Information Session for Yale/Stanford Global Health Scholars Program 2022 - Tennessee
October 25, 2023ID10900
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- 00:02So I went to Birchville
- 00:05Springs Medical Clinic.
- 00:06It's located in Grundy County, Tennessee.
- 00:08I'll talk a little bit about Grundy County.
- 00:11And I went as Doctor Sherman pointed
- 00:13out that about just about a year ago
- 00:15when I was a third year resident at YPC.
- 00:18And here's my contact information.
- 00:20I've switched over from Yale to YNHH,
- 00:23but I check my Gmail more often if
- 00:25you want to send an e-mail there.
- 00:31OK. So to talk briefly about
- 00:33kind of health outcomes,
- 00:35Grundy County has sort of
- 00:41in comparison to all of Tennessee,
- 00:45even with just counties that are just next
- 00:48door has very different health outcomes.
- 00:50And I'll talk a little bit about that is
- 00:53partly largely driven by access to care,
- 00:55which is where this clinic has
- 00:57tried to step in a little bit.
- 00:59But there are a lot of people who don't
- 01:03have health insurance and and it's
- 01:08also a really long ways to a clinic.
- 01:12So if you want a chest X-ray,
- 01:13it's maybe 25 minutes away.
- 01:15If you want ACT,
- 01:16you're good to go to the emergency room.
- 01:17It's like 45 minutes away.
- 01:20And for any kind of bigger hospital,
- 01:22it's really an hour and 20 minutes
- 01:24or so down to Chattanooga or
- 01:26you might be sent to Nashville.
- 01:28So it's it's really much further
- 01:31differences that we're used
- 01:32to in here in in Connecticut.
- 01:35So I was talking about sort
- 01:39of access to to medical care.
- 01:41Part of that is from a
- 01:43primary care perspective,
- 01:44there are just many fewer doctors and
- 01:48APRNS who are within sort of the primary
- 01:51care realm trying to take care of people.
- 01:54And so literally just finding
- 01:58somebody to look at whatever
- 02:01issue you have is difficult.
- 02:03And it's compared here to Hamilton County,
- 02:05which is a few counties next
- 02:07door and much more wealthy.
- 02:12So part of the reason that many of
- 02:16the patients at Birsipa Springs have
- 02:19difficulty accessing care and buying
- 02:22medications is that there was not Medicaid
- 02:26expansion that happened in Tennessee.
- 02:29So Medicaid expansion happened
- 02:31under the ACA with Obama.
- 02:36And you know, that happened
- 02:37well before I became a doctor.
- 02:38And so and I've only practiced
- 02:41in Connecticut.
- 02:42And so you know I really have just seen
- 02:47that sort of that one population and
- 02:50the reality is that Husky insurance is,
- 02:53is excellent in many ways.
- 02:55We really expanded the number of people
- 03:00that could be covered and so almost
- 03:03a 50% increase of people that could
- 03:06be covered under that insurance and
- 03:09whereas Tennessee didn't go through
- 03:10that and so there are almost you
- 03:13know almost 350,000 people who would
- 03:15have been eligible for coverage.
- 03:17And and these are kind of the this is
- 03:20the population that Bursary Springs
- 03:22Medical Clinic really tries to help
- 03:25and it's not you know a 25 year
- 03:29old that is healthy and you know
- 03:32is might be looking for Flonase.
- 03:34We're happy to to to see that
- 03:36population as well.
- 03:37But really it's the 60 year old
- 03:42person who you're trying to help
- 03:44them stop smoking and you need them
- 03:46to get a low dose CT scan and other
- 03:48primary care and sort of follow up
- 03:50with you know their ER visit from
- 03:52a week ago and get them on insulin.
- 03:54So it's it's that patient who is
- 03:57a little sicker and needs access
- 03:58to a lot of medication.
- 04:02So a little bit about Brisper Springs
- 04:05founded in 2010 and it's in Bursa Springs,
- 04:09which is one of the towns in Grundy County.
- 04:12And it's it's a nonprofit.
- 04:15It does not take any kind of funding
- 04:17from like federal or state sources.
- 04:20They just did a fundraiser actually where
- 04:24people donated and then ran a race and
- 04:28and then they buy a bunch of medications
- 04:32to try and and give people meds.
- 04:36If people want to donate money they suggest
- 04:39I think $10.00 for a visit if you can do it.
- 04:41Many people don't pay if they can't and then
- 04:46and and then we can give
- 04:48people medication basically.
- 04:49So the services that are provided
- 04:51both acute and chronic care,
- 04:52meaning primary care,
- 04:55there's some minor wound management,
- 04:58there are a few injections that they
- 05:01do and and then a dental clinic that
- 05:03gets really full up really quickly
- 05:05that comes about once a month.
- 05:07It was sorry more difficult during
- 05:11COVID when that was access to
- 05:13that was even more difficult.
- 05:14And then they refer to subspecialty
- 05:18clinics often that is, you know,
- 05:22one of the attending's who also
- 05:24Staffs the clinic will try and
- 05:26call a friend at one of their
- 05:28hospitals to try and figure out
- 05:30some sort of phone consultation.
- 05:32Or if somebody needs to be seen in person,
- 05:34the clinic can help pay for that.
- 05:38And it's when I was there,
- 05:41there was an NP there part time Monday,
- 05:43Wednesday and Friday
- 05:44when the clinic is open.
