Five months after opening, the Access to Care clinic at St. Anthony Hospital is giving routine medical care to patients who otherwise would visit its emergency room repeatedly.
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Pam Troup, executive director of St. Anthony North and organizer of the low-cost clinic, said 53 percent of visits to Oklahoma County emergency rooms in 2005 were for routine medical care. That year, St. Anthony counted 900 people who had visited its emergency room five or more times. Because emergency room care is expensive, intended to save people's lives and doesn't emphasize follow-up care, non-emergency patients are better served if they see primary care doctors.
However, in areas such as near-downtown St. Anthony, northeast-side OU Medical Center and south-side Integris Southwest, patients often don't have insurance or a go-to doctor, sending them to the emergency room instead.
"If we can do prevention and early intervention, then we can not only decrease the financial cost but the human cost,” Troup said. "They're already coming to us. They're already in our emergency room,” she said, describing clinic patients as chronically ill people who were doing the best they could and typically live near the hospital. Clinic patients' two most frequent diagnoses are high blood pressure and diabetes.
"The emergency room is good care,” she said.
"It's just not appropriate for someone who needs primary care.”
St. Anthony in April received $200,000 from the Butterfield Memorial Foundation to establish a "medical home” for patients who visit its emergency room for non-emergency reasons.
St. Anthony also received $50,000 from the Oklahoma City Community Foundation for the same purpose. OU Medical Center and Integris Southwest also received $50,000 each from the community foundation to establish medical homes.
Patients at the St. Anthony clinic, which has 112 patients, pay a flat rate for an appointment at the clinic, which is staffed by an advanced registered nurse practitioner and used to be a dental clinic. A "community health worker” helps patients navigate the federal, state and local assistance that may be available and reminds them of appointments and keeping to their treatment instructions.
"You just need a helping hand sometimes to get all that done,” Troup said.
‘Success story'
Nanette Shakula had just finished her appointment at the clinic on a recent Thursday morning. The woman, who lives on NW 34, said she lost her state-provided insurance when her daughter turned 18, and she wasn't able to work because of lung problems. She has a disability case pending. After an August surgery at St. Anthony, the hospital suggested she try the Access clinic. She comes once a week now.
"I used to walk 20 miles a day and now I can't walk a block without stopping,” she said. "I can't work. I can't breathe.”
Shakula, 51, praised the clinic's nurse practitioner, Jana Ortiz, saying, "It makes me cry to think of all the things she did.”
Ortiz, who retired from the Army this year after more than two decades of service, said she took the St. Anthony job because she believed in helping people like Shakula, getting them involved in their health care.
"The key thing,” she said, "is I've been able to stabilize a lot of patients here.”
She called controlling Shakula's blood pressure "a success story.”
The clinic is open from 11:30 a.m. to 8 p.m. Mondays through Fridays.
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A few years ago, St. Anthony's was not so nice to me. I went to the ER within 6 months of 2 visits. I had insurance but it didn't pay but about 1/2 of the $20,000 they charged each visit. On the second visit, the financial counselor recognized me. He said, "Look, we are not a charity. Since you insurance company only pays half of your bill, WE reccomend you visit one of the free or fee reduced clinics listed on this piece of paper."
The problem was that I still had a cathetor in my bladder for a severe UTI. I was basically told not to return to St. Anthony's to get it removed. I had to go to the ER at O.U. Medical to get them to remove it when the infection passed. The doctors at O.U. told me to file a complaint with the Board of state medical licensure. To me, it was like throwing good money after bad. I took my insurance card to O.U. medical and for several years, they have made me quite well where I walk 4 to 8 miles per day. St. Anthony was only interested in helping me if my insurance paid more. O.U. said they actually broke federal law by "dumping" me on another hospital.
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Patient Nanette Shakula sits in an examination room Sept. 13 during an interview at St. Anthony Hospital's Access to Care clinic in Oklahoma City. BY NATE BILLINGS, THE OKLAHOMAN
Emergency or routine?
In OklahomaCounty:
•Demand for medical care far exceeds the capacity of free clinics, resulting in waiting for care.
•Most free clinics do not have the ability to track detailed patient information or the number of diagnostic services they need or use.
•Fifty-three percent of emergency room visits are for non-emergency reasons.
•Emergency rooms are not designed to provide follow-up or preventative care.
•Almost three-fourths of nonemergency visits to emergency rooms are from 7 a.m. to 7 p.m.
•More than 100,000 of non-emergency visits to the emergency room in 2005 were by patients who were uninsured or underinsured.
Source: Health Alliance for the Uninsured
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The problem was that I still had a cathetor in my bladder for a severe UTI. I was basically told not to return to St. Anthony's to get it removed. I had to go to the ER at O.U. Medical to get them to remove it when the infection passed. The doctors at O.U. told me to file a complaint with the Board of state medical licensure. To me, it was like throwing good money after bad. I took my insurance card to O.U. medical and for several years, they have made me quite well where I walk 4 to 8 miles per day. St. Anthony was only interested in helping me if my insurance paid more. O.U. said they actually broke federal law by "dumping" me on another hospital.