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Initiating pain and palliative care outpatient services for the suburban underserved in Montgomery County, Maryland: Lessons learned at the NIH Clinical Center and MobileMed

Published online by Cambridge University Press:  16 September 2015

Sunil K. Aggarwal ,
Amrita Ghosh ,
M. Jennifer Cheng ,
Kathleen Luton ,
Peter F. Lowet  and
Ann Berger
Sunil K. Aggarwal*
Affiliation:
Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, Maryland
Amrita Ghosh
Affiliation:
Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, Maryland
M. Jennifer Cheng
Affiliation:
Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, Maryland
Kathleen Luton
Affiliation:
Mobile Medical Care Inc., Bethesda, Maryland
Peter F. Lowet
Affiliation:
Mobile Medical Care Inc., Bethesda, Maryland
Ann Berger
Affiliation:
Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, Maryland
*
Address correspondence and reprint request to: Sunil K. Aggarwal, National Institutes of Health, Clinical Center, Pain and Palliative Care Service, 10 Center Drive, 2-1733 MSC 1517, Bethesda, Maryland 20892. E-mail: sunila@uw.edu.
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Abstract

Objective:

With the ongoing expansion of palliative care services throughout the United States, meeting the needs of socioeconomically marginalized populations, as in all domains of healthcare, continues to be a challenge. Our specific aim here was to help meet some of these needs through expanding delivery of pain and palliative care services by establishing a new clinic for underserved patients and collecting descriptive data about its operation.

Method:

In November of 2014, the National Institutes of Health Clinical Center's Pain and Palliative Care Service (PPCS) launched a bimonthly offsite pain and palliative care outpatient clinic in collaboration with Mobile Medical Care Inc. (MobileMed), a private not-for-profit primary care provider in Montgomery County, Maryland, serving underserved area residents since 1968. Staffed by NIH hospice and palliative medicine clinical fellows and faculty, the clinic provides specialty pain and palliative care consultation services to patients referred by their primary care healthcare providers. A patient log was maintained, charts reviewed, and referring providers surveyed on their satisfaction with the service.

Results:

The clinic had 27 patient encounters with 10 patients (6 males, 4 females, aged 23–67) during its first 7 months of operation. The reason for referral for all but one patient was chronic pain of multiple etiologies. Patients had numerous psychosocial stressors and comorbidities. All primary care providers who returned surveys (n = 4) rated their level of satisfaction with the consultation service as “very satisfied” or “extremely satisfied.”

Significance of Results:

This brief descriptive report outlines the steps taken and logistical issues addressed to launch and continue the clinic, the characteristics of patients treated, and the results of quality-improvement projects. Lessons learned are highlighted and future directions suggested for the clinic and others that may come along like it.

Keywords

Palliative carePain managementUnderservedMarylandSuburbanization of poverty
Type
Original Articles
Information
Palliative & Supportive Care , Volume 14 , Issue 4 , August 2016 , pp. 381 - 386
Copyright
Copyright © Cambridge University Press 2015 

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References

REFERENCES

Beresford, L. & Meier, D. (2008). Outpatient clinics are a new frontier for palliative care. Journal of Palliative Medicine, 11(6), 823–828.Google Scholar
Healthy Montgomery (2014 a). Community dashboard: Adults unable to afford to see a doctor. Available from http://www.healthymontgomery.org/modules.php?op=modload&name=NS-Indicator&file=indicator&iid=11019338.Google Scholar
Healthy Montgomery (2014 b). Community dashboard: Persons with health insurance. Available from http://www.healthymontgomery.org/modules.php?op=modload&name=NS-Indicator&file=indicator&indid=3000988000761&iid=12177995.Google Scholar
Kayser, K., DeMarco, R.F., Stokes, C., et al. (2014). Delivering palliative care to patients and caregivers in inner-city communities: Challenges and opportunities. Palliative & Supportive Care, 12(5), 369–378.Google Scholar
Kneebone, E. & Berube, A. (2013). Suburban poverty profiles: Montgomery County, Maryland [Weblog]. Available from http://www.brookings.edu/blogs/the-avenue.Google Scholar
MobileMed (2015). FY 2014 report to the community: Successful transitions. Available from http://mobilemedicalcare.org/index.php?option=com_phocadownload&view=category&download=10:report-to-community-fy-2012&id=1:visitors-patients&Itemid=182.Google Scholar
Selvaggi, K.J., Vick, J.B., Jessell, S.A., et al. (2014). Bridging the gap: A palliative care consultation service in a hematological malignancy–bone marrow transplant unit. The Journal of Community and Supportive Oncology, 12(2), 50–55.CrossRefGoogle Scholar
Schwarz, E.R., Baraghoush, A., Morrissey, R.P., et al. (2012). Pilot study of palliative care consultation in patients with advanced heart failure referred for cardiac transplantation. Journal of Palliative Medicine, 15(1), 12–15.CrossRefGoogle ScholarPubMed
Turque, B. (2014). Affluent Montgomery County has pockets of poverty, mostly in the east. The Washington Post. Available from http://www.washingtonpost.com/local/affluent-montgomery-county-has-pockets-of-poverty-mostly-in-the-east/2014/09/06/e09dbb6a-1cea-11e4-82f9-2cd6fa8da5c4_story.html.Google Scholar
U.S. Census Bureau (2015). State & county QuickFacts: Montgomery County, Maryland. Available from http://quickfacts.census.gov/qfd/states/24/24031.html.Google Scholar
World Health Organization (WHO) (2014). 134th session, eighth meeting: Resolution EB134.R7: Strengthening of palliative care as a component of integrated treatment within the continuum of care. Available from http://apps.who.int/gb/ebwha/pdf_files/EB134/B134_R7-en.pdf.Google Scholar