I have diabetes type 2. My test results were not improving, with my A1C between 8.5 and 13. It was suggested I meet with Anne Dvorak who works for UniNet.
In my meetings with Anne, we discussed many reasons that could relate to my health issues I discovered that I had some mental issues which related to frustration. Anne was able to get me to talk about these issues and develop a plan with goals.
Anne has been able to establish a trust that I have for her. As a result of our meetings, I am now seeing a kidney specialist and a diabetes specialist. Because of her work, my health is improving as I am working on diet and exercise. Anne has been able to reach me in regards to putting my health first. It is imperative I continue to meet with her, as her knowledge and professionalism assist me in keeping on track for improved health.
I had a patient who started seeing me for his diabetes. He had not seen a doctor for years and had been without insulin for many months. As it turned out, he also has hypertension and hyperlipidemia. He told me he could not make appointments with his previous doctor because he works two jobs. He feels exhausted all the time and feels the world is closing in on him.
He supports not just himself but also his daughter and her two children. He has not taken advantage of his employer's insurance as it was too expensive and he hadn't thought about getting insurance on his own.
I approached our UniNet care coordinator for assistance. We both knew that his medical condition needed chronic care and management, which he could not get without some form of insurance. He needed supplies for his diabetes, notwithstanding insulin and other medications. The underlying issue was cost.
Just as it turned out, he only had four days before the health exchange in Iowa closed for the year. Iowa, like other states that decided to expand Medicaid for health insurance, allowed my patient to get insurance at a lower cost, just in the nick of time. My care coordinator contacted the UniNet social worker, who facilitated the paperwork to enroll him at an affordable price.
The hard work of making him come to his appointments was easier once he knew he had the resources to keep seeing us. For the first few weeks, he saw my care coordinator more than he saw me. When his medications were all refilled and he started giving himself insulin again, he felt much better. His A1C came down gradually from high 10's to a target of less than 7.0 He is much happier and follows me regularly now with medical visits. He has yet to miss a visit with me!
Mel Roca, MD, family practice physician, CHI Health Alegent Creighton Clinic
I called a patient to set up an appointment with her primary care physician. She said she would come, but she didn't like coming because it was another "downer" in her life and she just couldn't get in control of herself. She did show up to the appointment. I met her and asked if she would talk about how things were going with her diabetes, knowing that her A1C was high. While she talked with me, she tearfully recounted a life of unfortunate events. It broke my heart to hear that she felt her life was so hopeless.
I health coached her and we made a plan. More than anything, I knew I needed to be her friend and confidant. Her doctor agreed to have her come in for weight checks and to review her meds more frequently. We grew together as friends. As she realized that we were supporting and her and we cared, she slowly started changing.
First, she smiled more often and seemed more cheerful, then the weight started coming off as she started a walking program. I have never seen anyone change so much. She lost more than 40 pounds in a year. She had all that it took to make the changes - she just needed a friend and encouragement. She now believes in herself again.
At the last appointment, she said, "you have saved me." It was very touching and validated why we do what we do. Now that she has lost weight and feels better, she wants others to feel like her. She volunteered to teach an exercise class at her local senior center.
A patient came into the clinic with high blood sugar, A1C, cholesterol, triglyceride and LDL numbers. I immediately worked with him on his diet and reviewed basic carbohydrate counting. I was able to get him the diabetic supplies he needed, including a glucometer. He also was in need of a CPAP mask, so I arranged for a mask for him and he found one that worked well. I completed weekly health coaching calls for three months. We had some challenges with changes in his insurance plan, but continued to find alternative treatment that was covered and affordable.
In three months, his A1C dropped five points, and his other numbers decreased as well. Not only did his lab values significantly improve, but he is feeling better too! I realized just a few weeks ago that I had truly made an impact on this patient and his health.
He sent me the following note via MyChart: Thank you so very much for all you are doing to help me through my diabetes management issues. I truly appreciate your dedication to finding the right combination of medications and recommendations for my health. You're the best!
A patient who I have taken care of for many years has hypertension and hyperlipidemia. While she was very compliant with medications, diet and exercise—she was unable to quit smoking, even though I’ve talked about it with her. She started to have back issues and after non-surgical management failed, she needed spinal surgery.
When we discussed her seeing a neurosurgeon, I talked to her about the risks of smoking and how it could interfere with spinal surgery. She said she knew she needed to quit and subsequently started a smoking cessation program at her work. However, she did not feel connected to the coaches at her work program because they did not seem to understand the power of nicotine addiction.
When she came in for one last check before scheduling her surgery, she was frustrated. I reached out to UniNet Population Health Coach Terri Rose and asked her if there was any other support we could give my patient. Terri took that challenge and was fabulous.
After a few phone calls and talks with Terri, the patient felt more confident and supported. She then came back for her pre-operative exam—with success! The patient constantly states that she would never had been successful without her health care team at Alegent Creighton Clinic.
I had another patient who had no acute health needs, but was struggling with psychiatric issues with an adult daughter and was quite distraught. Terri met with the patient and established a relationship. The patient declined any services that day, but a few weeks later the she reached out to Terri for some help. This is a very private patient, and her trust in Terri shows the impact she makes when she talks to patients.
The work the health coach does makes me not feel alone when I have a difficult situation with patients. While I spend as much time as I can with patients, having the health coach helping re-educate, support, and show kindness to my patients helps me see more patients, and has given my patients another person to help support them.
Patricia Murdock-Langan, MD, family medicine physician, chief medical officer, CHI Health Lakeside and Midlands