Information Session for Yale/Stanford Global Health Scholars Program 2022 - Tennessee

October 25, 2023

ID10900

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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.