- 05:46But currently they're just
- 05:47two-part time employees.
- 05:48And then there are these attendings
- 05:51from a couple different hospitals,
- 05:54UT Chattanooga and
- 05:58you know I've forgotten the 2nd St.
- 06:00Thomas I think in Nashville coming
- 06:03over and volunteering time.
- 06:05And so it's been tough,
- 06:07I think to staff the clinic, you
- 06:11know, Monday, Wednesday and Friday all day.
- 06:13And so there's more telehealth. Basically,
- 06:18this is a picture of the clinic.
- 06:20It is right in the center of town and
- 06:23most people park right now in front of
- 06:26it and wait in their cars during COVID.
- 06:30And then when they're up,
- 06:32they get called from that front door here.
- 06:36And Renee who sort of runs the front,
- 06:40we'll call people in and get vitals done
- 06:42and then people will come back in and if
- 06:44they're having a respiratory symptoms,
- 06:45we'll see them outside in the porch and
- 06:49do vitals out there while wearing a mask
- 06:53and and and like do basically the full
- 06:56exam as long as everybody's comfortable
- 07:03from a day-to-day perspective.
- 07:06It is. When I was there,
- 07:08it was Monday, Wednesday, Friday,
- 07:098:00 to 4:00 and it's patients
- 07:11are every 15 to 30 minutes.
- 07:14I saw about 8 patients,
- 07:16sometimes I saw ten patients and 1/2 day.
- 07:19And from a resident perspective,
- 07:22I thought it was pretty busy and often that
- 07:27does not include actually medication refills.
- 07:30So people would come in,
- 07:32drop their meds off and then you know later
- 07:33in the day come back and pick them up.
- 07:35But you're looking through to make sure that
- 07:37this is the correct medication to give them.
- 07:39Sometimes we don't have
- 07:40that exact medication.
- 07:41So what medication could be substitute?
- 07:42So there are a lot of,
- 07:44it's sort of almost a a merry go round
- 07:47of different medications that we have
- 07:50that might work kind of in the same
- 07:52way that we can get people access to.
- 07:55And I spent a lot of time actually
- 07:59doing sort of education around like
- 08:01how to make sure that you're always
- 08:03taking you know every medication,
- 08:05there's nothing that's being
- 08:06you're not taking two of one,
- 08:08one day etcetera.
- 08:09So we got a bunch of pill boxes and
- 08:12I spent a lot of time doing some
- 08:15sort of education around that and
- 08:17then labs are sent off every day.
- 08:19And so we can get basically
- 08:22any lab on the sun.
- 08:25It goes to basically like a
- 08:26quest that comes to pick it up
- 08:28and but the clinic pays for it.
- 08:30So you have to be you want to be judicious
- 08:35and they're actually they have
- 08:37access to a lot of medications.
- 08:40Some of the medications come from Americares,
- 08:42which are medications that are donated.
- 08:45They're often in funny combinations,
- 08:49but they are often excellent
- 08:52medications that you know like.
- 08:54It'll have an SGLT 2 and
- 08:59DPP four. Or
- 09:05they had a bunch of GLP
- 09:07ones that were donated.
- 09:09So they have access to excellent medications.
- 09:12They're not often formulations that
- 09:14you've seen, but they are donating.
- 09:16So they're free.
- 09:17And so we go through those first and then
- 09:19you can order medications from andameds.
- 09:21But it's it gets you know,
- 09:24even for things like metformin,
- 09:25it gets you know,
- 09:27expensive really quickly.
- 09:29So most of the money that the
- 09:32clinic spends is on andameds to
- 09:34try and to get people hypertension
- 09:38meds and diabetes medications.
- 09:41And then and then there's
- 09:43some grant funding as well.
- 09:45This is a picture of sort of just
- 09:47across the street looking down,
- 09:49it's sort of on a mountain and this is
- 09:51sort of took looking down the valley
- 09:55and then I'm actually hoping
- 09:57to stay involved this year.
- 09:59And so I've spent a lot of time
- 10:00thinking about future directions and
- 10:02things that the clinic could do there.
- 10:05It's so difficult to get a lot of
- 10:09imaging that you know point of care
- 10:12ultrasound is a really sort of exciting
- 10:15area and one of the attendings at
- 10:18from Saint Thomas is particularly
- 10:20interested as well in in pocus.
- 10:22And then sort of there are a lot of Qi
- 10:24options about trying to get more people
- 10:26enrolled in in Tencare who certainly
- 10:29are eligible but don't have access.
- 10:32And then we're trying to,
- 10:34you know, call people up and say,
- 10:36you know there's a low dose CT
- 10:38that's coming in for free on Tuesday.
- 10:39Like you know,
- 10:41do you want to try and get there and
- 10:44can we help you do that, etcetera.
- 10:45So there are a lot of very exciting areas.
- 10:48I really enjoyed my time there.
- 10:51I'm hoping to stay involved.
- 10:53I loved working with Nick Camilio, Dr.
- 10:55Camilio. He's the former Yale.
- 10:57He
- 11:00was one of the, I believe,
- 11:01one of the chief residents in the I
- 11:04Am program triad program and is now
- 11:06attending down at UT Chattanooga.
- 11:08And his wife is one of the Pulm
- 11:10Credit attendings down there.
- 11:11She was a Pulm Credit fellow here,
- 11:14but it's and he's the assistant
- 11:16medical director and he's really
- 11:18been great to work with as well.