Providers felt rewarded by seeing improvements in older adults’ health, functioning and quality of life, and being appreciated by them and their caregivers. Findings from this literature indicate that physicians and nurses: (a) reported difficulty in managing patients with MCC with limited consultation time [21, 23]; (b) included limited consideration of the interactions between conditions [21]; and (c) encountered conflicts between their own and patient goals [23]. Effective communication between clients and providers was seen as necessary for quality of care. Master of Science in Nursing, Northern Arizona University, Hilltop Regional Health Center - Foster Adoption Clinic, Family Medicine, International Medicine, Rural Medicine, Community Mental Health, Foster Care, Adoption, Lakewood Family Dental Clinic & Spanaway Family Dental Clinic, School Based Health Center at Bethel Middle School, Medication Assisted Treatment for Opioid Dependence, Family Medicine Residency Application Process. She was the Chair of the Washington State Dental Hygiene Examining Board and also serves on two dental hygiene exam boards for Washington State. She enjoys spending time with her dogs and growing flowers and vegetables in her garden. She is certified in a number of evidence-based behavioral health practices such as screening, brief intervention, and referral to treatment (SBIRT) and cognitive behavioral therapies. Seattle, Washington “Definitely a more streamlined healthcare system. Community Health Care started providing dental care since almost half of Pierce County lacked dental insurance. COMMUNITY HEALTH CARE LOCATIONS AND PROVIDERS. Thousands Oak, CA: Sage; 2013. For urgent care, schedule an appointment at MedCheck or Community … It’s hard to put into words.”. Dr. Goldstein provides care at the Hilltop Regional Health Center Urgent Care and as a part of the Medication Assisted Treatment Team (MAT). Participants also proactively referred older adults with MCC to other healthcare and community support services to help them manage MCC at home. Healthcare providers described how they engaged older adults with MCC in proactively managing their care and equipped them with resources to achieve self-management goals: “So the patients need to be committed and lot more emphasis is on self-management, encouraging the patients to participate and be more proactive themselves, rather than the patient coming to you and wanting you to fix them” (Nurse Practitioner 9). They acknowledged the out-of-pocket costs of medications and the fixed incomes of older adults and used strategies to address these issues. Provides care at each location as neededSpecialties:Family Practice, Urgent Care, Associate of Applied Science: Dental Hygiene, Erie Community College, Williamsville, NY Many of our services are listed below; however, you may … Bachelor of Arts in Psychology, University of Washington, Seattle, Washington. 2015;385(9967):549–62. Bachelor of Arts in Psychology and Religion, Carleton University, Corey Hatfield received his Physician Assistant Training at Medex Northwest Physician Assistant Training Program at the University of Washington. Master’s in Public Health, California State University Long Beach, Long Beach, California, Medical Degree, University of California Irvine School of Medicine, Irvine, California, Bachelor of Science in Biochemistry/Cell Biology, Minor in Spanish Literature, University of California San Diego, La Jolla, California, Harbor-UCLA Department of Family Medicine, University of California, Irvine School of Medicine, Irvine, California. Washington, DC Erie County Medical Center, Buffalo, New York. In addition, he is a Washington State native being born in Everett, Washington. PubMed Central  Almost all providers working in primary care discussed collaborating with multiple disciplines to provide comprehensive care, while only about half of the providers in home care discussed this. Experience: Jo is an experienced critical and primary care nurse. Watching someone losing their limbs one at a time becomes a challenge. J Aging Health. A to Z List of Services. Education Doctor of Dental Surgery, University of Washington School of Dentistry, Arch Intern Med. Bachelor of Arts, Healthcare Leadership, University of Washington, Tacoma, Washington, Master of Science, Physician Assistant-Certified, Heritage University, Toppenish, Washington. “It just seems we are always short-staffed, the caseloads sometimes are really high numbers. Despite these challenges, they also felt rewarded in being able to improve the lives of their clients and being appreciated by their clients. Trust made it easier to collaborate with other healthcare providers when there were common goals, mutual respect and recognition of the skill of each profession. She has also been a faculty member at the University of Washington, School of Dentistry in their Restorative Dentistry Clinic. Bachelor of Arts in Neuroscience, Wesleyan University, PubMed Google Scholar. Cheryl Fewins, RDH earned her Bachelor of Science in Dental Hygiene at the Eastern University of Washington in Cheney, Washington. Terri Puett, RDH has been a practicing hygienist since 2002. Sales provides the full spectrum of medical care to patients of all ages. This education was often focused on improved understanding of disease processes, managing medications, and watching for signs and symptoms of worsening health of the older adult. She strives to provide quality, comfort, and education to