By Daniel Weintraub
Residents of poor, inner-city neighborhoods have a notoriously difficult time getting access to health care. Gloria McNeal has a simple solution to that problem: bring health care to them.
McNeal, dean of National University’s school of Public Health and Human Services, is director of a new, nurse-managed health clinic the university is setting up in the Watts community of South-Central Los Angeles. If it works, the project could be a model for the rest of California, if not the nation.
Funded by a grant from the federal government, the clinic will be mobile, moving to a different location every day. One day it might be at a church, the next day at a community center, then at the offices of a community-based organization.
“We are flipping the paradigm,” McNeal says. “Our services will be rendered in locations already frequented by the patients.”
The patients’ initial contact will be with community health workers, who will staff “virtual clinics” equipped with patient rooms, medical equipment and live video connections to the clinic’s central headquarters.
A team of nurses and other health professionals, working under the direction of UCLA Professor and physician Keith Norris, will provide the care. Patients will get routine physicals, OB/GYN care, and management programs for chronic diseases like diabetes, asthma, heart disease and high blood pressure.
Patients with ongoing issues will be able to come to the clinics regularly, sometimes even daily, to have their vital signs monitored. And for those who can’t make it that far, health workers will come to their homes.
“It’s probably the most densely populated area of the country, and one of the most under-served,” McNeal says.
She says 39,000 people, mostly African-American, live in the two-square mile area that the clinic intends to serve.
“It’s incredibly poor, and the statistics demonstrate that these individuals have high rates of diabetes, hypertension, congestive heart failure, obesity. And unfortunately because of the high crime rate, and the stress and depression and anxiety that come with living in that kind of environment, their life spans are incredibly shortened.”
The clinic hopes to offer about 3,700 appointments in its first year, and McNeal hopes most of those will be with people who are among the sickest in the community. By focusing on the toughest cases, she says, the clinic should be able to help people before their condition gets so bad that they need a difficult and expensive trip to the emergency room.
Patients who need to see a specialist will get referrals, with those visits paid for by either the Medi-Cal program for the poor or by private insurance provided by an employer or the federal Affordable Care Act. Social workers will be on hand to walk patients through the application process, if necessary.
All of this work will be documented and followed closely by a team of researchers who will analyze the effect on health outcomes and ER visits to see if, as hoped, providing health care to people actually helps them stay healthy.
It should, if for no other reason than the frequent contact with community health workers, nurses and other health professionals will help people understand what they need to do in their own homes and lives to stay healthy or better manage their chronic disease.
If that happens, the patients will be happier, the community better off and the health system relived of expensive cases that can be avoided with low-cost, accessible preventive care.