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Serving the Never-served

Photo by Daniel Dubois

When the Clinic at Mercury Courts opened in the summer of 2012, the staff expected to be inundated with patient visits.

Designed to provide medical care for people and families transitioning from homelessness and other poverty situations, the clinic on Murfreesboro Road is located within a 5-mile radius of 12 properties serving low income and transitional housing residents, including the gated Mercury Courts near downtown Nashville.

But the clinic stood mostly idle for days on end.

“We came in here thinking that just because we opened up shop that people would be lining up for services,” said Christian Ketel, MSN, RN-BC, manager of the Clinic at Mercury Courts. “What we didn’t realize was that we had a lot of work to do to create relationships with those in the community who had become accustomed to health care coming and going. It was not abnormal for a health care practice to open and within months be gone.

“Our biggest challenge was setting into motion that we were not going anywhere,” he said. “We had to develop trust with the members of the community. It didn’t happen overnight, but once word spread, the patients came.”

It’s been nearly two years since the clinic opened and patient volume continues to grow. There are 900 patients who have chosen the clinic as their medical home. Providers see up to 150 patients a month.

It’s a far cry from the first quiet weeks at the Vanderbilt University School of Nursing-run primary care clinic.

On a cold, overcast day in January, the four-room clinic is bustling with regular patients, walk-ins and some passersby popping in for a visit.

It doesn’t take long for the 1,200-square-foot space to feel full. It is exactly what Bonnie Pilon, DSN, RN, senior associate dean for Clinical and Community Partnerships at VUSN, envisioned.

“We see everything that a primary care office would see from flu and colds to warts and heart disease,” she said. “We are providing an essential service to this community and we can see that they are benefiting from our practice.”

The services provided at the Clinic at Mercury Courts help get patients diagnosed and treated quickly and keep them from using area emergency rooms for basic medical care. The clinic, which offers labs and medications, uses the local safety net referral network for uninsured patients with more complex health care needs, said Pilon.

Mercury Courts opened in 1992 in the landmark Mercury Motel, which was refurbished to make way for 160 apartments for formerly homeless or low-income individuals. The clinic, which previously housed the security office, sits at the front of the property outside the gated community. It is accessible to anyone in need of health care.

“This patient population is used to either not seeking care at all or going to the ER when they are sick,” Pilon said. “We have done a good job of providing access to care to a group that didn’t have it previously.

“We are meeting the needs of not only an ‘underserved’ community, but also what we sometimes refer to as the ‘never-served.’ For such a small clinic, we are doing a lot.”

The clinic utilizes a unique model of care that brings together interprofessional, licensed providers in a nurse-led primary care site to work alongside students with multi-professional backgrounds including nursing, pharmacy, social work and medicine to provide preventive and chronic disease management.

SIDEBAR

Funding
The clinic is funded by a variety of sources, the largest being a collaborative project grant from the Health Resources and Services Administration (HRSA) Division of Nursing to investigate interprofessional health care team development and outcomes. Read more »

The patient population and the interprofessional team focus is what attracted family nurse practitioner nursing student Hanna Chapman to work at the clinic during her first year at VUSN.

Although anxious about the slow start when the clinic opened, Chapman credits her experience at Mercury Courts for further solidifying her decision to work with the medically underserved.

“Working at the clinic, I have been challenged by the extensive barriers to care, said Chapman. “These patients’ medical conditions are complicated by other issues that must be addressed, including transportation, diet, finances, medications and housing.

“I have learned the importance of building relationships with patients and developing trust. A patient has to know that you are there because you truly care and want to help them achieve a better quality of life,” said Chapman. “Sometimes, it’s not about the stethoscope. It goes way beyond that.”

Half of the patients utilizing the clinic are residents of an Urban Housing Solutions development, a nonprofit organization committed to providing affordable housing for the homeless, mentally ill and physically disabled, as well as people in recovery, newly released from prison and others in need of an affordable place to live.

Building Trust

Angela Hudgens, a resident of Mercury Courts for more than two years, is affectionately called the Momma of Mercury. Unofficially she serves as the eyes and ears of the complex. Although it took a little getting used to, she said, people are happy the clinic is becoming a fixture in the community.

“When they first came here, we were all shocked.  The clinic is in the same office where we got carded to get into the gated community, “ recalls Hudgens. “But after the shock wore off and we saw that they were staying and wanting to help us, we slowly warmed up to the idea.

“There are so many people who need this … residents and homeless around here wouldn’t get the help they really need if the clinic wasn’t here. The clinic offers more than medical care. They go above and beyond the call of duty.

“But what really means the most— we are treated like we are supposed to be treated—like we are human beings. That goes a long way, it really does.”

Hudgens boasts that her primary care provider, Aaron Scott, likes to spoil his patients.

“I don’t spoil any of my patients. I just treat them like I would want to be treated and we are consistent no matter who walks in our clinic doors,” said Scott, FNP-C, MSN, RN, lead nurse practitioner at the clinic.

“We take the time to listen and talk to our patients. We teach our patients how best to take care of themselves. We make sure they have the resources they need to make that happen. We don’t dismiss them. We don’t judge,” said Scott.

Hudgens knows this first-hand.  After 17 years as a medical assistant, she was plagued by seizures.  She could no longer work and had to apply for disability.  Displaced from her apartment and after living at her sister’s home, she became a Mercury Courts resident.

