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Lindsay O’Brien serves as the VP of U.S. Programs & Partnerships at Americares. In this role, she focuses on building capacity within the health care safety net throughout the country.
We all know that it’s a good idea to have a list of critical questions ready for our short visits with the doctor in order to maximize those precious few minutes with an expert. (With doctors’ appointments averaging about 18 minutes1, it makes sense to come prepared). And yet how many of us have given a quick “no” at the end of an appointment when asked, “Do you have any questions for me?” Whether it’s because we’re unprepared or embarrassed, the appointment is ended on an incomplete note, and we may have missed an opportunity to give our care providers an important piece of the puzzle.
The Greater Killeen Free Clinic in Killeen, TX is working to solve this problem.
linic in the spring, I was struck by the impressive health outcomes of the Killeen’s Chronic Care Clinics. These “clinics” are actually year-long education series and wellness visits for individuals suffering from a chronic disease – diabetes, hypertension, heart diseases, asthma or COPD and/or thyroid disorders. (The national statistics on these preventable health problems are staggering: about ½ of all adults in this country have a chronic health condition, and these chronic conditions are the leading cause of death and disability in the U.S.2 These conditions are also notoriously difficult to treat.3) Patients enrolled in the Chronic Care Clinics at Killeen are provided with education on subjects including proper nutrition, exercise regimens and disease and prescription management. They learn effective ways to manage their disease.
Before acceptance into a Chronic Care Clinic at Killeen, patients sign a contract promising to attend mandatory appointments and education sessions. The contract explicitly states the dates and times of quarterly appointments as well as the ramifications of missed appointments. An addendum to Killeen’s Patient Contract is the Pledge of Care. Both patients and Killeen staff pledge to adhere to 14 different standards of care, including mutual “respect, honesty and compassion” and always telling the truth.
One pledge really caught my attention: Killeen promises their patients that they will “listen to and answer your questions.” On the flip side, the patient pledges to ask questions when he/she does not understand “until I do understand.” There is an expectation at Killeen that patients will learn everything that they can about their conditions, and they will come to appointments prepared and leave informed. Just as importantly, Killeen staff are committed to ensuring that their patients are empowered with the information to make informed decisions about their care.
Explained by Executive Director Marlene DeLillo, “Patients in the program are wholly committed to improving their health. The Patient Contract clearly explains the program expectations and our commitment to serving as their medical home. And the Pledge ensures that patients know how much we care about them while also demanding participation and honesty. The contract and pledge have definitely enabled the success of the Care Clinics.”
The results of this comprehensive, patient-centered care at Killeen are impressive. Of the 188 diabetic patients participating in Killeen’s clinics, 153 showed an average of 3% point decline in A1C levels over the course of 24 weeks. “One patient’s A1C level dropped from 11.4 to 6.2 in 12 months. We were thrilled,” said Sheila Brooks, clinical supervisor.
When Brooks asks her chronic care patients, “Do you have any questions for me?,” you can bet she doesn’t take no for an answer.
As the nation’s largest provider of donated medical aid to the U.S. health care safety net, AmeriCares works with over 800 free clinics and health centers in all 50 states. Supported by the GE Foundation, the U.S. Programs help partner clinics to increase capacity, provide comprehensive care, improve health outcomes and reduce costs for patients. Our vision is for every person in this country to have access to affordable and high quality health care regardless of their ability to pay. The Greater Killeen Free Clinic in Killeen, TX is one of our safety net partners.
1 https://www.washington.edu/news/2008/07/14/rx-for-time-crunched-physicians-communication-skills-that-increase-physician-efficiency-and-patient-satisfaction/2 https://www.cdc.gov/chronicdisease/overview/3 https://ecp.acponline.org/augsep98/cdm.htm#Note1