her patients. Experience Experience Cheryl has also provided volunteer dental services in Mazatlan, Mexico. Her first nursing position was serving as a Commissioned Navy Nurse Corps Officer at Bethesda Naval Hospital. Uhlig K, Leff B, Kent D, Dy S, Brunnhuber K, Burgers JS, et al. Jo is an experienced critical and primary care nurse. She has volunteered extensively to advance compassionate and empowered care to all communities. First, participants included only small numbers of certain professional groups such as home care case managers, nurse practitioners, pharmacists and dietitians. Experience Connecticut Community Care. Written informed consent was obtained from all participants by either a research coordinator or research assistant. Iowa City, Iowa. And what we have certainly found works best is seeing.the elder once a week routinely, and addressing in small bits, their needs.”. A special focus of his career has been helping people access dental care. Bachelor of Arts in History, University of Washington, Seattle, WA, Master of Science - Nursing, Family Nurse Practitioner Specialty, Pacific Lutheran University, Tacoma, WA. Doctor of Medicine with distinction in research, University of Rochester, Rochester, New York Maureen Esparza, Psy.D. Doctor of Dental Surgery, University of Missouri, School of Dentistry, Education Bachelor of Arts in Psychology, University of Houston, Houston, TX Prior to that, he served as a pediatrician at MultiCare Medical Center in Tacoma, Washington. A qualitative descriptive study on the alignment of care goals between older persons with multi-morbidities, their family physicians and informal caregivers. She provides full spectrum medical care, including obstetrics, pediatrics, adult care, and geriatrics. In making often complex treatment decisions, they recognized the need to prioritize quality of life over quantity of years lived. Medical Degree, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, Residency: Hattiesburg, Mississippi. In doing so, they often addressed barriers to health promotion such as finances and transportation. She also worked in Maternity Support Services for almost three years integrating mental health services with obstetrical care. Education Throughout the pandemic, we’ll be providing our community healthcare providers and partners with the most up-to-date information to you as it becomes available. Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, Pennsylvania. We used purposive sampling strategies including criterion and maximum variation sampling [26]. Providers reported feeling frustrated when clients with MCC did not follow the care plans established by the primary care team. Licensed by the State of Washington as a Nurse Practitioner, Kimberly Sales, ARNP, practices with Community Health Care's Hilltop Regional Health Center  Family Medical Clinic. His work history includes serving as a dentist with Family Health Care Clinics, Inc. in Monticello, Mississippi. Dr. Beck earned her medical degree at the University of Washington School of Medicine with a focus on the medically underserved. Master of Science in Counseling and Guidance, Loyola University, Bachelor of Science, University of Washington, Seattle, Washington, Residency Experience includes pediatric emergency medicine, tribal healthcare in Washington and Alaska, and international medicine in Costa Rica, El Salvador, and Papua New Guinea. Experience This work is part of a program of research (Aging, Community and Health Research Unit, School of Nursing, McMaster University) supported by the Canadian Institutes of Health Research Signature Initiative in Community- Based Primary Healthcare (http://www.cihr-irsc. Healthcare providers such as physicians, pharmacists, and nurse practitioners felt that they often had to balance the need to treat chronic conditions with the potential risk of medication side effects for older adults. Emory Family Medicine Residency, Community proudly offers individual health insurance in the new Health Insurance Marketplace. Become a Community Provider Community Cares Connecting you to the best health insurance for every stage of life. Can J Commun Ment Health. “I offer them a bunch of options, whatever I can offer to them. In summary, there are few studies that examine the perspectives and experiences of a diverse group of primary care and home care providers (such as nurses, social workers, physiotherapists, personal support workers and others) in caring for older adults with MCC. The current study is unique as it provides a Canadian lens on how home care and primary care providers other than family physicians implement person-centred care for older adults with MCC in the community. She was honored again when she received the ‘Alumni Outstanding Service’ award from the University of Missouri-Kansas City. Community Health Care Family and Community Residency, Tacoma, Washington. Dental clinics provide preventive and restorative services for all ages, focusing on early screening for all children and sealants for school-age children. Dr. Dunham's work experience includes eight years of community health dentistry. Providers. Dr. Smith earned his medical degree from the University of Washington, School of Medicine. He has provided full spectrum dental services including preventative and restorative care of teeth, crowns and bridge work. She received a certificate from the University of Southern Indiana in Oncology and she is a licensed esthetician. The experiences