{"id":4785,"date":"2016-05-11T00:00:00","date_gmt":"2016-05-11T06:00:00","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/2016\/05\/11\/cu-physician-led-group-takes-medical-care-to-the-streets\/"},"modified":"2024-11-04T09:04:31","modified_gmt":"2024-11-04T16:04:31","slug":"cu-physician-led-group-takes-medical-care-to-the-streets","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/cu-physician-led-group-takes-medical-care-to-the-streets\/","title":{"rendered":"CU physician-led group takes medical care to the streets"},"content":{"rendered":"
<\/div>

Vehicles clustered near a Food Bank of the Rockies tractor-trailer in a parking lot near 60th Avenue and Quebec Street in Commerce City. Tables laden with non-perishable food items lined the front of the trailer and people queued up, waiting to fill bags and small carts. Others were busy unloading food into cars and trucks.<\/p>\n

\"Katy-Boyd
Katy Boyd-Trull and nurse practitioner Kara Palfy (facing camera left and right, respectively) and volunteers set up to deliver free medical care near a Food Bank of the Rockies truck April 15.<\/figcaption><\/figure>\n

Behind the trailer on this cloudy mid-April Friday morning sat a short row of card tables staffed by a small group of people. Stenciled signs announced free services available to anyone who wanted them: pneumonia vaccination shots, smoking cessation counseling, blood-pressure tests, and general assistance with other medical questions and issues.<\/p>\n

It might have seemed an unlikely place to find a lawyer, but Donnia Howell, Esq., a solo practitioner in Commerce City, stood near the tables helping to check people in. Howell isn\u2019t there to drum up business. She is on the board of directors of the YHC Clinic, a nonprofit dedicated to medical outreach to those in need. Howell, secretary of the group, donated her attorney skills to set up YHC as a 501 (c) (3) non-profit in 2015.<\/p>\n

In her professional life, Howell provides bread-and-butter legal services, like estate planning and probate. Why get involved in a free medical clinic? Howell gestured toward one of the card tables, where a woman spoke animatedly with a middle-aged man.<\/p>\n

\u201cIt was Katy,\u201d she said. \u201cShe\u2019s very persuasive.\u201d<\/p>\n

Hospital to the streets<\/strong><\/p>\n

\u201cKaty\u201d is Katy Boyd-Trull, MD, founder and executive director of the YHC Clinic. Like Howell, Boyd wears another hat, although hers is a medical version. Boyd is inpatient director for the University of Colorado School of Medicine\u2019s Department of Family Medicine. In that role, she devotes a good deal of her time working with other providers to help patients make a smooth transition from University of Colorado Hospital to outpatient and community care. The goal: help them to improve their overall health and avoid unnecessary hospital and emergency department visits.<\/p>\n

To do so, the transitions-of-care team identifies and addresses barriers to care, such as finances, transportation, insurance, housing, and a host of other issues that for many patients complicate access. The work has been particularly successful at UCH\u2019s A.F. Williams Family Medicine Clinic in Denver’s Stapleton neighborhood.<\/p>\n

But the work touches only a fraction of patients facing serious medical problems with limited resources. Boyd, nurse practitioner Kara Palfy, NP-C \u2013 who serves as YHC vice president and treasurer \u2013 and a host of volunteers, both clinical and non-clinical, regularly take to the streets to deliver health care to the most vulnerable in Commerce City.<\/p>\n

\u201cThere is tremendous need,\u201d Howell said. \u201cThere is a lot of poverty in this city.\u201d<\/p>\n

The data back that up; roughly one in five Commerce City residents live below the poverty level<\/a>. But Boyd sees more than cold statistics, having lived in the community the past nine years. As a resident, fellow, and attending physician at UCH, Boyd noticed the large number of patients from Commerce City\u2019s 80022 zip code readmitted to the hospital as a result of poorly controlled blood pressure and cholesterol, diabetes, asthma, and other conditions that worsen health and drive up costs \u2013 unnecessarily, in her view.<\/p>\n

\u201cI\u2019d see people in the hospital who\u2019d had strokes because they had uncontrolled blood pressure but couldn\u2019t afford their meds,\u201d Boyd said.<\/p>\n

She chafed at the notion that patients get sick because they don\u2019t comply with their medication regimens. She noted that for an unemployed or homeless individual with kids, the $4 to buy a bottle of blood pressure pills, say, might mean an entire day of food. In that case, the challenge is not getting patients to take their medications, but rather getting them the medications without forcing a decision to eliminate something else.<\/p>\n

