Lessons Learned Creating A Personal Medical Home Internationally

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Lessons Learned: Creating A Personal Medical Home Internationally Deborah K. Witt, MD Christina Hillson,

Lessons Learned: Creating A Personal Medical Home Internationally Deborah K. Witt, MD Christina Hillson, MD, Resident Assistant Professor Thomas Jefferson University Department of Family & Community Medicine Philadelphia, Pennsylvania

Patient Centered Medical Home Principles • • • Personal Physician Directed Medical Practice Whole

Patient Centered Medical Home Principles • • • Personal Physician Directed Medical Practice Whole person orientation Coordinated Care Quality & Safety Enhanced access “Comprehensive care for children, youth & adults”

• Evangelist Dorothy J. White from Copperas Cove, Texas, founder of Glory Unlimited

• Evangelist Dorothy J. White from Copperas Cove, Texas, founder of Glory Unlimited Ministries 1998 • Initiated Mission 2001, Medical team • Powerpoint to encourage youth on Abstinence • Kings Glory Healing Clinic, 2005 (solo) • Elective developed with Dept. of Family & Community Medicine, March 2008

TOP TEN CAUSES OF DEATH 2002 - Jamaica • • • Cerebrovascular disease Diabetes

TOP TEN CAUSES OF DEATH 2002 - Jamaica • • • Cerebrovascular disease Diabetes mellitus Ischaemic heart disease Hypertensive heart disease Lower respiratory infections HIV/AIDS 18 % 11 % 10 % 6% 4% 4% http: //www. who. int/entity/healthinfo/statistics/bodgbddeathdalyestimates. xls

Overview of ELECTIVE • Quarterly intense 1 - week program • Began Feb 2008

Overview of ELECTIVE • Quarterly intense 1 - week program • Began Feb 2008 with residents • 2 nd and 3 rd year Family Medicine Residents and 4 th year medical students • Exploring the area of International /Global Health, underserved 3 rd world population • Montego Bay, Jamaica, West Indies • Non-traditional setting – Faith based group

GLOBAL HEALTH ELECTIVE ORIENTATION PACKET • • • SUBMIT APPLICATION GOALS & OBJECTIVES ORGANIZATIONAL

GLOBAL HEALTH ELECTIVE ORIENTATION PACKET • • • SUBMIT APPLICATION GOALS & OBJECTIVES ORGANIZATIONAL OVERVIEW- POWER POINT CUSTOMS/LODGING ATTIRE TRANSPORTATION INTRODUCTION TO JAMAICA – WORLD HEALTH ORGANIZATION FACT SHEET PREP TIME CLINIC SCHEDULE FOCUS GROUP PROJECT FEEDBACK FORM POST ELECTIVE DEBRIEF

INTENSE SCHEDULE MARCH 2008 - 350 patients • • • SATURDAY 8 -1 –

INTENSE SCHEDULE MARCH 2008 - 350 patients • • • SATURDAY 8 -1 – RETIREMENT DISTRICT MONDAY 9 -5 – LILLIPUT, TRELAWNY TUESDAY 9 -5 – MT. PELIER, SANDY BAY WEDNESDAY 9 -4 – MORNING ROUND CORNWALL REGIONAL HOSP – ST JAMES/TRELAWNY INFIRMARY UPSTREAM FOCUS GROUPS EACH CLINIC JUNE 2008 – 300 patients • • MONDAY 9 -5 – LILLIPUT, TRELAWNY TUESDAY – CLINIC PREP & BOYS HOME – ST JAMES/TRELAWNY INFIRMARY WEDNESDAY 9 -4 – MT. PELIER, SANDY BAY THURSDAY - AM – MORNING ROUND CORNWALL REGIONAL HOSP – CLINIC 1 -5 RETIREMENT DISTRICT

ELECTIVE CURRICULUM INCLUDES • • HOME VISITS EDUCATIONAL SEMINARS GIVEAWAYS FOOD, CLOTHES, ETC NURSING

ELECTIVE CURRICULUM INCLUDES • • HOME VISITS EDUCATIONAL SEMINARS GIVEAWAYS FOOD, CLOTHES, ETC NURSING HOME VISITS HOMELESS CARE HOSPITAL ROUNDS CULTURAL EXCHANGE IN COMMUNITY

TEAMWORK

TEAMWORK

Mountaintop Clinic – Mt. Pelier, JA

Mountaintop Clinic – Mt. Pelier, JA

Making a Difference

Making a Difference

Cases • • Family with Rickets Sexual Abuse 3 year old Rape/Incest Domestic Violence

Cases • • Family with Rickets Sexual Abuse 3 year old Rape/Incest Domestic Violence Severe Depression Mumps Home Remedies/Alternative Medicines Multiple skin diseases

Residents Comments • “actually providing health care to a needy population and they are

Residents Comments • “actually providing health care to a needy population and they are doing so in a longterm commitment” • “it’s absolutely wonderful to see the continuity in patients charts” • “it adds so much to our residency program” • “I couldn’t believe the breathtaking views from our ‘mountaintop clinic’” • “I had a life-changing experience”

STUDENT’S FEEDBACK “This was such a unique and amazing experience. I was doing things

STUDENT’S FEEDBACK “This was such a unique and amazing experience. I was doing things and seeing things I thought I’d have to wait until residency to see and do. This trip reinforced so much of why I wanted to become a doctor in the first place. ”

Food for those unfortunate family

Food for those unfortunate family

Shopping in the Shelter

Shopping in the Shelter

Encouragement

Encouragement

Challenges • Communication – technology • Permit to Import Medications – Chief Pharmacist –

Challenges • Communication – technology • Permit to Import Medications – Chief Pharmacist – OTC, Prescribed • Work Permit/Registration of Clinic – Ministry of Health, Kingston • Waiver from Customs Duties • Cost of Medications • Comparable Medications • Language Barriers – Patois (Patwah) – Jamaican Creole • Low Literacy – Power Point on Nutrition - Cultural Foods • Learning the Culture and Traditions of the Native people

BEFORE EMR!!

BEFORE EMR!!

EMR Amazingcharts. com

EMR Amazingcharts. com

Amazingcharts. com

Amazingcharts. com

Lessons Learned • Needs Assessment • Collaboration with Government & Community Leaders • Building

Lessons Learned • Needs Assessment • Collaboration with Government & Community Leaders • Building trust although short term tour • Identifying Community Resources • Local physician contacts & support • Implementation plan • International healthcare systems • Dispel myths of foreign aid

Success • • • Collaboration with Faith Based Organization Ministry of Health – main

Success • • • Collaboration with Faith Based Organization Ministry of Health – main contact person MAP International Employee Discount for generic Bulk Medication Donations – Monies for Pharmaceuticals Donations from Department of Family & Community Medicine • Nurture global health volunteerism/career • Permanent Registration as JA physician

FIRSTS- RETURN RES, MED STUDENT, DO, OUTSIDE RES, EMR

FIRSTS- RETURN RES, MED STUDENT, DO, OUTSIDE RES, EMR

PROGRESS REPORT • DATA ANALYSIS In progress • ELECTRONIC MEDICAL RECORD Done • INCREASING

PROGRESS REPORT • DATA ANALYSIS In progress • ELECTRONIC MEDICAL RECORD Done • INCREASING FUNDING OPPORTUNITIES In progress • EDUCATION MODULES Done • OPEN TO OTHER RESIDENTS AND STUDENTS NATIONWIDE Done • UNIVERSITY OF WEST INDIES • DOCUMENTARY OF EXPERIENCE

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