of these primary care and home care providers reveal that they use a broad array of relevant strategies and approaches to support the complex care of older adults with MCC living in the community. Stacie Beck, MD is Board Certified in Family Medicine and practices at Community Health Care’s Downtown Clinic. Education Physician Assistant Training, MEDEX Northwest, University of Washington, Department of Family Medicine, Seattle, Washington. She has also been a clinical instructor for the University of Washington School of Nursing. Quotes are labelled with the profession of participants and ID number. They referred clients to community support programs that had little or no cost. After completing his Family Practice Residency at Swedish Family Medicine in Seattle, he entered private practice in Eastern Washington and also served as Medical Program Director for Pend Oreille County's Emergency Medical Systems and Trauma Service. She has also worked as a social worker, school psychologist, and behavioral specialist. JP and KF designed this project, wrote the protocol and obtained ethics approval, and oversaw data collection in each province. She has also co-published training manuals and papers on behavioral health treatment. Two recent reviews have found that the social determinants of health have not been well integrated into conceptualizations of multimorbidity [37, 38]. He has provided care in community health settings and in hospitals in the United States. Gill A, Kuluski K, Jaakkimainen L, Naganathan G, Upshur R, Wodchis WP. “We find out financing; we find out when they’re really taking their medications, which ones are being skipped; then we will work with our wonderful pharmacist to see which other meds that we can get them on that are paid and we can try and simplify their dosing regimens.”. McMinnville, Oregon, Residency Erin Longley, MD has worked as a family physician in the United States Air Force and Group Health Cooperative. Participants represented diverse disciplines from primary care and home care settings. Doctor of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam. Educating caregivers to support older adults with MCC: “it’s about education.” Healthcare providers offered education to caregivers on how to best support the person with MCC at home through clinic or home visits, and group sessions. She has also worked in residency programs training other physicians. Seattle, Washington. Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. Masters of Public Health, Global Health Policy, George Washington University, Family Medicine of Southwest Washington, Peace Health, Family Medicine Residency, Vancouver, WA, Education Ms. Bachelor of Science, Nutritional Sciences, University of Florida, Gainsville, FL. “I have a patient right now who was referred to me because of slight general mobility, she had pulled and hurt her ankle...and she has severe Alzheimer’s but she also has rheumatoid arthritis. We would like to thank all the healthcare providers who participated in the study. Healthcare providers such as nurses and social workers felt that older adults were more willing to share some pieces of information important to managing their conditions with them, rather than physicians as suggested in the quote: “they don’t want to tell the doctor that.” This suggests the value of an interprofessional team, with unique perspectives and skills, contributing to health care decision making to support older adults with MCC. Fellow in Faculty Development, San Bernardino County Medical Center, San Bernardino, California. One of her focus areas is helping patients who are struggling with chemical dependency issues. It’s like a process that just makes the healthcare system not really time effective and cost effective. Since becoming a dentist he has worked in private practice in the states of New York and Washington. Bachelor of Clinical Health Services, MEDEX Northwest, University of Washington, Seattle, Washington Education Credibility, described as the accurate reflection of participant experiences, [32] was achieved through: (a) including participants with diverse roles from two provinces in the identification of themes; and (b) investigator triangulation where analysis was conducted by investigators with expertise in qualitative approaches, older adults, multiple chronic conditions and community care. 2012;13(56):1–7. Terms and Conditions, Typically, older adults with MCC receive care from multiple healthcare providers across various care settings [13]. Amber de la Vega, ARNP has worked as a Family Nurse Practitioner in community health since 2012 in Tacoma. They used proactive approaches to prevent conditions from worsening or new ones from developing such as promoting lifestyle changes and self-management, and supporting people to connect with health and social services in the community. Patients with concerns about patient care and/or safety within Community Health Care, Inc. are encouraged to contact the CHC Quality Team. Education Experience Education He has worked for Community Health Care since 1996. