CCOSC - the results

At Beaufort Jasper Hampton Comprehensive Health Services (an FQHC), a provider asked the CHW if she was available to work on a weekend. The CHW thought it was for a health fair, but the provider said it was for a patient she was trying to keep out of the hospital who needed a home visit to check on blood pressure. The CHW coordinated the home visit, reviewed medications with the patient, and found out the patient didn’t have a beta blocker. The CHW then notified the provider, who sent in a prescription that day; the patient picked it up next day, which the CHW confirmed when she returned to the patient’s home. By the patient’s follow-up on Tuesday, their blood pressure (BP) was excellent.

CHWs spend time helping individuals living with sickle cell disease (SCD) with their utility bills when they are struggling to pay them. For individuals living with SCD, extreme high or low temperatures can trigger SCD crises, which in turn results in greater usage of emergency medical services.Additionally, stress can lead to SCD crises . While SCD is recognized as a progressive, lifelong disease, CHWs at JR Clark help patients avoid preventable emergency care usage by reducing both exposure to extreme temperatures and financial stress through providing support with utilities.

A CHW at AccessHealth Tri-County highlighted how they effectively collaborate with physicians as a member of the patient’s care team. The CHW provides critical supports for the patient, such as helping to make medical information easy to understand and serving as a patient-provider liaison:

‘A lot of my patients… go to the free clinics and I work with the physicians that are there…the patient will see them usually once every [month]. And so…[the physicians] leave notes for me, and I leave notes for them. So [the patient] saw their endocrinologist and I’m not able to [attend the appointment], I have the notes of what was said or happened, if any medications change …when I meet with the patient I can further explain, ‘This is the

kind of medication you’re on. This is how you’re supposed to take it. How are you feeling?’ and things like that. Because patients don’t always understand the doctors, honestly… so that opens a door for me because they’re more trusting in me to say…’lt’s making me feel weird or it’s making me not have an appetite,’ or things like that. And so I can relate, I’m like that liaison, I can relay that to the physician, things that the patient doesn’t always feel comfortable saying. Because again, the theme that I do see is a lot of our…underinsured or uninsured [patients} …don’t feel like they have the right to question what their medical provider says when that is absolutely not the case.”

Access Kershaw’s CHW connects patients to cancer screenings by collaborating with both providers and local and state resources, in addition to addressing social determinants of health-related needs. The CHW shared an example of a client that was able to receive a life-saving procedure for breast cancer:

“I had a former client come to me needing help getting medicine. She was having a hard time getting to her local FQHC. So after sitting there and talking to her about what was going on … I referred her to CareSouth. At the end of the appointment, the provider asked … ‘Is there anything else you have going on?’ And the client says, ‘Well, I had this lump on my breast.’ The provider turned around. She’s like, “I can see it from here…” [The client had} had this for some time….[a previous] provider [had} said …’you just have dense breasts.’ So [the client] went and had a mammogram. Turns out she did have cancer. CareSouth referred her to McLeod, and she started seeing McLeod, got a double mastectomy. But you know, the good news is, had I not referred her to them and they took care of her and got her connected to McLeod, this patient would not be here.”