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The Washington county essential health clinic: Conducting a quality management assessment; the development of clinical practice guidelines for hypertension, diabetes, asthma, and gastroesophegal reflux disease and the study of pre-packaged medicines.

1 August 2004


The Essentials Health Clinic (EHC) was established to meet the unique needs of the people of Washington County, made up of a large- migrant population as well as many other citizens with unique healthcare needs. Many of Washington County's citizens are uninsured or under insured. It is the on going mission of the EHC to not only meet the needs of the local citizenry but also to provide compassionate and quality care to its patients. As a part of this ongoing process the EHC has been conducting a quality management assessment on a yearly basis. This survey provides the clinic with the tools to compare, analyze, and gather ideas for improvement. The EHC operates only one evening per week. This fact coupled with an all 'Volunteer staff makes follow up and continuity of care difficult. This study developed specific clinical guidelines to address the uniqueness of the EHC and to provide a specific framework that will greatly enhance - follow up and continuity of care issues currently facing the EHC. Also an attempt was made to analyze and streamline the use of pre-packaged medicines, provided by Providence Health Systems.

Objective: This study has three parts; (1) To conduct a quality management assessment for the EHC and provide updated information concerning its last year of operation. (2) To develop and implement specific clinical guidelines for the treatment of patients with abnormally high blood pressure, abnormally high blood sugar, uncontrolled or poorly controlled asthma, and uncontrolled or poorly controlled gastroesophegal reflux disease (GERD). (3) To examine all pre-packaged medicines provided by Providence Health System to determine if there are medications that need to be added, and if there are medications that need to be deleted.

Design: This is a descriptive research study with an administrative emphasis.

Procedure: A total of sixty-one patient satisfaction surveys were administered over a three-week period. In addition a separate volunteer satisfaction survey was conducted. Each survey had a set number of Likert style questions. Each question had space provided for written comments and space was provided to encourage written comment on the topic of clinical improvements. The volunteer surveys were mailed. Included in the mailing was an addressed return envelope with postage in hopes of facilitating their return. To develop the clinical guidelines current criteria and stepwise approaches were cited. In conjunction with these already existing criteria volunteer providers were asked to comment and contribute ideas in the creation of the EHC specific guidelines. By reviewing EHC data it was determined which of the drugs that are provided to the clinic by Providence are used most frequently. Recommendations concerning drugs that are not currently supplied but would be beneficial were made, and ones that are not being used were recommended for discontinuation.

Results: The patient satisfaction surveys as well as the volunteer satisfaction surveys described high levels of satisfaction. Compared to the past two years of available . data this years results represent an increase in the level of both patient and volunteer satisfaction. This increase is also representative of a three-year trend in a positive direction. Many positive comments were offered for continued improvements by both patients and volunteers. The clinical guidelines were also a success. With the help of many of the volunteer providers a sound set of guidelines was devised that reflect both the mission of the clinic and its commitment to quality care. The clinical guidelines also reflect the clinics commitment to providing appropriate medications for the ailments that are commonly treated. The study of the pre-packaged medicines was an offshoot of as well as a synthesis with the clinical guidelines. In the end the recommendations for pre-packaged medicines closely reflected the nature of the guidelines. Again it was with the help of the volunteer providers that these recommendations were arrived at.

Conclusions: The success of this study is a direct reflection of the spirit of the EHC. The EHC occupies a unique and valued place in Washington County. Although this study may be seen as the tip of the iceberg concerning what might or could be done, the enthusiasm with which all of its author's requests were met is a positive reflection of the care and the dedication that goes into each patient encounter at the EHC. With continued care and dedication the EHC will continue to improve and meet the needs of the under and uninsured citizens of Washington County and beyond.


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