The Solution to Our Nation's Access To Care Issue

[Dispatcher]: “911: What’s Your Emergency?”

[Caller to Dispatcher]: “I’m calling for my wife. She took her blood pressure medicine, and was feeling dizzy. She seems confused. She’s breathing okay, I think.?

[Caller To Wife]: Jane, can you wake up honey? Jane…?

[Caller To Dispatcher]: I’m having a hard time keeping her awake. Please send someone.”

People tend to be surprised when they hear that I’m a pharmacist who works with emergency medical services (EMS), fire fighters, and other first responder teams.?

Many respond with confusion at first.

“Wait, what? How does that work?”

As a pharmacist, I am a medicine expert – and I know a lot about meds used in critical care, emergency response, ambulances, and crash carts—but this isn’t my everyday focus.?

My typical focus is the patient above. Now this patient may be having a cardiac event, a stroke, or an embolism. She might have an infection, an unknown bleed, fluid losses resulting in shock, or one of a hundred other medical events.?

She also might simply be overmedicated.?

She might be using multiple pharmacies or seeing multiple physicians, and as a result, taking medications that don’t play nicely together.? Now have resulted in a dangerous drug interaction.?

She might have medication accumulating in her body, because it isn’t being eliminated properly by her kidneys.

She might have cut an extended release tablet in half - literally “cutting corners” to make ends meet - because her meds are too expensive and she’s having to choose between paying rent or preventing a heart attack. But now she has 10 times the intended dose coursing through her blood stream - what should she do now?

She might be on too high of a dose of blood pressure medicine. She may have gotten confused about her medications and inadvertently mixed them up.? She might have accidentally consumed her meds with alcohol, mistakenly taken her husband’s meds, or taken her meds at the wrong time of day.?

Jane will go to the ER. She will pay a small fortune to be treated. She will be sent home with instructions to follow up with her primary care physician. Then, because we have an access to care problem in our country, this patient may NOT BE ABLE TO DO SO.?

Cue whichever terminology your community uses. Jane becomes a:

“Frequent Flyer”

“High System Utilizer”?

“Loyalty Customer”

Often EMS will visit this patient again and again, for the same or similar issues, related to poorly managed chronic diseases. EMS will not be compensated for identifying her issues or helping a patient navigate those issues – they only receive payment if transportation to the ER occurs - but they are still out the time, expertise, and resources to respond to this

... human being in genuine need of care.

(Payment models and reimbursement deserve their own article, a topic for another day).?

Mobile Integrated Health (MIH) and Community Paramedicine (CP) are the solution to our nation’s access to care problem. We can utilize paramedics, expand their knowledge base in chronic care management, partner them with interprofessional healthcare providers, and mobilize them to solve these problems in the field. We can send them right to Jane.?

My first role within MIH/CP was with Manatee County’s Community Paramedicine Program in Bradenton, Florida. We launched a 3-year pilot, utilizing a pharmacist-paramedic team to identify chronic disease and medication issues contributing to unnecessary 911 calls and ER visits.? We found patients on average had 3-4 medication issues, issues just like Jane’s.? We also found that mobilizing our team saved over $5 million in healthcare costs in3 years.? That’s a savings of $4.01 for every $1.00 spent on program implementation.?

For more on our pilot, visit JEMS.

Now my role is to build, train, and support these mobile healthcare models with expertise in chronic disease, medication management, point-of-care testing, remote patient monitoring, mobile integrated health operational workflow and paramedicine health outcomes.???

(Here it comes!)? “Wait, what? How does that work?”

Here’s how it works:

We create clinical protocols for Paramedicine teams to evaluate and treat acute events outpatient, buying time and reducing costs until the patient can see their provider.?

We establish processes for mobilized chronic care options, increasing revenue opportunities for physician teams.

We provide training for interprofessional teams breaking down barriers to care, like those establishing mass vaccination efforts, mental health programs, and outpatient COVID-19 therapeutics.?

We evaluate MIH and CP program efficiency and determine their IT and workflow needs.

We provide comprehensive medication review, virtual and telehealth patient counseling, and remote consult for teams who have identified a medication or chronic disease challenge with their patient in the field.

We provide support and expertise for health systems, physicians, EMS and first responders who are innovating to reduce unnecessary spending, solve the access to care crisis, and create healthier communities.?

As someone who has seen first hand how the system needs changing - MIH and CP implementation is the answer to our access to care issue. No one should suffer from preventable issues as Jane has - especially when we’ve proven this model of care works.

Ultimately, it comes down to this:?

We support you, so that you can provide solutions for Jane.

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Dr. Victoria Reinhartz is the Chief Executive Officer of Mobile Health Consultants, Inc. is a certified woman-owned small business specializing in clinical education, disease management, and consulting services for interprofessional and mobile health teams. For additional information on Mobile Health Consultants or Dr. Victoria Reinhartz, visit?www.mobilehealthconsultants.com