Nashville, TN - Neighborhood Health Downtown Clinic
Health and Homelessness: A Quality Improvement
Study Subhash Gutti, Neighborhood Health Downtown Clinic
The average American requires only a few prescription medications, has a stable source of food and water, and lives comfortably with a roof over their head… and oftentimes, still manages to be non-adherent. Medication adherence is a phrase that refers to how accurately patients take their prescription medicine in comparison to their doctor’s instructions. Now consider a person living in homelessness, with erratic food/water access, limited transportation and money, and with a far greater number of health issues. As one can imagine, the issue of medication adherence is greatly amplified for this unique demographic.
Nashville has one of the nation’s fastest growing homeless populations. Fortunately, we also have the Neighborhood Health Downtown Clinic, a federally-funded nonprofit clinic that provides free healthcare to the local homeless population. This summer, the “DTC” became a home for both myself and for hundreds of patients who otherwise would be unable to receive much-needed care. My goals where to gather quantitative and qualitative data on how adherent patients currently are, identify which medications were most often misused, determine how to improve our adherence rates and appointment attendance rates, teach nutrition classes to those living in transitional housing, recruit non-patients from the streets to come in for check-ups, and identify major healthcare barriers present for each distinct form of homelessness.
This was my first time working with the homeless population, and to put it simply, my mind was blown in numerous ways. After spending weeks interviewing people in the streets, in our clinic, and in various shelters, I learned about the challenging plight of many, and the accompanying “survival mentality” that they often develop as a result. I watched as countless people defied the stereotypes of homelessness with their intellect, humility, and generosity. Most importantly, I documented the patient’s (or non-patient’s) perspectives, living situations, unique culture, and their own ideas for improving our clinic’s effectiveness – which, despite having great value, can often go unheard in the busy setting of a non-profit clinic.
Throughout my project, I collected an immense amount of data. I measured the increase in appointment attendance rates resulting from my telephone reminders. After conducting surveys on recommendations for improvement, I distributed weekly pillboxes to various locations. I listened to peoples’ food situations, and returned with some home-cooking and nutrition curriculum. And using three different metrics, I determined which medications were most often misused, and how these rates are greatly affected by one’s housing situation.
How do you translate this data into tangible “service”? Conveniently, my clinic also began to draw up a Medication Therapy Management program, which is essentially a program designed to more directly monitor, instruct, and assist patients in regards to medication adherence. The data I’ve collected has great value, since it identifies numerous topics of focus for specific groups of homeless people and for specific medications. My data served its first use when pharmacists used in their grant proposal for the MTM program. (Our clinic ended up winning this grant competition, along with the $200,000 prize.) At the end of my project, I presented the full findings to the clinic staff, which they found to be compelling evidence for many of their theories. As far as future plans, I hope to continue assisting with the Medication Therapy Management program as it launches in the fall. Additionally, I hope to eventually share my findings to relevant audiences, through outlets such as the National Healthcare for Homeless Council’s regular newsletter (which is disseminated to other non-profit health centers throughout the country), and potentially in a partner’s upcoming book focused upon health and homelessness.