As a nurse who’s worked in clinical care settings in rural Franklin County for over 30 years, I’ve derived a lot of satisfaction caring for patients. In addition to this role, I’ve also worked as coordinator of a “Healthy Communities” effort and as a care manager. But recent work – helping to lead a MeHAF-funded project to better understand who uses the emergency room (ED) and who receives free care at Franklin Memorial Hospital (FMH) – has been some of the most rewarding work I’ve done. This work, Franklin C.A.R.E.S, goes beyond clinical care to identify ways to help these individuals live healthier lives. I’ve learned a lot about the barriers the health system puts up for uninsured and under-insured people, and also about other issues that keep these individuals from getting needed care on a regular basis.
Many of the uninsured individuals I have worked with over the past 18 months have indicated a desire to keep their health concerns, illnesses, and financial matters very private. They see connecting with a primary care provider, or even enrolling in an insurance plan as a violation of that privacy. This means that making connections for health care services is viewed as intrusive and inappropriate.
Another challenge in working with people who may never have had health insurance is getting them to recognize the value of insurance and how to use it. Health insurance is really different from car insurance, which you don’t use unless something goes wrong, like a major accident. With health insurance, the idea is to use preventive and disease management benefits in your plan to stay healthy.
These are big barriers to break down, and often the most successful approach is one-on-one, face-to-face discussions. Helping uninsured individuals overcome the fear of divulging personal information and put their trust in a system that is complicated and foreign to them takes time and patience, but the impact can be life-changing.
One individual, a gentleman in his mid-40’s, had not made an appointment to see a dentist as recommended after repeated ED visits for an oral health issue. He suffered from a variety of other medical conditions, none of which were under the care of a primary care provider. He wasn’t connected to a dental practice or insurance plan. After speaking with him for some time, it finally became clear that the reason he hadn’t called was simply that he did not know how to make an appointment, had never made an appointment over the phone, and was afraid that he might be asked a question that he would not know how to answer. Once we addressed this and practiced making an appointment, he was in a different frame of mind regarding his engagement in his own health and wellbeing. He is now interested in participating it a chronic disease self-management education series we are planning.
We are beginning to understand that “patient-centered/patient friendly” services or health care has a very different meaning to individuals seeking services than it does for those providing the services. Patients will often report that the most “patient friendly” way to receive health care is by visiting the ED because they can get everything they need at the time they feel they need it most or at the time that is most convenient to them. And, they are able to maintain their privacy and not have to engage in a relationship with a ‘concerned’ provider or office staff.
If our goal is quality care, less cost, and a satisfied and healthier patient, it’s not just about the services we deliver. It’s about the relationships, partnerships and the communication we build with patients, and our ability to help them navigate the system and get connected with community resources. A vital step is listening to patients and understanding the barriers that may be standing in the way. Without learning about and addressing these barriers, we may provide skilled clinical care, but we will never improve patient health outcomes, improve quality of care, or reduce costs. My work with Franklin C.A.R.E.S has made me committed to continuing this approach at FMH because of the patients whose lives we’ve already touched and those we will touch in the future.
Tracy Harty is a Nurse Navigator at Franklin Memorial Hospital.
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