The 11th Street Family Health Center is providing important access to primary care, behavioral health and dental services for individuals whose only care choice is often the emergency room. Since the 11th Street Family Health Center opened in September 2002, the number of primary care visits to the center has grown substantially, from 2,200 in 2003 to 6,800 in 2005 to over 10,000 in 2007.
In addition, visits to the Center’s traditional co-located behavioral health service have grown significantly, from 210 in 2003 to 3,205 in 2007. Dental services began in 2005 with 944 visits and grew to 6,772 visits in 2007. The center posted an additional 2,767 encounters for health education and wellness programs. In the first four months of the integrated behavioral health program, more than 600 patients received care.
The center’s Performance Improvement Plan establishes a schedule of chart reviews to assess impact and opportunity for improvements. A recent pediatric chart audit showed an improvement in pediatric immunization rates as a result of recalls and use of a summary sheet at each visit to alert the nurse to the patient’s status on a variety of measures. The adult audit indicated that a number of women, mostly uninsured, were not receiving mammograms at the recommend intervals. As a result, the staff arranged for the mobile mammography van from Fox Chase Cancer Center to spend three days at the center each year, which has improved both screening and follow up.
Evaluation of outcomes for patients who attended diabetic education classes revealed uneven levels of improvements. Discussion with patients and a review of the literature suggested that behavioral theory-based nutrition education programs are more successful knowledge based programs for achieving behavior change. As a result, the center revised diabetic education to include group visits and referrals to the physical therapist and fitness trainer.
Anecdotally, integrated primary behavioral health care has improved access to mental health services, improved patient adherence to treatment regimens and self-management, and decreased levels of depression.
Anecdotally, nurse practitioner satisfaction, already high, improved with the implementation of the integrated behavioral health consultation model. NPs feel that the model fosters mutual respect and camaraderie among providers, trust and confidence among patients, and a healthy sense that “we’re all in this together.” In addition, nurses appreciate having ready access to a resource to address the psychological issues. A sample comment: “As a Family Nurse Practitioner, the satisfaction I gain from working with a collaborative transdisciplinary team in providing care to one of the most chronically ill and underserved populations of Philadelphia is immeasurable.”
In May and October 2007, 11th Street Family Health Services conducted an assessment of client satisfaction; scores consistently fell in the 4 to 5 range on a five-point scale. Patients complete the survey directly on the computer, which provides for better confidentiality for respondents and facilitates data analysis. Patients positively noted the friendliness of the staff, the way patients are personally greeted on arrival, and the breadth of programs and services offered.