\u201cMost patients will take their meds once they get them,\u201d Boyd said. \u201cBut we have to have a financially feasible system that keeps an eye on the needs of the population and provides them with consistent care.\u201d<\/p>\n

She\u2019s not alone in that view. Boyd\u2019s YHC work has the support of the Department of Family Medicine. \u201cThe department approves of and appreciates all of Katy\u2019s work in the community,\u201d A.F. Williams Medical Director Corey Lyon, DO<\/a>, wrote in an email.<\/p>\n

\u201cThey realize that improving access to care saves millions of dollars,\u201d Boyd said. Identifying the \u201chot spots\u201d of unmet need, like Commerce City, and sending in resources is the proper strategy for making that happen, she maintains. \u201cThe mission of YHC is basically to provide free health care to high-need communities.\u201d<\/p>\n

Back to the basics<\/strong><\/p>\n

Many times, the services people need aren\u2019t complicated, Boyd said. They include regular screenings for diabetes, blood pressure, and cholesterol and checks of vital signs, weight, and oxygen levels. But social problems frequently make it difficult for people to access the help, and the list of resources to address them is \u201cthin,\u201d Boyd said. Salud Family Health Centers<\/a>, Access Housing and Catholic Charities<\/a> shoulder much of the load.<\/p>\n

Palfy checks the blood pressure of a patient (photo courtesy YHC).<\/figcaption><\/figure>\n

Boyd and her YHC colleagues work to bridge the gap. They spot the homeless on the outer edges of places like a Walmart parking lot, talk to them and see what they can provide to help them stay whole \u2013 like the truck driver unable to work because of his diabetes that Boyd found recently during one tour of the streets. She gave him a prescription for medications on the spot. They send nurses to the homes of people with high blood sugars for foot care \u2013 a key to preventing limb loss. They find low-price alternatives for medications like long-acting insulin and antibiotics and work with pharmacies to cover costs when patients can\u2019t afford them.<\/p>\n

The work depends on help from people like Melissa Clement, a nursing student and advanced care partner in UCH\u2019s Oncology Unit. Clement, also a nine-year Commerce City resident, got involved in YHC through Palfy, who serves as her mentor. Clement goes to most of the Food Bank of the Rockies distributions to help with patient assessments, blood pressure and glucose readings, and other tasks.<\/p>\n

\u201cIt\u2019s helpful for me as a student to gain experience, watch other providers, and ask questions,\u201d she said. \u201cIt boosts my education.\u201d<\/p>\n

Hidden needs<\/strong><\/p>\n

Her work benefits people like Sarah (not her real name), who had driven to Commerce City from Northglenn to pick up supplies from Food Bank of the Rockies. A 42-year-old mother of four, Sarah said she and her husband, an electrician, have Medicaid for their kids but make too much to qualify themselves and can\u2019t afford private coverage, even with a large deductible.<\/p>\n

\u201cI couldn\u2019t go to the doctor,\u201d Sarah said, but YHC helped out. She got an exam that included a blood pressure check, a flu shot, lab work, and a prescription for needed medications.<\/p>\n

It\u2019s a typical situation, Boyd said. \u201cPeople will get medical care for their kids but don\u2019t prioritize themselves,\u201d she said. \u201cBut we say a dead parent doesn\u2019t help their kids, so we try to target adults.\u201d<\/p>\n

It all takes building relationships with businesses, service organizations and individuals in the community. During the food truck visit, for example, Palfy administered free pneumovax shots with vaccine a local Walgreens sold YHC at cost.<\/p>\n

\"Food
Lines form to pick up supplies at a Food Bank of the Rockies distribution.<\/figcaption><\/figure>\n

After the food truck crowd began to thin later that morning, Palfy and Boyd piled equipment, medical supplies, toys, towels, soap, water, books and candy into a van and headed for a dusty lot that is home to a \u201cmotel\u201d \u2013 no more than a collection of shacks \u2013 in a poverty-stricken area of Commerce City south of 88th Avenue.<\/p>\n

The bleak outpost is far from the landscape of competitive health care, a home to unemployment, drug abuse and crime, Boyd acknowledged. But the need for attention is precisely why she and Palfy go there.<\/p>\n

\u201cWe keep coming through to develop trust,\u201d Boyd said.<\/p>\n

Palfy\u2019s daughter Ivy carried a plastic jack-o-lantern holding candy and other supplies and volunteer Jill Dinneen acted as a Spanish language translator. The group split up, knocking on doors, and calling, \u201cYHC. Do you need anything?\u201d A young pregnant woman sleepily emerged from one. Boyd asked if she needed prenatal vitamins; the woman said, no, she got them from University.<\/p>\n