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. Pre-MEDEX Coursework, Pierce College, Tacoma, Washington Northwood M, Ploeg J, Markle-Reid M, Sherifali D. Integrative review of the social determinants of health in older adults with multimorbidity. Experience: For older adults with MCC living in the community, these healthcare providers are mainly from primary care and home care settings and include a broad range of providers such as nurses, physicians, social workers, pharmacists, physiotherapists, … Doctor of Pharmacy, University of Washington, Seattle, Washington Bachelor of Science in Psychobiology and Women’s Studies, University of California, There is a need to better understand how home care workers collaborate with each other and professionals in primary care settings to support older adults with MCC. Providing compassionate care for those living with an illness while providing support for those caring for a loved one is the mission of Community Healthcare of Texas. Dental Hygiene Program, Eastern Washington University He enjoys providing support to Community Health Care’s diverse patient base. "where do we go from here?" Experience Bachelor of Science Degree in Nursing, University of Washington, Seattle, Washington They also helped to link caregivers to community programs and services to support them in their caregiving roles. Individualizing care: “[care] catered to their individual needs.” Healthcare providers respected the preferences of older adults and their caregivers when making decisions about management of MCC. Community Health Care Family Medicine Residency, Tacoma, WA. 2011;171(1):75–80. Chicago, Illinois Ancker JS, Witteman HO, Hafeez B, Provencher T, Van de Graaf M, Wei E. The invisible work of personal health information management among people with multiple chronic conditions: qualitative interview study among patients and providers. Seattle, Washington His community health experience has mostly been in Mexico where he volunteered at multiple orphanages and Saint Innocent’s Ranch and Home for Boys. Participants described the challenges of poor team communication that negatively impacted their care provision. World Health Organization (WHO). Bachelor of Science in Biology, University of Rochester, Rochester, New York, Internship: © 2020 BioMed Central Ltd unless otherwise stated. Bachelor of Clinical Health Services, University of Washington, Dr. Wu has worked in private practice, and at Kitsap Community Health Center prior to his work with Community Health Care. Bich Ngoc Nguyen, RDH has a strong background in medicine and dentistry. Part of They considered the social situation of their clients and the level of involvement that caregivers have in helping to manage MCC. Before moving to the Northwest, Dr. Kahng worked in private practice in Texas, where she provided the full spectrum of general dental services. All interviews were audiotaped, and their average length was 60 min. It has been argued that the increasing prevalence of chronic diseases and the shortage of primary care physician are powerful forces driving primary care towards more Nurse Practitioner and Registered Nurse participation in provision of chronic care services [45]. He is a member of the You don’t need to have … Transcripts were cleaned for accuracy by an experienced research assistant. Middletown, Connecticut, Residency NEJM. Accessed 27 Dec 2018. 2014;29:670–9. Providers also suggested longer primary care clinic visits to fully address client questions and better manage MCC. Dr. Rhee has provided dental services to young children through Head Start Programs in Milwaukee. In his free time he likes to explore the outdoors, travel, stay physically active, and entertain the multifaceted routes in individual’s lives. Doctor of Dental Surgery, Loyola University of Chicago, J Adv Nurs. Prior to working in community health, Ms. Puett worked with dentists in private practice. Bachelor of Arts Degree, University of Montana, Missoula, Montana Community Home Health Care is a senior in-home care provider based in Farmington Hills, Michigan at 28200 Orchard Lake Rd, Suite 102. A total of 42 healthcare providers participated in this study from Ontario (n = 22) and Alberta (n = 20) (See Table 2). Privacy 2014;62(12):2261–72. View Profile. Third, study results indicate that these healthcare providers recognized the critical roles played by family and friend caregivers to support older adults with MCC living in the community and included them in their care approaches. Julia’s experience includes working with youth, adults, and families in community mental health, substance abuse, co-occurring, and brief intervention services. Bachelor of Science in Nursing, University of Washington, Community Health provides the highest quality of care to our patients and families, while conducting our health care and business practices in a legal, ethical and professional manner. These primary care and home care providers played key roles in supporting older adults with MCC and their caregivers. Doctor of Dental Surgery, University of Texas Health Science Center, You cannot walk away from that personal, emotional situation; no matter how late you are, you cannot walk out the door.”. Consistent with the ID design, we used the 6 steps of inductive thematic analysis as an analytic approach [30]. He has an accreditation in Career in Residency Education, Curriculum, Administration. It’s a lot of wasted time.”. We serve children, seniors and adults. CAS  She was also a Camp Nurse and taught School Nursing at Pacific Lutheran University School of Nursing. Her undergraduate degree is in Biology from Seattle Pacific University in Seattle, Washington. Douglas Aguirre, PA-C’s work experience includes serving as a Special Forces Medic in the U.S. Army. Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. 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