital system HealthPALs The Center for Family Medicine SpartanBurg Regional Hospital system

HealthPALs P- PATIENT A-ADVOCATE L-LIAISON

WHO ARE “HealthPALs” GROUP OF VOLUNTEERS VARIOUS LEVELS OF TRAINING laypeople nursing students Pre-professional health students medical students residents clergy

HealthPALs COMMON INTEREST “HELPING PEOPLE IN NEED MAKE BETTER HEALTHCARE DECISIONS”

“POOR” DECISIONS USING THE ER FOR PRIMARY CARE - EXPENSIVE - FRAGMENTED CARE -POOR OUTCOMES -LAPSES IN FOLLOW UP

“POOR” DECISIONS WHY DO THESE PATIENTS GO TO ER? NOWHERE ELSE TO GO? EASY ACCESS but long wait NO COPAY! DON’T KNOW ANY BETTER THEY CAN GET WHAT THEY WANT FAILURE OF SYSTEM

“POOR” DECISIONS COMPLIANCE AND ADHERENCE ISSUES DON’T PICKUP PRESCRIPTIONS DON’T KNOW HOW TO TAKE MEDS UNCLEAR OF INSTRUCTIONS HURDLES WITHIN SYSTEM POOR FACILITATION LACK OF UNDERSTANDING PRESCRIPTIONS APPOINTMENTS TESTS

“POOR” DECISIONS PRESCRIPTION MEDICINE ABUSE -narcotic pain meds, benzos, stimulants ILLEGAL DRUG USE -cocaine, heroin, meth, bath salts, mj, etc. SUBSTANCE ABUSE -alcohol, tobacco

OPPORTUNITIES Interact with patients in continuity Engage and lend a friendly ear Provide assistance through resource tools Establish an advocacy relationship Provide value to people in need Make a difference!!!

HealthPALs at CFM Patient selection: Needy for various reasons Frequent no shows Trouble following plan Reinforcement Reassurance Special programs

HealthPALs at CFM List of patients in need of assistance Phone lines, EMR access Screen view of patient information Script of questions and guidance Contacts with community healthcare resources Opportunity to meet patients and interact Establish continuity relationship Supervision by faculty Attendings, residents, nursing staff, social workers

The Encounter Introduce yourself Let them know that you mean to help Establish rapport “talk with them like your grandparents” Examples: “have you gotten your prescriptions?” “ did you get your lab tests?” “do you understand…?”

Encounters: Special Programs “I’d like to let you know about a special program at the Center for Family Medicine…” For example smoking cessation, ABI screening, diabetes group visits, nutrition counseling, … Many patients are just not aware of the services available

Special Programs Hospital follow up Smoking cessation Weight management Complex medication management Others

HealthPALs at CFM Summer Session Pilot Duration 6 week program June 8th to July 17th Sessions Held Tuesday through Thursday AM & PM Record of each Encounter and any interventions Debrief after each session

Week 1 - Patients with No-shows to appointments Goal: investigate reasons patients are no-showing, reschedule patients and encourage them to attend appointments Students began training in patient advocacy with close guidance and attention of the clinical coordinator Review of script with volunteers followed by an example call completed by coordinator and an example write-up Students were then encouraged to call patients and ‘get their feet wet with the process’ Students showed a range of comfort talking to patients – some were eager and confident talking to patients – others were more shy and nervous speaking with patients EMR access was granted to the HealthPALs and students were instructed on appropriate use of medical records as a tool for patient advocacy.

Week 2 - follow up previously called patients, patients with frequent ER visits (5 or greater in the last 23 months) Goals: investigate reasons patients are going to ER for primary care concerns instead of CFM, educate patients on appropriate use of ER vs primary care clinic, suggest local resources for improving care (outside the ER), schedule patients for follow-ups at CFM HealthPALs were given a packet of resources in Spartanburg area (food, shelter, transportation, substance abuse rehab, family planning etc.) the weekend before to study and use as a tool as advocates. Students were also instructed to assess patient’s understanding of PCP and educate patients on importance of having a PCP. Data on selected patients was recorded

Week 3 – Follow up with previously called patients, CFM patients with any ER visits in last 23 months, no show patients. Goal: use EMR to investigate patients on ER lists and no show lists to find gaps in care that can be effectively bridged with patient advocacy. Patients with fewer than 5 ER visits in the last 23 months were excluded in the previous week which focused on excessive ER use.

Goal: Reach out to CFM patients recently discharged from the hospital Week 4 – Continue follow-up with previously called patients, CFM patients recently discharged from the hospital Goal: Reach out to CFM patients recently discharged from the hospital HealthPALs built advocacy relationships with patients recently discharged Bridged the gap between providers and patients to ensure patients were comfortable with their recovery plan and have no questions Coached patients on importance of following discharge instructions, taking meds, reaching out for assistance etc.

Week 5 – continue follow-up with patients Goal: Follow Up with patients called in previous 4 weeks of summer session Ensure patients are able to attend appointments and have appropriate means to access care Continue to coach patients of the importance of maintaining a relationship with their PCP instead of using ER for primary care needs Follow through with recently discharged patients to ensure they are able to complete their recovery Remind patients that they can contact the providers at CFM at any time if they have any concerns regarding their health.

HealthPALs – Summer Session Data total attempted calls approx. 430 Patients Encounters interventions total 150 215 86 ER Patient Data Pts Answered Knowledge of PCP No Knowledge of PCP 34 19 15 55.90% 44.10% Reason for ER Visit over CFM Care needed after CFM hours 10 Perceived severity of illness 17 CFM staff 'doesn’t give me what I need' 1 Sent to ER from CFM for admission just because'

Problems/limitations/errors Major Issue we are trying to advocate for patients who are non-compliant, have chronic disease, have issues with access to care  this patient population frequently does not have reliable contact information. Many move locations frequently/change phone and address, many use pay as you go phones that run out of minutes but can still be utilized for texting, many patients change addresses or give a false address/phone number to staff at CFM to avoid getting billed HealthPALs volunteers can become frustrated and disillusioned when spending time calling patients without being able to contact them (part of the process before calling a patient involves spending time looking up the patient on the EMR to investigate their case) Volunteers are disappointed when they are unable to contact patients they think could use their help (then show up in the ER for care.)

Future Considerations Increased face to face interaction with patients – (telemedicine concept?) encourage meeting patients in the office at appointments to put a face to the name and solidify relationships Work on integrating the HealthPALs program into the routine care/care coordination at CFM potential for nurses, residents and attendings to refer difficult patients to HealthPALs for follow-up calls and investigative purposes Increased awareness of HealthPALs Pamphlets for each patient’s room, signs throughout the hospital Increased coordination with other community healthcare agencies Year round sessions to provide continuity of support