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Kalihi clinic Vicente Torres, 66, has a good chance of achieving his goal "to make my life long" because of a Kalihi-Palama Health Center program.
helps needy
A program treats underserved
clients with cardiovascular
or diabetes problemsBy Helen Altonn
haltonn@starbulletin.comHe had no doctor or medical insurance when he arrived from the Philippines in September 2000 with diabetes, high cholesterol and hypertension, putting him at risk for stroke or heart attack.
"In the Philippines, there you have to pay," he said. "If no money, no free care, no free medicines. If no money, you die alone."
A public service radio announcement about a diabetes clinic for Filipinos drew him to the Kalihi-Palama Health Center last March.
"Without insurance, if he didn't find us, I don't know what would have happened," said Marissa Dela Cruz, a registered nurse who leads a diabetes and cardiovascular self-management program at the center.
The program is part of a national collaborative sponsored by the Bureau of Primary Health Care in the Institute of Health Care Improvement. The goal is to eliminate disparities in access to quality care for minorities and underserved populations.
The Waianae Coast Comprehensive Health Center, Waimanalo and Kalihi-Palama health centers started with diabetes programs.
Kalihi-Palama expanded in May to cardiovascular patients of Drs. Joseph Humphry and Glenn Rediger, "physician champions of the collaborative," and family nurse practitioners Anne Leake and Jackie Hui. Center Director May Akamine is senior leader.
"Part of the thesis of the collaborative and contract with the institute is, you have to change the health care system," said Humphry, who was a prime mover in establishing Waianae's diabetes program.
"Rather than writing prescriptions and sending patients home with pills, we have to work at getting patients really involved. We actually discuss what is the best practice and come to some conclusion so patients don't get different messages from different providers."
The Kalihi-Palama center has about 500 patients in the diabetes registry and 210 in the cardiovascular group. Some, like Torres, are in both.
Education is emphasized so they understand the diseases and what they can do through diet, exercise and proper nutrition to manage them, Dela Cruz said. Interpreters assist non-English-speaking patients.
They're encouraged to set goals and develop an action plan with diet, exercise and lifestyle changes, if needed, such as stopping smoking.
Patients record glucose, blood pressure and cholesterol on self-management forms to compare with targets. "We try to help them set reasonable goals," said Dela Cruz.
Torres' readings were dangerously high when he entered the program. Now they're below recommended levels.
"It's like a car," Dela Cruz said. "He's the driver. We're teaching him to be a self-manager. We can say, 'Do this, do that,' but if he doesn't do it, forget it."
An electronic management system enables the team to track patients in the two registries.
All information is computerized, including medications, lab tests, smoking history, dates of flu and pneumonia shots, exercise, diet and diagnoses and notes from doctors and nurses, their appointments and whether they're no-shows.
"Everything is graphed," Dela Cruz said. "We can show if the patient is doing good or bad."
A team member goes through the self-management form with the patient on every visit to review and update the readings and discuss lifestyle or medication changes.
"We make sure they have flu shots, and if a patient doesn't have insurance, we try to hook them up," Dela Cruz said.
The team meets weekly to review the program and discuss developments and changes. They integrate with other health programs and groups in the community.
"All those types of activities, if we do them right, will enhance our care over what was available when we all took care of patients in our individual offices," Humphry said.
He said the Institute of Health Care Improvement intends by 2010 to mandate all community centers receiving federal funds to join in changing the health care system.
Kalihi-Palama is a model for the program, he said, adding, "Marissa has done an excellent job."
Patients are charged minimal fees on a sliding scale, and the center seeks donations for educational materials. It relies heavily on help from pharmaceutical companies, diagnostic laboratories and other community resources.
The Bureau of Primary Health Care gives the center no money but flies team members to training sessions on the mainland four times a year.
Kalihi-Palama was chosen to showcase its program at a session next Thursday to Feb. 10 for 20 Western community health centers.
As participants learn the technique, Humphry said, the intent is to spread it to all chronic diseases and possibly other aspects of medical care.
"We don't want to just improve quality of care for people who have heart attacks. We're committed to making the system change."