By Minali Nigam
North Carolina hospitals say they are moving toward a new way of health care delivery: patient care beyond hospital walls.
Hospital officials and staff members came to the legislature last week, where they talked about how they’re partnering with community groups like food pantries and home-visiting programs to improve medical services and patient outcomes.
In one of the interior courtyards of the legislative building in Raleigh, a dozen hospitals and health care companies had tables displaying everything from new ways of measuring patient satisfaction to information about a community farmers’ market at a local hospital.
“We’re here to let the General Assembly know that we are working steadily on an innovational advancement to transform health care in North Carolina,” said Cody Hand, a lobbyist for the North Carolina Hospital Association.
Melissa Lewis, a nurse at Ashe Memorial Hospital, said many of her patients have difficulty following through with their medical-treatment plan because they lack basic necessities, like food.
In Ashe County, one in six adults and one in three children have limited access to food, Lewis said.
To combat their patients’ hunger, last December the Ashe County Sharing Center suggested making the hospital a food pantry for the community. Every patient admitted to Ashe Memorial Hospital is asked on an intake form about food insecurity. When they’re discharged, those patients in need are given a food box that lasts for about a week.
“I’ve had patients come back three months later, and when asked if they want a food box they say, ‘No, I don’t need it anymore. It was there when I needed it, and I have a job now, and I’m doing great,’” said Lewis, who’s also the hospital’s food pantry program director.
“It was a need at that moment. And that’s very humbling. I was able to help someone by roughly a $3 food box,” she said.
Hospital CEO Laura Lambeth said Ashe Memorial is the first hospital in the state with a food pantry program, and hopes for continued growth.
“Our philosophy is to help our community. But how can patients heal when they don’t have nutritious food?” she asked.
Supported through grant money, the Ashe Memorial Food Pantry Program has helped 176 patients get food boxes since its launch. In the fall, Lewis is adding a “Cooking Matters” class to the program, inviting patients who received food boxes to learn to grocery shop and cook on a budget.
“In a couple years, I hope to see readmissions rates go down,” Lewis said. “I’d like to see involvement in the community more, maybe even getting local farmers to do some produce, and cutting down our food insecure population in the county.”
In Vance and Nash counties, hospitals have directed attention toward improving transitional care by partnering with the N.C. Mobile Medication Program, or MMP, a pilot initiative for visiting behavioral health patients in their home.
Staff members teach patients with severe mental health problems how to take their medications and build medication management into their daily routine.
“After psychiatric hospitalizations or an ED visit, patients are sometimes prescribed up to 10 to 12 different medications,” said Katelyn Chiang, a MMP assistant.
“A lot of times, it’s not that they want to be uncompliant with their meds, they’re just honestly confused. When you have 10 different pills, you don’t always know when to take them and what to take them with.”
Launched in early 2015, the MMP works with patients for six months, starting with daily home visits and transitioning to weekly phone calls, with the ultimate goal of patients taking medications routinely without any help. Chiang said that with the program still in its infancy, there’s uncertainty about whether it would include services for patients with issues other than mental health.
Participants in Nash and Vance counties are already more likely to take their prescribed medications on time and correctly, according to a case study done by the MMP. Patients have also had a 75 percent reduction in psychiatric hospitalization.
Chiang says these types of health outcomes make MMP expansion to other counties more promising.
Access to specialized pharmacies
It’s one thing to take your medications correctly; it’s another to be able to get them at all, especially if you’re uninsured. But a program in Durham is helping patients do just that.
Lynn Robbins, who heads pharmacy services at Lincoln Community Health Center, said a partnership with Duke Regional Hospital has eased the burden for uninsured patients to get specialty medications. Patients using the health center’s pharmacy can get discounts for medications and a face-to-face consultation with a pharmacist.
“In the hospital setting, we know about quality, we know how to do performance improvement,” Robbins said.
“Because of this partnership, we’re able to integrate those quality tools into our health safety net organizations and bring about transformational care,” she said.
The majority of patients who receive their primary care services at Lincoln are uninsured. Robbins said the collaboration with Duke Regional enables patients to receive good health care by making sure their medications are affordable and accessible.
“A premier partnership of hospital and community can decrease health care cost and improve population health,” she said.