What's Working

Knocking It Out of the Park
The Full Spectrum of Treatment While You Wait

  What's Working - Fall 2011 - Knocking It Out of the Park

Rosa Medina (right) and her son got needed care, thanks to Susan Gonzalez, MA, a behavioral therapist, and Tillman Farley, MD, medical services director, at Salud Family Health Centers' rural clinic in Fort Morgan.

By Rebecca Jones
Photography by Barry Staver

When her teenage son began complaining of anxiety, shortness of breath and a pounding heart, Rosa Medina knew exactly how he felt. The 44-year-old Fort Lupton woman was experiencing the same uncomfortable symptoms.

Medina, a Mexican immigrant who came to the United States 14 years ago, brought her son to Salud Family Health Centers, a health system that cares for low-income and medically underserved clients in nine communities throughout northeast Colorado, including Fort Lupton. A medical provider saw that the boy's symptoms were stress-related and called Susan Gonzalez, MA, a behavioral therapist at the clinic. Together, they worked to address the boy's concerns.

Gonzalez doesn't always wait to be called in for consultations. She visits with many people while they are waiting for health care at Salud and performs simple mental health screenings to detect underlying conditions or life stressors that may be affecting their physical health. More than one-third of the 80,000 people who are treated at Salud suffer from depression or anxiety. More than 10 percent have experienced some kind of emotional trauma. Many are heavy alcohol users – all things they may not reveal to their physicians, but which can have profound impacts on their health.

So on her next Salud visit when Medina mentioned that she, too, sometimes felt overwhelmed by worry, Gonzalez recognized a problem she sees frequently.

"Many of our immigrant patients have a lot of financial anxiety, plus there are language barriers, cultural pressures and isolation," Gonzalez says. "But they come in because they feel they can't breathe or they're having headaches. We give them a name for the problem, and we give them some coping skills. Even though their situation stays the same, we help them learn how to manage it better."

Gonzalez saw in Medina all the classic signs of anxiety disorder. Before she left the exam room, she had booked Medina for an immediate follow-up appointment. Medina wouldn't have to go elsewhere or even come back on another day to see a counselor. She would get what she needed right then, before she left Salud.

Physical, mental and even dental health care is integrated seamlessly throughout Salud's 14 clinics. People who come in with a physical complaint are screened for mental health issues and vice versa. While they are waiting, young children receive fluoride treatments from dental staff.

"When you go to a doctor, first you sit in the waiting room awhile, then you sit in the exam room awhile," says Dr. Tillman Farley, MD, Salud's medical services director. "We try to do all these things in the time the patient would be waiting anyway. But even if it takes a little longer, it's a value-added service."

Pharmacists at Salud also play a key role in the primary care some people receive. For example, individuals taking Coumadin (a blood thinner) see a pharmacist for blood-level monitoring and education about the drug's side effects. "That takes a gigantic load off the physicians," Farley says.

Salud providers are hoping to expand this approach and use pharmacists to check medication levels of clients with high blood pressure. These clients then will meet with a health educator to learn more about controlling their condition. They will see a physician only quarterly to make sure everything is working as it should.

"This is something we should have thought of years ago," Farley says. "It has been demonstrated that physicians don't do a good job of giving patients all the advice and counseling they need. ... We have patient educators who are really well-trained who will do a better job.

"If we can do this right, I can take 80 percent of my patients who need chronic disease management and [give] that work to people who frankly are better-qualified than I am to do it," he says. "It will increase my capacity to see patients with difficult diagnostic dilemmas, which is really the physician's purview."