Over the course of three years volunteering at Student Health Action Coalition (SHAC), the nation’s oldest student run health clinic, Laura Cone and Stephanie Kiser continually faced the challenge of doing chronic disease management for patients in an acute care setting. Although patients with chronic conditions were routinely referred to providers in the Chapel Hill area to establish long-term primary care, waiting lists of up to a year at those clinics meant that many of them repeatedly returned to SHAC long after their medications had run out and their disease had become even more unmanageable. Further complicating their treatment was the fact that SHAC’s acute care design meant that even when they made it to the student-run clinic they had no continuity of care because they saw a different team of providers at each visit.
Concerned about the impact this lack of comprehensive primary care was having on their chronically ill patients, Cone and Kiser, both UNC medical students studying public health, decided to investigate the frequency of the problem. What they found was alarming: roughly 40 percent of patient visits to SHAC were for chronic disease management.
One patient in particular inspired Cone to work toward a solution. Cone diagnosed her with diabetes late one evening, shortly before the clinic closed. “She rightly had a lot of questions about her new diagnosis and I educated her the best I could in the small amount of time we had,” Cone recalls. “I felt like I hadn’t provided her the best care possible because of time constraints and I had no way of personally following up with her as you would in a typical primary care clinic. Within our new Bridge-to-Care model, we can now provide these types of patients with all of the benefits of continuity with the provider and the education needed through group visits.”
Bridge-to-Care is the program Cone and Kiser developed as BCBSNC Foundation Schweitzer Fellows. Patients at the clinic, which is housed at SHAC, are ensured the continuity of care necessary to manage their chronic diseases. They are assigned a dedicated medical team that sees them each time they visit and receive resources and assistance to overcome the barriers to finding a medical home and having better control of their disease. Additionally, with an eye toward educating patients on how to live a happy and healthy life in the setting of a chronic disease, Cone and Kiser hold weekly group visit sessions with their patients to discuss issues related to managing their conditions.
Both students are excited about the positive impact continuity of care is having on their patients. Kiser proudly recalls one of the first patients they saw, a woman with a 10-year history of Type 2 diabetes who had neglected her medication regimen. At her initial visit, the patient was worn down and had difficulty completing the tasks of daily living. She was skeptical about medication.
“I worked with her over the next six months, during which she gained complete control of her diabetes, was able to lose weight, and doubled her productivity at work,” says Kiser. “While we had all of the resources to help her achieve those goals she had gone for a very long time without believing there was anything she could do about her disease. It’s often easy to take for granted the resources we have and this was a reminder not to do that. This story along with many others has been so inspirational to me and is the reason I love our program and this patient population!”
Their program is getting excellent results and they were recently recognized for their work with the Alcott Fellowship Award. Cone and Kiser will be presenting about their program at the Society of Teachers of Family Medicine conference in Orlando and the Southern Group on Educational Affairs conference in Charlotte this April. Kiser and Cone also believe Bridge-to-Care will be easily sustainable through the SHAC infrastructure. “We already have recruited strong leaders to take over the program over the next years and will continue to work with the overarching SHAC organization to ensure the program is supported and sustained,” says Cone.
Given the level of support Bridge-to-Care has received throughout their Fellowship, that’s a likely scenario. Cone and Kiser each say that teamwork was critical to their success.
“The most surprising part of this experience has been the overwhelming amount of support we have received from our mentors, other Schweitzer Fellows, students, school, patients and community,” says Kiser. “We have reached out to so many individuals for help throughout the course of our project and have been met with open arms and enthusiasm. Seeing the passion that others have for ending health disparities and promoting the health of others is inspirational and I am truly thankful for all of the support we continue to receive.”
“Bridge-to-Care has truly been a group effort with many members of both the UNC and Chapel Hill/Carrboro community stepping up to provide the services for our patients,” adds Cone. “Many people were ready and willing to take on the challenges of starting a new program such as finding resources, volunteers, and funding. People in this community have true passion for caring for the underserved.”