Program Details

Practice Type:	Promising
Program Name:	Primary Access To Health
Organization:	Brevard County Health Department
Web site:
Overview:	Primary Access To Health
Year Submitted:	2011
Responsiveness and Innovation:	Primary Access to Health (PATH) clinic was established in response to the medical needs of the less fortunate in our community. The current unemployment rate in Brevard County is 11.6%, which diminishes the health care dollar. Approximately 26% of the current populations in Brevard County who are below 100% of the federal poverty guidelines and who are without healthcare coverage routinely use the local emergency departments as primary care. Many clients have the mindset that the emergency department (ED) is the portal to health care because it is looked upon as a site guaranteed where treatment and care will be rendered, however, with a high price tag. Not only are the emergency departments used for primary care they are also used for subsequent follow-up visits within 48 to 72 hours that normally would be seen in a primary care office when clients do not have access to care. The PATH program provides healthcare for non-emergency acute and chronic health conditions, disease management and education, diagnosis, treatment and follow-up care, basic laboratory services and in-house ultrasound and EKG testing. With the establishment of a primary care clinic, the underprivileged residents of Brevard County can now have a medical home and receive services at the fraction of the cost of an emergency department visit. A priority in services includes local hospital emergency department diversion. Diversion from the emergency department is accomplished by the PATH clinic by providing increased access to health care for treatment, evaluation and follow-up care, discounted medications or enrollment to pharmaceutical medication assistance programs, disease management and education.
Agency and Community Roles:	The Primary Access to Health (PATH) program manages the healthcare needs to eligible adult Brevard County residents. The PATH program provides healthcare for non-emergency acute and chronic health conditions, disease management and education, diagnosis, treatment and follow-up care, basic laboratory services and in-house ultrasound and EKG testing. Services are provided by Brevard County Health Department, Viera clinic. The PATH clinic is staffed with paid Brevard County Health Department personnel. The clinic staff consists of a medical doctor, registered nurse and health support technician. In addition, auxiliary support staff from medical records and appointment center assists in the daily operations of the PATH clinic. The Brevard County Health Department PATH clinic coordinator has taken an active role in the community as liaison between volunteer providers and with local hospitals. Recruiting and retaining specialty providers has been instrumental in providing continuum of care to clients. The PATH coordinator uses diagnosis to seek out specialty providers specific to a disease process. In the process of recruitment of specialty physicians partnerships have been established to reciprocate care to clients. Examples are with Circles of Care. They provide mental health visits for our clients and in turn we become their primary care provider to manage their acute and chronic health conditions. Specialty providers are extended sovereign immunity for providing services to clients. The PATH coordinator continually recruits physicians, hospitals and diagnostic centers for volunteer time. The success of the current model being used assists in the attractability for future providers. The end result is a collaborative relationship among healthcare providers in Brevard County.
Costs and Expenditures:	On July 1, 2009, the Brevard County Health Department established a part-time health care clinic; Primary Access To Health (PATH) clinic to provide a medical home for uninsured/low income Brevard County residents. According to the Florida Department of Health, Florida charts data of 2007, Brevard County has a population of approximately 550,000 people. Of those, approximately 85% report having health insurance of some type, which leaves 15% with no medical coverage. In fiscal year 2009, the PATH clinic offered free primary care, on a part-time basis, for the approximate 82,000 residents of Brevard County who are uninsured and without health benefits, includingfederal and state funded insurance plans. Residents of the county who are below 100% of the federal poverty guidelines are eligible to receive health care through the PATH clinic. The clinic is staffed by volunteer specialists (private practice physicians) and paid primary care staff from the health department. The PATH clinic extends services to all eligible residents of Brevard County. The current 11.6% rate of unemployment in Brevard County further diminishes the health care dollar. The PATH program provides healthcare for non-emergency acute and chronic health conditions, limited disease management and education, diagnosis, treatment and follow-up care, basic laboratory services and basic EKG testing. Services are provided by the Brevard County Health Department Viera clinic with support from the Board of County Commissioners, local hospitals and volunteer private providers. The PATH clinic is staffed with a medical doctor, registered nurse and health support technician. In addition, Volunteer primary and specialty physicians donate their time both in our clinic facility as well as in their private offices. All services provided are provided at no cost to the client. Several target areas have been identified in Brevard County with a high population of the residents afflicted with chronic health conditions. According to the Centers for Disease Control and Prevention, 9.5% of the population of Brevard County has been diagnosed with diabetes. Primary Access to Health (PATH) clinic recognizes that co-morbidities exist among such diseases as diabetes, cardiovascular illness and chronic obstructive pulmonary disease and will include conditions that increase risk factors such as nutritional insufficiencies and obesity. Other disease processes are targeted through this program are hypertension, pulmonary disease and hyperlipidemia. The primary goal of the PATH program is to provide the highest of level medical, health and wellness to the underinsured/low-income population of Brevard County by allowing this population to have a medical home for pimary care services and thereby reduce the number of unnecessary emergency department (ED) visits and hospitalizations. These services are provided at no cost to the client. By giving clients a medical home and focusing on ED discharges, the PATH Clinic provides primary care services and comprehensive education to improve patient compliance for managing their chronic condition(s), improve their overall health, and reduce reliance on the ED. Currently, the overall reduction among PATH clients rendering care for diabetes-related issues for the closest local ED is 42%. This valuable program demonstrates the power of community partnerships as it evolves and expands to create a network of health and wellness throughout the community. Health outcomes of the clients have greatly improved in the past year. Close monitoring of diabetics hemoglobin AI-C has been drastically reduced from critical high of 16 percent to 7 percent or lower. This can be contributed directly to increased access to healthcare, medications, i.e., insulin and testing supplies, and by knowledge gained through diabetic education classes that were initiated in January 2010. By reducing their AI-C levels we have also decreased their risk for other diseases such as cardiovascular disease and hypertension. In addition, by having access to laboratory services on site, turn around times of laboratory values are within one to two days. This allows for successful management of their disease process by adjustments in medications.
Implementation:	Primary Access to Health (PATH) clinic was established in response to the medical needs of the less fortunate in our community. The current unemployment rate in Brevard County is 11.6%, which diminishes the health care dollar. Approximately 26% of the current populations in Brevard County who are below 100% of the federal poverty guidelines and who are without healthcare coverage routinely use the local emergency departments as primary care. Many clients have the mindset that the emergency department (ED) is the portal to health care because it is looked upon as a site guaranteed where treatment and care will be rendered, however, with a high price tag. Not only are the emergency departments used for primary care they are also used for subsequent follow-up visits within 48 to 72 hours that normally would be seen in a primary care office when clients do not have access to care. The PATH program provides healthcare for non-emergency acute and chronic health conditions, disease management and education, diagnosis, treatment and follow-up care, basic laboratory services and in-house ultrasound and EKG testing. With the establishment of a primary care clinic, the underprivileged residents of Brevard County can now have a medical home and receive services at the fraction of the cost of an emergency department visit. A priority in services includes local hospital emergency department diversion. Diversion from the emergency department is accomplished by the PATH clinic by providing increased access to health care for treatment, evaluation and follow-up care, discounted medications or enrollment to pharmaceutical medication assistance programs, disease management and education.
Sustainability:
Lessons Learned:

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