Opening the doors to community care Outreach: Community health workers go to the homes of the poor who suffer from chronic illnesses, bringing care and social support.

November 01, 1995|By Diana K. Sugg | Diana K. Sugg,SUN STAFF

Pausing at the front door, Emily Garey hollers up the stairs, "It's me!" Within moments, she is at Mary McNeil's kitchen table, chatting with the diabetes patient about her blood sugar levels, glaucoma, and exercise routine.

Ms. Garey has a little black bag, but she isn't a nurse or a doctor. She is a community health worker who takes on the roles of sister, friend, and social worker, visiting poor people with chronic illnesses such as diabetes and hypertension.

The success that Ms. Garey and her peers have had controlling disease -- and its costs -- is the subject of a study released yesterday at a meeting of the American Public Health Association.

Their outreach program, run by the University of Maryland's pharmacy school, achieved a 30 percent reduction in emergency room visits, a 34 percent drop in hospitalizations, and a 23 percent decrease in days per hospitalization among a group of diabetes patients.

That translates into a 27 percent drop in costs that Medicaid paid for their care. By contrast, costs went up in each category for a comparison group of patients not visited by the workers.

"I'm convinced that basically the treatment of poor and under-served people requires some kind of intervention beyond setting up a clinic," said Professor Donald O. Fedder, the project's director. "You've got a lot of talent in the community that with a little direction and help can be turned on."

The outreach program has shown so much success turning around the lives of patients that administrators want to double the program's size. They now have 12 full-time paid workers, along with a dozen part-time volunteers, who together see about 200 patients, mainly in Sandtown-Winchester.

The workers are trained to take blood pressure and perform CPR, among other skills, and they gather for their own version of "grand rounds," where each worker presents a troublesome case and gets advice from the others.

Besides making home visits and telephone calls, they accompany patients to the doctor's office, deal with pharmacies and educate family members. They also routinely examine the feet of diabetic patients to prevent amputations.

As peers of the people they are helping and through a nontraditional approach, they have met success in overcoming long-standing barriers to their health care.

For instance, community workers discovered people were taking their medication incorrectly because they were illiterate and couldn't read the label. Other patients were spending what little extra money they had to pay the electric bill, rather than buy a prescription. One woman whose furnace was broken couldn't focus on her diabetes because of the cold.

At first, the staff was overwhelmed by the number and depth of those issues. "It was a scramble for resources," said Sheila Curry, the outreach program's coordinator.

But the workers drew on their activist, volunteer background. They knew what churches to contact and how to help their patients get food stamps, shoes or dental care and even avoid eviction.

"When I first met you," Miss McNeil told Ms. Garey, "I was sitting around, flopping around, doing nothing. But I started to say, 'OK, if Em says I can do it, I can do it.' "

Miss McNeil, 58, has diabetes, asthma, hip problems and has suffered five heart attacks. Since she began working with Ms. Garey in 1991, she has put her blood sugar under control, began to take walks and lost weight. "It's just like I left the shell behind, like I was boxed in. Now I feel like: Lord, I just opened the door."

Now she is able to volunteer regularly in the grandparents program at a nearby elementary school and is recruiting others. She is encouraging a young girl to stay in school. "I want to help somebody else," said Miss McNeil.

Meanwhile, the outreach workers say they are gaining, too.

"The knowledge we learn, no one can take it away from us," said Ms. Garey proudly.

They also work with patients on emotional and family issues. Some patients are shocked at the diagnosis of diabetes and need to have things repeated -- much more than any physician has time to do. One patient wasn't measuring her blood sugar because she was too afraid to prick her finger. So Ms. Garey pricked her own, to show her it was simple.

Most of her 12 patients have both her home telephone and pager numbers. "Everyone of us, we are just like children" who thrive when asked about personal details, said Ms. Garey. "It makes you feel like someone cares."

Experts say this sort of care is critical for poor patients, particularly the elderly. Many have no transportation, or they grew up in the generation before Medicaid, when there were no resources to pay for a doctor, and they put off care until they were so sick they had to go to the hospital.

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