Many doors remained closed or opened only a crack for people to offer curt answers. But the visit produced a tangible success. A heavyset man welcomed Palfy into his cluttered unit and accepted her offer of a pneumovax shot. He said he\u2019d been to Salud\u2019s Commerce City clinic and to National Jewish Health but had difficulty keeping his appointments because of transportation problems. Palfy and Boyd say that\u2019s a common barrier for residents of areas like this one that are perceived as dangerous for drivers to enter.<\/p>\n

The outreach work walks a fine line. The YHC team visits worlds where illicit drugs, spousal and child abuse, prostitution, and sex trafficking are present. They extend a helping hand but will not look the other way at illegal behavior. They try also to encourage positive behaviors and personal responsibility without moralizing.<\/p>\n

Palfy summed it up as she watched a thin woman in her mid-20s pick through books and toys for her kids. The donations, she said, aren\u2019t handouts, but rather a conduit to a longer conversation about better health.<\/p>\n

\u201cWe\u2019re trying to give people help without enabling them,\u201d she said.<\/p>\n

Clement, who has accompanied Palfy and Boyd on these \u201cstreet medicine\u201d trips, says her work with YHC has taught her that patient care calls for \u201cteaching, educating, and understanding without judgment.\u201d She said she\u2019s carried the lesson to her work at UCH. \u201cIt\u2019s my job and my duty to be an active listener to my patients, to understand what they need and not judge them on the basis of societal problems or issues,\u201d she said.<\/p>\n

Being the change<\/strong><\/p>\n

Boyd speaks freely of her belief in the power of the individual to effect change. \u201cKindness speaks volumes,\u201d she said. \u201cYou don\u2019t know what one act can do for a person in the world.\u201d But she\u2019s also acutely aware of the practical importance of building alliances if YHC is to help address the vast unmet need of the community.<\/p>\n

Her long-range goals include working with other non-profits to open a drug treatment facility and a shelter for battered women and building partnerships with law enforcement. In addition, YHC has formed alliances with the public schools in Commerce City to identify kids with few resources, as well as with Community Uplift Partnership<\/a> (CUP), a faith-based organization that provides both physical and spiritual help to people in need.<\/p>\n

CUP\u2019s Hope Family Resource Center offers basic help with food and clothing, but also gives people an opportunity to interact in a safe environment, share their experiences, and learn to manage their resources, said Executive Director Keely Thompson, as she stood near the YHC card tables during the Food Bank distribution. Like YHC, her organization strives to build trust among people wary of accepting help.<\/p>\n

\u201cThat takes time and intimacy,\u201d Thompson said. \u201cYHC provides people in our community health care, which is a whole other piece. They are reaching more people.\u201d<\/p>\n

\"Katy
Melissa Clement, an advanced care partner at UCH, helps a patient during a recent Food Bank of the Rockies distribution, while Katy Boyd documents.<\/figcaption><\/figure>\n

At the most basic level, that is what Boyd has been trying to do for much of her life. She grew up in Mead, Colo., where she says her family worked hard but went without health insurance \u2013 as did the migrant farmworker community that arrived each season. \u201cI also grew up around addiction,\u201d Boyd said, \u201cand I hated all that.\u201d<\/p>\n

As she began her medical career, Boyd thought about finding an area of need. She found the answer simply by looking around her. \u201cI saw that the needs are everywhere,\u201d she said. \u201cIt\u2019s just that people don\u2019t know they are there.\u201d She decided that her profession and her faith called her to stand up for \u201cpeople without a voice.\u201d<\/p>\n

Boyd has done medical volunteer work in Rwanda, Honduras, and Mexico. But she said she has often found more hope in the ravaged communities of these countries than in the drug pockets of Commerce City.<\/p>\n

Her motivation to restore hope is personal, but Boyd believes that society ignores the people YHC serves at its peril. The epidemic of addiction alone continues to sap spiritual and financial resources and will continue to do so without a reasoned, nonjudgmental response to medical and behavioral health needs.<\/p>\n

\u201cThey are not living in the lap of luxury,\u201d she said. \u201cThese are people who are barely making it and they are often doing it through socially unacceptable means. It\u2019s costing us billions of dollars. We have to come up with a system that reaches the people who want recovery.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Vehicles clustered near a Food Bank of the Rockies tractor-trailer in a parking lot near 60th Avenue and Quebec Street in Commerce City. Tables laden with non-perishable food items lined the front of the trailer and people queued up, waiting to fill bags and small carts. Others were busy unloading food into cars and trucks. 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