Program reaches out to community

Bringing to life Chancellor for Health Affairs Dr. Ralph Snyderman's vision for prospective care in the Durham community, a new program now provides medical outreach to hundreds of local residents. Started in January of 2000, Promising Practices aims to help patients who suffer from asthma, diabetes and hypertension take care of themselves.

Partnering Duke Hospital with Lincoln Community Health Center and the departments of social service and public health, "[Promising Practices] focuses on diseases that come to the emergency room that could be treated better if treated at home," said Snyderman, also CEO of the Duke University Health System.

The program brings back the tradition of house calls. Doctors and nurse practitioners visit patients' homes, providing exams and valuable information. The medical professionals--who see five to six patients per day--also provide equipment to the participants so they can monitor their conditions on a daily basis.

Program administrators say house calls are not your typical visit with the doctor. "We spend about an hour with each patient, teaching them about the medications they are on... about how to change their lifestyles to better deal with the disease," said Kristi Barrett, a nurse practitioner. "This empowers the patients--many of whom are illiterate--because they have the medications, they know what to do and they are not afraid or embarrassed to call us if they have questions."

Officials decided to target asthma, hypertension and diabetes, discovering that the majority of patients with these problems are clustered in four Durham zip codes: 27701, 27703, 27704 and 27707, said Dr. Richard Liebowitz, medical director of the program. The program has been so successful in these areas that a new region will soon be added.

Officials say Promising Practices has already found success as a model for prospective care. With over 600 patients involved in the program, results show fewer visits to the emergency room and fewer hospitalizations.

"We have been able to document better control of glucose for our diabetic patients, which over the long term translates into fewer complications such as heart attacks and strokes," Liebowitz said.

The chosen conditions affect several different demographic groups within the community. "The cases of asthma are more pediatric-related, where as diabetes and hypertension have a high number of people age 40 and older," said Jackie Tatum, administrative director of Promising Practices.

Barrett said about 15 to 20 percent of cases deal with pediatric-aged patients, 40 percent of cases with senior citizens and the remaining portion with middle-aged adults. The majority of patients in the program are referred by their primary care physicians, while a number are enrolled through screening or seek out the program themselves.

Matt Brumm contributed to this story.


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