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At CommunityHealth, a free clinic in Chicago, about half of patients live with a chronic condition. Approximately a quarter have diabetes.
Diabetes is a complex condition that generally requires changes to diet and exercise as well as careful monitoring and medication. “You’re often assuming, as a medical provider, that they may be able to join a gym or be able to buy exercise equipment,” said Laura Starr, director of development and communications at CommunityHealth.
But the vast majority of the clinic’s patients are uninsured and low income, making a holistic approach to diabetes care difficult. Many work in restaurants or on construction sites.
“It became very clear very quickly that what [a provider] would recommend to any patient with diabetes might be more difficult for them to access,” Starr said. “We knew early on at CommunityHealth that, if we were going to recommend something to our patients, we wanted to be able to provide that thing if at all possible.”
Today, CommunityHealth’s offerings include services from a wide variety of doctors and specialists, such as podiatrists, nephrologists, and ophthalmologists, who deal with some of the complications of diabetes. But the clinic is also intensely focused on providing the kinds of resources that help keep patients from needing those services to begin with.
Patients can meet regularly one-on-one with a pharmacist or nurse. Glucometers and test strips are available for patients who need them. A cooking and nutrition class is designed to teach patients to care for their health in a way that’s accessible and culturally appropriate. Patients who need help accessing nutritious food are connected to a local food pantry. And pre-pandemic, the clinic offered kickboxing, pilates, yoga, and other exercise classes. “We’re only as limited as the volunteers we can find,” Starr said.
In addition, the clinic just created a micro-site in a neighborhood where many of their patients live – and that, for many of them, required two bus transfers to get to a clinic location. Patients can have their vitals checked and labs drawn, and a reliable telehealth connection is available on-site. The site shares a location with a community organization that offers food services, English-language courses, and other resources.
Supporting on-the-ground efforts
CommunityHealth was the recent recipient of a grant from Direct Relief and the Baxter International Foundation, to support their work caring for diabetes in a holistic and sustainable way. The Transformative Innovation Awards in Community Health, as this three-year program is known, invests in programs that work to expand access to diabetes care through nutrition, prevention, and treatment.
“Providing patients with resources and education to manage and prevent diabetes is an important component of our commitment to empower patients,” said Verónica Arroyave, executive director of the Baxter International Foundation. “We are inspired by how each clinic that has received funding through this program has implemented innovative solutions that address specific needs of their community members.”
The awards come as safety net providers around the country take on the challenge of finding creative but sustainable ways to meet the needs of patients with chronic diseases. Many clinics and other organizations rely on volunteers or private funding to keep their doors open.
But underserved patients rely on these organizations and programs in turn. “Patients who come to CommunityHealth are typically those who don’t have anywhere else to go,” Starr said. When providers ask patients where they’d receive treatment if the clinic weren’t open, “most either say ‘the emergency room’ or ‘I wouldn’t get care’ or ‘I don’t know.’”
An integrated approach
At Faith Community Health, a charitable clinic in Branson, Missouri, and another awardee of the Baxter International Foundation-funded program, a 12-week class teaches first healthy living habits, then cooking, in a way that takes into account their patients’ financial and environmental challenges.
For example, a patient may need to exercise but “may live in a place that doesn’t have sidewalks or it’s very hilly,” said Heather Lyons-Burney, a clinical pharmacist at Faith Community Health. Someone who needs to lose weight may not have a scale. Someone who needs to cook healthy meals may need an appliance to cook them in.
Faith Community Health works to meet those needs for patients, providing Instant Pots, scales, access to food, and other necessities for people enrolled in the course.
“We’re all about ‘How do we change someone’s lifestyle?’” said Lyons-Burney. “You’ve got to give someone the skills and the tools to do that.”
Lyons-Burney explained that having this program integrated into their clinic operations makes it particularly effective. “It’s a place that they are already comfortable with. They come to us as a clinic; they come to us to get their medications,” she said. “They’re coming to see familiar faces.”
For many patients, just meeting basic needs is a challenge. Dealing with the complexities of diabetes care, and the holistic approach it so often needs, might be insurmountable without Faith Community Health’s intervention.
“No one would ever think of a dietician or cooking class,” Lyons-Burney said. “Getting exposure to these things would be completely outside their budget, and they would just remain unhealthy.”
At Puerto Rico’s Asociación Puertorriqueña de Diabetes, patients who participate in a holistic program have been shown to have improved A1C levels – a blood sugar test that’s frequently used to monitor diabetes. Program participants meet with a health educator, nutritionist, psychologist, endocrinologist, and personal trainer to address the different ways that a diabetes diagnosis affects their lives.
For example, a psychologist can help a patient come to terms with the changes in lifestyle and feelings that come with a diabetes diagnosis, said Adia Aponte, the organization’s coordinator of communications and health education services.
The program is designed to lower A1C levels, decrease body mass index, and teach patients to incorporate healthy habits into their daily lives. Patients exercise together, learn healthy cooking together, and even have a dedicated WhatsApp chat.
In a previous group, one patient lost 10 pounds in a month, Aponte said. This new iteration of the program, funded by one of the Baxter International Foundation awards, will serve 25 patients over three months.
Aponte stressed that the goal is to teach sustainable habits that will continue long after participation is over. “The change doesn’t stop with the program,” she said.
This ability to help patients – particularly those who may not otherwise receive reliable health care – make lasting changes can’t be overstated. That’s one of the many reasons why supporting the efforts of safety net healthcare providers is so essential, said Rose Levy, a program manager at Direct Relief.
“These providers are doing amazing work,” she said. “It doesn’t take moving heaven and earth to help them do well by their patients.”