Category Archives: Health Care Access
Vanessa Grubbs, MD, MPH, is an assistant professor at the University of California, San Francisco, School of Medicine, and a scholar with the RWJF Harold Amos Medical Faculty Development Program. She is writing a book about what she calls the “sometimes irrational use of dialysis in America,” which will include a version of this narrative essay.
It is a Monday afternoon like any other and time to make my weekly rounds at the San Francisco General Hospital outpatient dialysis center. I push my cart of medical charts down the long aisle of our L-shaped dialysis unit and see Mr. Rojas, my dialysis patient for over a year now. He is in his mid-40s and slender, sitting in the burgundy-colored vinyl recliner. His blue-jeaned legs and sneakered feet are propped up on the extended leg rest. The top of his head shines through thinning salt and pepper hair. White earbud headphones peek through gray sideburns. He is looking intently at his Kindle, rarely glancing up at the activity around him.
I roll my cart up to his recliner, catching his eye. His right hand removes the earbuds as the left pauses his movie. He looks up at me, smiling. “Hola, Doctora. How are you?” he says with emphasis on the “are.”
“I am good. How are you doing?” I smile back at him as I grab his chart from the rack. I write down his blood pressure and pulse—both normal—and the excellent blood flow displayed on the dialysis machine. My eyes shift to his fistula, the surgically thickened vein robustly coursing halfway up his left forearm like a slithering garden snake. It is beautiful to me. Through it, Mr. Rojas is connected to the dialysis machine.
“I am good, Doctora. No problems. I feel healthy. Strong.” His brown eyes glint.
Kristi Henderson, DNP, NP-BC, FAEN, is the chief advanced practice officer and director of telehealth for the University of Mississippi Medical Center, where she holds dual appointments in the School of Medicine and School of Nursing. She has an administrative and clinical practice as a family and acute care nurse practitioner, and is a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow. This post is part of the “Health Care in 2014” series.
As we ring in the New Year, do any of these scenarios ring true for you or your family?
- There is someone who suffers from diabetes but lives an hour from a diabetes specialist. They can’t stay in the community where they live for treatment and an already-taxing diagnosis becomes a burden to treat. What if there was a way that the diabetes specialist, diabetes educator, pharmacist, ophthalmologist, and nutritionist could all be brought to this patient virtually by way of today’s technology? What if there was a way for a treatment plan to be customized to each patient and adjusted in real-time from information uploaded from a smartphone?
- There is someone who has heart failure and for every ‘flare up’ the only option is to go to the local emergency room (ER). Medication and check-up regimens are followed every year but the ER visits are the only way to see a health care provider at a moment’s notice. What if health stats, vital signs, and symptoms could all be tracked by the health care provider to identify subtle changes early on, or when symptoms begin to worsen, and interventions could avoid an ER visit? Imagine if symptoms, vital signs, weight and medication side effects were monitored while a patient with heart failure goes about their day, not just at their scheduled check-ups.
Janice Johnson Dias, PhD, is a Robert Wood Johnson Foundation New Connections alumnus (2008) and president of the GrassROOTS Community Foundation, a health advocacy that develops and scales community health initiatives for women and girls. She is a graduate of Brandeis and Temple universities and a newly tenured faculty member in the sociology department at City University of New York/John Jay College of Criminal Justice.
Policy action and discussion this month have focused on poverty, sparked by the 50th anniversary of Lyndon Johnson’s War on Poverty and Dr. King’s birthday. Though LBJ and King disagreed about the Vietnam War, they shared a commitment to ending poverty. Half a century ago, President Johnson introduced initiatives to improve the education, health, skills, jobs, and access to economic resources for the poor. Meanwhile, Dr. King tackled poverty through the “economic bill of rights” and the Poor People's Campaign. Both their efforts focused largely on employment.
Where is health in these and other anti-poverty efforts?
The answer seems simple: nowhere and everywhere. Health continues to play only a supportive role in the anti-poverty show. That's a mistake in our efforts to end poverty. It was an error in 1964 and 1968, and it remains an error today.
Let us consider the role of health in education and employment, the two clear stars of anti-poverty demonstrations. Research shows that having health challenges prevents the poor from gaining full access to education and employment. Sick children perform more poorly in schools. Parents with ill children work fewer hours, and therefore earn less. Health care costs can sink families deeper into debt.
On Martin Luther King, Jr. Day, an RWJF Scholar and Soon-to-Be Physician Resolves to Help End Health Disparities
Cheryl Chun, MS, MA, is a Robert Wood Johnson Foundation Health Policy Scholar (2011) at the Center for Health Policy at Meharry Medical College and a medical student at Meharry Medical College. She received a BS degree from George Washington University and an MA from American University. She taught for Teach for America for two years.
Every year on Martin Luther King, Jr. Day, our country takes a moment to reflect on the progress we have made toward becoming the nation we have always strived to be—one of equality. And while many of us would agree that significant headway has been made, we all know that we still have so much farther to go before we can truly achieve Dr. King’s dream.
I read the local and national news regularly and there always seems to be another article or story that speaks to the ongoing challenges of realizing this equity, including the educational achievement gap, health disparities, and even policies that allow inequalities to continue to exist across our society. It is almost scary that so many critical components of our lives are determined solely by our place of residence. In fact, it’s one’s zip code that often has the greatest impact on the quality of one’s education, one’s future health status, and even the types of food and nutritional resources to which one has access. These social determinants of health ultimately decide who will remain healthy throughout life and who will eventually become unwell.
