Rina Ramirez, MD FACP Teresita Lawson, BS Pharm, CDE Established - - PowerPoint PPT Presentation

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Sep 04, 2023 250 likes •369 views

Rina Ramirez, MD FACP Teresita Lawson, BS Pharm, CDE Established in 1990 in Dover FQHC since 2004 Serving 4 counties in NW NJ Serving homeless, residents of public housing, farm workers Served 15,000 in 2011, 95% under

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Rina Ramirez, MD FACP Teresita Lawson, BS Pharm, CDE

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 Established in 1990 in

Dover

 FQHC since 2004  Serving 4 counties in NW

NJ

 Serving homeless,

residents of public housing, farm workers

 Served 15,000 in 2011,

95% under 200% poverty level, 70% uninsured, and the majority were Hispanic or other ethnic minority.

 73% of patients are

adults, 6% are seniors (most are residents of public housing)

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

Open 7 days/week with late hours at most sites, and Saturdays in two sites

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24/7 bilingual call coverage

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Some services provided:

Pediatrics
Adult Medicine
Family Medicine
Women’s Health
Ryan White Part A and C
Dental
Dental Screenings for Children
Podiatry
Behavioral Health
Clinical Pharmacy Services
Outreach Services
Patient Navigation
Case Management
340B Pharmacies
Reach Out and Read
Support Groups

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 Clinical Pharmacy Services

Pharmacist provides education &

counseling on medication management, diseases, nutrition, lifestyle changes to help patients with diabetes, high blood pressure, lipids and HIV

 Healthy Weight

Collaborative

MAs and providers review healthy lifestyles including exercise, eating habits and the Plate Method

 Breast Patient Navigator

Program

Uninsured patients receive free

mammograms and f/u studies, assistance through system if have breast cancer and other conditions

 Patient Centered Medical

Home

Team working towards NCQA recognition, and improving access to care, care management, medication reconciliation on transitions of care, patient empowerment and more

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Our Morristown office is located 1 block away from a public housing building and 2 blocks away from a large residential complex. During Hurricane Sandy, parked the mobile van outside

ur center to provide care to

patients despite having no power.

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 Presented with A1C of 10.1% in January 2011  Significant Barriers – isolation, loneliness, low

self esteem, social and cultural barriers, denial, low health literacy and medication non adherence

 Was on multiple oral diabetes medications

(metformin, glipizide, januvia, starlix) and did not want to go on insulin

 What we did to help him…..

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 For the next two months, met with PCP and

clinical pharmacist

Resisted going on insulin- kept avoiding visits
Team did not give up on him - kept calling and

rescheduling

Whenever he came:

 Discussed his situation, built trust with every visit  Asked open ended questions, “peeling an onion” - addressing barriers  Reviewed all aspects of living with diabetes  Used motivational techniques and gave encouragement  Reviewed Self Care Behaviors at every visit always building

n each accomplishment - monitoring

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 Started insulin May of 2011  In July 2011, A1C down to 7.8%

Patient sees progress with insulin use
Patient encouraged by not having to take so many

pills

 Set backs due to loneliness and isolation  Despite these setbacks and challenges, FP

now keeps every appointment he has with the pharmacist and with the provider.

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 Frequent follow with same provider, clinical

pharmacist and staff

 Consistent “what’s in it for me” motivation  Lowering and simplifying his medication load  Patient/Team work and collaboration  The patient is at the center of his care-

Involved in making decisions
Makes sure that he gets all preventive services
Is 100% adherent with medications

 Trust Building  Listening

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