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When Fernando Gallegos arrived at his patient’s house – a standard medication delivery and check-in – he found the man frantic.
His patient had accidentally upset his pillboxes, spilling their contents all over the floor. Legally blind and barely able to see colors and shapes, he’d been unable to pick many of them up.
Gallegos, a community health worker and pharmacy technician, didn’t bat an eye. Helping his patients out in unconventional ways – from offering a sympathetic ear to moving heavy objects around the house – was a part of the job.
“We spent a good time on his kitchen table just trying to sort out all his medications,” Gallegos recalled. He refilled the pillboxes and gave them big, brightly colored labels to differentiate the morning medications from evening ones.
Gallegos works for the Orange County, California-based community health center Share Our Selves, which has developed a new clinical pharmacy program designed to treat diabetes and hypertension more effectively in their largely Spanish-speaking community. Most of their patients are at or below the federal poverty line.
BD, together with Direct Relief, provided a $150,000 grant to Share Our Selves as a winner of the Helping Build Healthy Communities initiative. With the award funding, they’ve developed a program that combines home visits and medication delivery with improving patients’ digital literacy – with the goal of having them participate in more convenient telehealth visits.
A New Model of Care
Many community health centers and clinics moved to telehealth when the pandemic hit. But even before the pandemic, Share Our Selves’ clinical pharmacy team was doing telephonic visits.
“The reason why it started was because the pharmacy department was having really bad no-show rates,” explained clinical pharmacy manager Nancy Dao. For some patients, “it’s a ten-minute visit, and they have to take the bus for two hours.”
Because consultative visits with the pharmacy department don’t need to be billed to insurance, “we can be kind of the dark horse” and figure out the most effective way to conduct visits, Dao said. “We were essentially the model of care for everyone else.”
In addition, the pharmacy department often has brief meetings with patients biweekly or monthly, with the intent of meeting short-term goals like improving blood sugar or blood pressure. Making sure they could participate in visits was an important part of meeting those goals. Dao wanted to establish video visits for her patients – and get their medications directly to them at home.
That’s where Gallegos came in. Dao knew him from a previous job, and reached out to ask if he was interested in a position as a community health worker.
“What really attracted me was coming back and talking to the people – my people – and helping my people. And I thought, I could really make an impact down here,” Gallegos said.
Gallegos grew up in eastern Santa Ana, in a neighborhood similar to the ones where many of his patients live. “I grew up on the bad side of town…it can get really rough,” he recalled. “Our first language was Spanish; I didn’t learn English until I was in the second grade.”
When they set out to establish video telehealth for their patients, they assumed that many of their patients wouldn’t have had the technology. They were wrong, Dao said.
“What we’ve found so far is that patients actually do have access to technology,” she said. “Patients have these smartphones, but they don’t know how to download apps.”
Often, a son or daughter buys the phone for a parent who has little idea how to use it. Dao said that writing down the username and password for the videoconferencing app has made a big difference to patients.
So when Gallegos arrives at a house, he’s not just there to drop off medications and medical equipment like a glucometer or blood pressure cuff. He brings a computer and Wi-Fi hotspot, so he can help with any technology problems and even sit in on a virtual visit if need be.
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 [a home visit],” Dao said. Since the beginning of May, approximately 60 patients have signed up for home visits.
But, according to both Dao and Gallegos, the visits have blossomed into much more than just a medication delivery and technology troubleshooting session.
Because many patients are experiencing food insecurity, someone from the pharmacy team will typically call a few days in advance to ask if they’d like a food bag along with their medication. Then, the home visit becomes an opportunity to gain a more complete understanding of the patient’s health and circumstances.
“It’s almost like social work. When you go in there, you kind of see how they’re living. You…get a sense of the whole picture of the patient,” Gallegos said.
That sense might include where and how a patient sleeps. Whether an older adult is experiencing neglect or isolation. Whether food, transportation, or other support is needed. “These are the people that nobody thinks about,” Gallegos said.
Dao explained that the clinical pharmacy program has given them insight into patients’ needs, but that figuring out how best to help them isn’t always easy. One patient may urgently need money; another might be illiterate. But the goal is to figure out concrete steps to address some of the challenges they see most often.
“Now that we’re actually in the home and we can see more social determinants of health at play, we’re trying to see how we can capture that data,” Dao said.
Gallegos’s rapport with patients plays an important role. One patient, living in an apartment with minimal furniture and no bed, confided a long history of abuse that had driven her to come to the United States with her brother. “She had a really tough life, and…she still had a really positive outlook,” he recalled. “Always laughing, always smiling. That really stood out to me.”
Gallegos is working to get a bed for her. “People need to rest,” he said.
Another patient, who only learned to read late in life, loves 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 a little bit better, they’re a little more comfortable with me,” he said. Sometimes, he said, his role is to be “just an ear for somebody to talk to. Sometimes they need to let it out.”