Newly minted physicians who train in underserved health facilities are much more likely to continue practicing in such facilities after completing their residency training, according to research by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, an independent research unit of the American Academy of Family Physicians (AAFP).
The study, “Do Residents Who Train in Safety Net Settings Return for Practice?,” found that up to half of medical residents who trained in rural health clinics, critical access hospitals, and federally qualified health centers—which serve most of the nation's uninsured and underinsured patients—returned to practice in those settings. The study is published in the December issue of Academic Medicine.
“Overall, between one-third and one-half of the residents we identified in any of these settings during training were also identified as practicing in these same settings after training,” writes Robert Phillips, MD, MSPH, and his co-authors.
Telepresence robots are expanding access to specialists in rural hospitals experiencing shortages of physicians, and in other hospitals throughout the country, reports the Associated Press.
Devices such as the RP-VITA, introduced earlier this year, can be controlled remotely with a desktop computer, laptop, or iPad, allowing physicians to interact with patients through video-conferencing via a large screen that projects the doctor's face. An auto-drive function allows the robot to find its way to patients' rooms, and sensors help it avoid obstacles. It also gives the physician access to clinical data and medical images.
Dignity Health, a hospital system with facilities in Arizona, California, and Nevada, started using telepresence robots five years ago to promptly evaluate patients who had potentially suffered strokes. Dignity now has robots in emergency rooms and intensive care units at about 20 California hospitals, giving them access to specialists in areas such as neurology, cardiology, neonatology, pediatrics, and mental health.
Ryan Greysen, MD, MHS, is an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program, and an assistant professor of medicine at the University of California, San Francisco (UCSF), Division of Hospital Medicine. He works closely with the Global Health Hospitalist program at UCSF to help train fellows and conduct research in quality improvement for hospitalized patients in developing settings. Phuoc Le, MD, MPH, is an assistant clinical professor of medicine and pediatrics at UCSF. He co-directs the Global Health-Hospital Medicine Fellowship at UCSF, directs the Global Health Pathway for the Pediatric Residency, and is director of international rotations for the Internal Medicine Residency.
U.S. medical education has entered a golden era of growth in global health interest and involvement, but surprisingly little is known about global health after training is completed. In 1978, only 6 percent of graduating medical students reported experiences in global health (GH), but today more than 25 percent participate in global health activities during medical school, and 66 percent plan to participate in GH work during their career. Since this "surge" has started with trainees, many of the recent studies on global health work have focused on medical students or residents.
Interestingly though, we have much less information on what happens after the trainees become full-fledged physicians. Do they continue to engage globally either as professionals or volunteers? If so, do they focus on clinical work, education, research, or health policy? We recently conducted a pair of surveys to answer these questions in two specific groups of doctors: those who have received research and leadership training through the longest- program of this kind in the U.S. (the RWJF Clinical Scholars program) and those who have joined the ranks of the medical profession's fastest-growing sub-specialty: hospitalists.
Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of RWJF’s nursing programs, and the latest news, research, and trends relating to academic progression, leadership, and other essential nursing issues. These are some of the stories in the November issue:
For decades, experts have called for more team-based care but the movement has gained traction in recent years with more health professions schools incorporating interprofessional education into their coursework. Proponents say this kind of education will prepare students to practice in coordinated, well-functioning health care teams, which in turn will help meet increasing, and increasingly complex, patient needs. Officials in several professions are considering making interprofessional education and training a requirement for accreditation for health professions colleges and universities.
For nearly 25 years, Robert Wood Johnson Foundation Community Health Leader Carmen Velásquez, MA, has helped members of Chicago’s immigrant community access the health care they need. She founded the Alivio Medical Center in 1988, which has now grown to six locations that serve 25,000 patients annually. Two more clinics are slated to open later this year.
In recognition of her work, Illinois Governor Pat Quinn proclaimed October 2, 2013 “Carmen Velásquez Day.” At an event celebrating Latino Heritage Month at the National Museum of Mexican Art in Chicago, Quinn called Velásquez “a true pioneer in public health policy and health care affordability.”
“As the immigrant population in the Pilsen neighborhood grew in the 1980s, Carmen Velásquez was among the first to see the crying need for a health clinic, so she went out and built Alivio Medical Center,” he said. “Hundreds of thousands of Illinoisans are alive today thanks to her, proving that one person truly can make a difference.”
The U.S. Department of Health & Human Services (HHS) last week released a report that looks at Medicare patients’ access to care before and after the enactment of the Affordable Care Act. The report from HHS’s Office of the Assistant Secretary for Planning and Evaluation finds that Medicare beneficiaries’ access to care has remained high and stable in recent years.
The percentage of office-based physicians accepting new Medicare patients remained stable from 2005 to 2012, at approximately 90 percent. That rate is “quite similar” to the number of physicians accepting new privately insured patients during the same time period, the report says.
The report also finds that the number of providers participating in and billing Medicare steadily increased during those years.
“Based on multiple data sources, Medicare beneficiaries’ access to care appears to be excellent: it has been stable over the past five years and is comparable to or better than access reported by privately insured individuals,” the report says.