santa clara valley health and hospital system
DESCRIPTION
TRANSCRIPT
Valley Homeless HealthcareProgram (VHHP)
Cheryl J. Ho, MDCheryl J. Ho, MDCharles Preston, PhDCharles Preston, PhDSanta Clara Valley Health and Hospital SystemSanta Clara Valley Health and Hospital SystemMarch 6, 2008March 6, 2008
VHHP Mission StatementVHHP Mission Statement
““Valley Homeless Valley Homeless Healthcare Program Healthcare Program seeks to establish a seeks to establish a safety-net for the safety-safety-net for the safety-net.”net.”
VHHP Mission StatementVHHP Mission Statement
“ This program seeks to address the needs of vulnerable populations who require an integrated model of care incorporating medical, mental health, and substance abuse services.”
Mental Health
Drug and Alcohol
Valley Medical
Barriers to Health CareBarriers to Health Carefor Homeless Individualsfor Homeless Individuals
Patient
Health Care Provider
Health Care System
Health Status of Homeless Individuals: Health Status of Homeless Individuals: “Multiplicity of Needs”“Multiplicity of Needs”
Higher prevalence ofHigher prevalence of::– HIV, TB, Hepatitis CHIV, TB, Hepatitis C– Hypertension (2x)Hypertension (2x)– Poor dental health (31x)Poor dental health (31x)– TobaccoTobacco– Alcohol problems(6-7x)Alcohol problems(6-7x)– Severe, chronic mental illnessSevere, chronic mental illness
Expanded Scope of Practice Expanded Scope of Practice Methods and PrinciplesMethods and Principles
Co-LocationCo-Location: with Addiction Medicine: with Addiction Medicine
““Mini-Fellowship” ModelMini-Fellowship” Model: HCV Clinic: HCV Clinic
Integration of Care, or the “One Stop Integration of Care, or the “One Stop Shop”Shop”: Psychiatry, Psychology and Social : Psychiatry, Psychology and Social Work ServicesWork Services
Co-LocationCo-Location
Co-Location: Co-Location: Addiction Medicine and Primary CareAddiction Medicine and Primary Care
““Mini-Fellowship” ModelMini-Fellowship” Model
HCV Prevalence HCV Prevalence in Population Subgroups: USin Population Subgroups: US
Civilians(NHANES, n= 21,241)
EMT(Philadelphia, n= 2136)
VA Outpatient(SF area, n= 1032)
Homeless(Palo Alto VA, n= 829)
Male Inmates(CA state prison, n= 6536)
Female Inmates(CA state prison, n= 577)
55%
39%
40%
18%
3%
2%
0% 20% 40% 60%
Hepatitis C Treatment and Hepatitis C Treatment and the “Mini-Fellowship” Modelthe “Mini-Fellowship” Model
Difficulty with Gastroenterology accessDifficulty with Gastroenterology access
““Mini-Fellowship” for 9 monthsMini-Fellowship” for 9 months– ½ day per week½ day per week– Own “panel” of patients within GIOwn “panel” of patients within GI– Developing a relationship based on trustDeveloping a relationship based on trust
Site VisitsSite Visits
Quarterly Conference and Review with Quarterly Conference and Review with GastroenterologyGastroenterology
Hepatitis C Treatment and Hepatitis C Treatment and the “Mini-Fellowship” Modelthe “Mini-Fellowship” Model
Integration of CareIntegration of Care“The One Stop Shop”“The One Stop Shop”
Barriers to Care:Barriers to Care:The Health Care SystemThe Health Care System
704-0900 488-9919
334-1000
Barriers to Care:Barriers to Care:The Health Care SystemThe Health Care System
704-0900 488-9919
334-1000
Mental Health Drug and Alcohol
Valley Medical
Integrated Care:Integrated Care:A New ModelA New Model
Mental Health
Drug and Alcohol
Valley Medical
Integration of Care: A New ModelIntegration of Care: A New Model
Side by Side PracticeSide by Side Practice– Psychiatry and PsychologyPsychiatry and Psychology– Sees patient at the same timeSees patient at the same time
““Warm Handoff”Warm Handoff”– In person, in real-timeIn person, in real-time
Practice InnovationsPractice Innovations– PsychologyPsychology– Chat RoomChat Room
Mental Health In Primary Care Mental Health In Primary Care
Quicker and better access for patients Quicker and better access for patients
More comprehensive care for patientsMore comprehensive care for patients
Reduced demand on primary care time Reduced demand on primary care time
Instant access to consultative relationships with Instant access to consultative relationships with reduced demand on specialists for treatmentreduced demand on specialists for treatment
Increased physician satisfaction Increased physician satisfaction
Training of residence- patient self-managementTraining of residence- patient self-management
Expanding services to pre-existing primary care Expanding services to pre-existing primary care clinicsclinics
Medical HomeMedical Home