1. Angela Hudgens, aka the Momma of Mercury, believes she and Family Nurse Practitioner Aaron Scott are a team when it comes to her health care. She started seeing Scott for specific health situations, then made him her primary provider and The Clinic at Mercury Courts her health care home. 2. Nursing student Hannah Chapman examines one of the young members of the Alam family, an example of the full range of services the clinic provides. 3. Like all of the Mercury Courts residents, Eugene Dotson and his grandson, Zalowen Smith, receive free primary health care at the clinic. 4. The Clinic at Mercury Courts’ Christian Ketel has used friendship as a way to connect with Jason Lester and improve his health. Photography by Daniel Dubois.

 

At 46, Hudgens has a series of health complications including arthritis, asthma, intermittent high cholesterol and high blood pressure, but she feels that her health concerns are under control these days.

“The clinic has been a godsend to me and a lot of people,” said Hudgens.  “My health is a lot better and if there’s something wrong, I can go to the clinic.  I have made Aaron my primary care provider, so he’s where I go.  He knows me and understands my issues like no one else.”

When she was recently having some dizzy spells, Scott and Hudgens determined that her three medications were causing her typically high blood pressure to drop unexpectedly.  Hudgens also lost a few pounds which may have impacted her dosage.

“It was mind boggling to me, but we figured it out, and Aaron took me off some of my meds.  Now I feel much better,” said Hudgens.

Teaching

“It’s interesting,” Scott noted. “As we are teaching our students about how to provide good, quality health care, we are also teaching our patients. It all goes hand in hand.”

Although created to provide access to care to an often forgotten population, the clinic also exists to serve as an important teaching health center and practice site for VUSN faculty.

Ketel encourages all clinical faculty members to volunteer at the clinic.

“We would love to have more faculty involvement,” said Ketel. “Now that we are more established and we continue to attract more patients, we could use more assistance.

“There are so many opportunities for our faculty to participate in caring for patients, community engagement and supporting students as they experience the clinical setting.

“Our patient care model is truly cutting edge in terms of the way we deliver health care.  It’s an interprofessional, team-based approach engaging the patient as a team member, and the team itself is connected to the local community.  And, we are looking at how to expand it to other sites. Mercury has really reignited my passion for nursing and opened my eyes to the potential nursing can have locally as well as the influence it can have on a larger scale.”

The Clinic at Mercury Courts is open from 8 a.m. to 7 p.m. on Mondays, 8 a.m. to 4 p.m., Tuesday through Friday, and closed on weekends. Since opening its doors, providers have become very aware of the constraints of a three-exam room clinic.

Currently a mobile care program for off-site holistic care is in the works. The idea is to provide complete wraparound services—physical, spiritual and social support—to those who are unable to get to the clinic, who are often the most vulnerable in the community.

The clinic serves 30 Urban Housing Solutions properties as well as transitional housing residents, homeless and local businesses. Despite reaching 3,000 patient visits since August 2013, it has not reached capacity.

As spring and summer approach, health fairs and neighborhood events will provide occasions for the clinic staff to identify potential patients, said Ketel. And since the area is populated with transitional groups, there are always opportunities to offer health care to those in need.

Fulfilling Needs

Carole Bartoo, MSN, RN, AGNP-BC, nurse practitioner/transition advocate for the Vanderbilt Center for Quality Aging, spent one year volunteering at the clinic after obtaining her master’s degree from the School of Nursing.

She said the clinic provides a service that does not exist anyplace else, making it “beyond essential.”

SIDEBAR

Affordable Medications
Dispensary of Hope, a nationwide distributor that provides unused or surplus medications to health care providers and clinics to disperse to people with no pharmacy coverage, is a key component to the Clinic at Mercury Courts’ ability to provide access to affordable medications. Read more »

“Everyone deserves basic health care services,” said Bartoo. “If I learned anything while I was there, it was just how huge the crack is that people fall into in Tennessee. I saw patients who had no family support, no resources, who were suffering from chronic illnesses and had not seen a health care provider in a long, long, long time.

“There is such a distrust of the medical community as a whole among this population, which is why this clinic is vital. It operates on the notion that everyone who walks through that door is treated the same, period,” Bartoo said.

“There is no preconceived judgment about how or why a person is in the situation they are in. The focus is addressing the health concern at hand. It should be that way everywhere, but sadly it isn’t.”

Traci Patton, the health services coordinator for residents of Urban Housing Solutions, knows this all too well.

With 20 years of experience working with the low-income and homeless communities, she welcomed the commitment expressed by the School of Nursing to establish a clinic in the Murfreesboro Road area.

“Health care is a barrier for people in poverty,” said Patton. “And health care also requires a level of trust that is tough for a community that has a lack of trust for all systems.

SIDEBAR

Key Results
Although long-term clinical outcomes data is not yet available, here are a few highlights. Read more »

“Once the clinic established that it was indeed a part of the community is when people stopped seeing it as just another building and as a place that could help them,” she said. “The clinic is a solid medical home for so many and is a point of contact where medical needs are addressed.”

Patton said she has heard from local business owners along Murfreesboro Road that the clinic has not only impacted those seeking quality medical care, but has also been a positive improvement for the area.

Patton saw the clinic as an opportunity to open the door for better things in the community.

“If you go up and down Murfreesboro Road, what do you see?” asked Patton. “Lots of doors leading to destruction and bad choices.

“What door leads to chances and opportunity? Our clinic is a door of hope. And we are an open door.

“That is what I really like. The blinds on the window are never closed. When you come in someone always says hello. Sometimes all you need is for someone to show that they care and to believe in you.”

 

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