For low-income patients, providing home health care


When Fernando Gallegos arrived at his patient’s – a delivery of medication and a standard check-in – he found the man frantic.

Her patient had accidentally overturned her pill containers, spilling their contents on the floor. Legally blind and barely able to see colors and shapes, he had been unable to grasp much.

Gallegos, a community health worker and pharmacy technician, didn’t bat an eyelid. Helping his patients in unconventional ways – whether it was offering a listening ear or moving heavy objects around the house – was part of the job.

“We had a great time on his kitchen table trying to sort all of his meds,” Gallegos recalls. He filled the pill organizers and gave them large, brightly colored labels to differentiate the morning from the evening medication.

Gallegos works for the Share Our Selves Community Health Center based in Orange County, Calif., Which has developed a new clinical pharmacy program designed to more effectively treat diabetes and hypertension in their predominantly Spanish-speaking community. Most of their patients are at or below the federal poverty line.

BD, in collaboration with Direct Relief, awarded Share Our Selves a grant of $ 150,000 as a recipient of the Helping Build Healthy Communities initiative. With prize funding, they developed a program that combines home visits and drug delivery with improving patients’ digital literacy – with the goal of getting them to participate in more convenient telehealth visits.

A new model of care

Many health centers and community clinics switched to telehealth when the pandemic struck. But even before the pandemic, the Share Our Selves clinical pharmacy team was making phone calls.

“The reason it started is that the pharmacy department had very high no-show rates,” said Nancy Dao, director of clinical pharmacy. For some patients, “it’s a ten minute visit, and they have to take the bus for two hours.”

Because advisory visits with the pharmacy department don’t need to be billed to insurance, “we can be a kind of dark horse” and find the most efficient way to visit, Dao said. . “We were basically the model of care for everyone.”

Share us in Costa Mesa, California. (Photo by Donnie Lloyd Hedden Jr. for Direct Relief)

In addition, the pharmacy department often holds brief meetings with patients every two weeks or every month, with the goal of achieving short-term goals such as improving blood sugar or blood pressure. Ensuring that they could participate in the visits was an important part of achieving these goals. Dao wanted to set up video visits for his patients – and get their medications straight to their homes.

This is where Gallegos came in. Dao knew him from a previous job and asked him if he was interested in a community health worker position.

“What really attracted me was coming back and talking to people – mine – and helping mine. And I thought I could really make an impact here, ”said Gallegos.

Gallegos grew up in eastern Santa Ana, in a neighborhood similar to where many of his patients live. “I grew up on the wrong side of town… it can get very difficult,” he recalls. “Our first language was Spanish; I didn’t learn English until I was in second grade.

When they decided to implement video telehealth for their patients, they assumed that many of their patients would not have had the technology. They were wrong, Dao said.

“What we’ve seen so far is that patients actually have access to the technology,” she said. “Patients have these smartphones, but they don’t know how to download apps.”

Often a son or daughter will buy the phone for a parent who is unsure of how to use it. Dao said writing down the video conferencing app’s username and password has made a big difference to patients.

So when Gallegos arrives at a home, he’s not just there to drop off medications and medical supplies like a blood glucose monitor or blood pressure cuff. He brings a computer and a Wi-Fi hotspot, so he can help with technological issues and even attend a virtual tour if necessary.

Inside the patient’s home

For many of their patients, these home visits are more than just a convenience. “I hear the dogs barking, I hear the children screaming, and I’m like, OK, no wonder you want to [a home visit]Dao said. Since the beginning of May, around 60 patients have signed up for home visits.

But, according to Dao and Gallegos, the visits have become more than just a session of drug delivery and technological troubleshooting.

Since many patients are food insecure, a member of the pharmacy team usually calls a few days in advance to ask if they would like a bag of food with their medication. Then, the home visit becomes an opportunity to gain a more complete understanding of the patient’s health and situation.

Nancy Dao, Clinical Pharmacy Manager and Fernando Gallegos, Community Health Work and Pharmacy Technology.  in the Sharing Our Selves (SOS) pantry in Costa Mesa, California.  where donated food is repackaged and served to those in need.  As the winner of the BD Helping Build Health Communities award, Share Our Selves (SOS) has strengthened its clinical pharmacy program specifically to more effectively treat chronic conditions such as diabetes and hypertension.  They used grant funds implemented by Direct Relief to hire a community health worker and pharmacy technician (Fernando Gallegos) to make home visits, dispense medications, assess social determinants of health and further develop the effectiveness of telehealth and digital literacy.  SOS is a nationally recognized health center that provides comprehensive, high quality safety services to the Orange County community.  One of 256 health centers nationwide to be designated as a homeless health care provider, SOS is a patient-centered medical home and values ​​the concept of the right person, the right treatment, at the right time.  PHOTO: Donnie Lloyd Hedden Jr. 2021
Nancy Dao, head of clinical pharmacy and Fernando Gallegos in the pantry of Share Our Selves. (Photo by Donnie Lloyd Hedden Jr. for Direct Relief)

“It’s almost like social work. When you go there you kind of see how they live. You… get a feel for the overall picture of the patient, ”said Gallegos.

This sense can include where and how a patient sleeps. If an elderly person is the victim of neglect or isolation. Whether food, transportation, or other support is needed. “These are the people that no one thinks of,” said Gallegos.

Dao explained that the clinical pharmacy program has given them a better understanding of patients’ needs, but it’s not always easy to find the best way to help them. A patient may be in urgent need of money; another may be illiterate. But the goal is to find concrete steps to address some of the challenges they see most often.

“Now that we’re actually at home and can see more of the social determinants of health at play, we’re trying to see how we can capture this data,” Dao said.

Gallegos’ relationship with patients plays an important role. A patient, living in an apartment with few furnishings and no bed, shared a long history of abuse that led her to come to the United States with her brother. “She had a very difficult life and… she always had a very positive attitude,” he recalls. “Always laugh, always smile. It really marked me. “

Gallegos works to find him a bed. “People need to rest,” he said.

Another patient, who only learned to read late in life, enjoys talking about books with Gallegos, who is an avid reader. (He cites Carlos Castaneda and Gabriel García Márquez as favorite authors.)

“Culturally… I can get to know the patients better, they are a little more comfortable with me,” he said. Sometimes, he said, his role is to be “just an ear to talk to. Sometimes they need to let him out.

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