Local Medicine

Could a neighborhood-clinic movement bring much-needed health care to more people?

Fifteen people daily may stop by the Walgreens at Prince and Flowing Wells roads to receive medical attention. Meanwhile, dozens of patients get treatment weekly at a free clinic located south of downtown.

While different in numbers, both these programs are part of an expanding neighborhood-based network of health care in Tucson.

Walk-in clinics were established late last year inside six local Walgreens, and the drugstore chain plans to add two more clinics by mid-March. These clinics are open 8 a.m. to 7:30 p.m., Monday through Friday, and from 9:30 a.m. to 5 p.m. on weekends.

The clinics are operated by Take Care Health Systems. Company spokeswoman Lauren Tierney says the goal of the program is to "provide access to high quality, affordable health care to all."

Tucson program manager Danica Stout explains: "A nurse practitioner staffs the clinic--someone who is a registered nurse with further education. They treat minor illnesses and injuries, write prescriptions and do follow-ups."

While each clinic now sees about 15 patients every day, Tierney says the company's national experience is that the number can grow to 30. For now, there is often no wait to be seen in one of the two examination rooms.

"These people have coughs and colds, eye infections, skin rashes or urinary-tract infections," Stout explains of the typical patient. While some medical tests can be done on site, others have to be sent out for results.

The average price for service, which usually includes a 15- to 20-minute consultation with the nurse practitioner, ranges between $59 and $74. Most insurance plans are accepted, and Arizona's medical coverage program, AHCCCS, is expected to be accepted in the future.

Tierney indicates eight out of 10 patients pay for the service through insurance, with the remainder paying cash.

"Nationally, 30 percent of the patients don't have primary-care physicians," Tierney comments. Stout adds the clinics provide primary-care referrals.

With short waiting times and follow-up calls within 48 hours standard at the clinics, Stout says: "The response has been very encouraging and enthusiastic. I hear people say they're happy we're here, because they don't have primary-care physicians and don't have to wait a long time at an emergency room."

Tierney adds: "At the national level, 43 percent of the patients have told us they would have gone to an ER, urgent care or gotten no treatment" if the Walgreens clinic they used hadn't existed.

Steven Walls, a nurse practitioner with the program in Tucson, says the proximity of the clinics to patients is key.

"This is an access point for people in the neighborhood to get health care," suggests Walls. "Seventy-percent of urgent care cases could have been handled here."

Several miles away from the Walgreens, about two dozen people sat in the waiting room of Clinica Amistad one night last week. Among the bustle of activity, clinic coordinator Ricardo Elford took a few minutes to explain the history of the clinic.

"Our primary goal is to provide free and quality integrative primary and preventative care to low-income people who have no health insurance," Elford says. "Five years ago, when we started, we put out fliers to let people know about us, but now, it's by word of mouth. ... You should have seen it earlier tonight. There was a line out the door.

"We see lots of high blood pressure and diabetes cases," Elford says. "It's urgent-care-type stuff along with colds and cuts."

Utilizing the services of four primary-care physicians, the Monday clinic can also refer patients to a growing list of specialists. These patients will be seen in the doctor's office at a later date at no charge.

"A lot of these people are in pretty bad shape," Elford says of those who visit the clinic, "and we're absolutely keeping some of them out of emergency rooms. We do send some to ERs or other health-care providers like El Rio, but usually handle the cases here."

That is an important consideration in Tucson. With most ERs in town having excruciatingly long waiting times to see a doctor for ordinary ailments (See "State of Emergency," June 7, 2007), providing medical care close to people's homes might help cut down on that predicament.

Clinica Amistad is funded through donations, and in an e-mail message, Elford indicates the number of patients seen last year was more than 2,000. That figure was a 32 percent increase from 2006, and Elford writes it was "due to the streamlining of our operation."

Expanding on the clinic's mission, Elford states in the e-mail: "With sufficient funding for laboratory tests, X-rays and prescription and (over the counter) medicines and supplements, the clinic was able to maintain that quality of care for the greater number of people."

One of the ways the clinic is doing this, Elford points out, is through a collaborative effort with St. Elizabeth of Hungary Health Center. That organization provides a health promoter--a person who, among other responsibilities, gives a talk in the waiting room "on subjects such as diabetes, nutrition and exercise."

"There are dozens of volunteer doctors, nurses, nurse practitioners and others," Elford says, speaking above the activity in the clinic's waiting room. "They are the primary care providers for these people, because they have nowhere else to go."

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