It might sound like an unusual question for nurse practitioner Nancy Raborn to ask but it can tell her a lot.
“How many pillows?” she asks heart failure patient David Hope, as he sat on a table in the University Hospital Disease Management Clinic.
“It’s one,” Hope said. When heart failure patients get into distress from things like fluid buildup, they have difficulty breathing when lying flat and tend to prop themselves up with more pillows or even sleep in a chair.
“If they are sitting up in a recliner at night, you know you need to do something,” Raborn said. But thanks to her careful management, Hope has gone from a frequent visitor to the Emergency Room and ending up in the hospital to walking and riding his bike every day around the neighborhood.
“Oh my goodness, I feel real good,” Hope said. “I feel like I’ve never been in the hospital.”
The clinic is one way University is taking care of one of the most pressing needs in the community, the management of patients with chronic health problems such as heart failure, diabetes and chronic obstructive pulmonary disease and asthma. University’s recently completed Community Needs Assessment shows there is a lot of care still needed.
• One of the highest diabetes rates and death rates from diabetes in the country, according to the assessment. In Richmond County, 11.6 percent of adults age 20 and older had diabetes, compared to a rate of 8.3 percent for the U.S. Even worse, the death rate from diabetes was more than double the U.S. average, with 45 per 100,000 people dying from diabetes in Augusta compared to a U.S. average of 22.4 percent.
• Cancer incidence and death rates in Augusta are also high. The death rate from cancer overall was 214.9 per 100,000 in Richmond County, compared to 184 per 100,000 for the U.S. It is even worse for men and prostate cancer, where 41.1 per 100,000 men die of it compared to a Georgia average rate of 27.5 per 100,000 and a national average of 23.6 percent. Breast cancer incidence is also higher, with 134.8 cases per 100,000 in Augusta, compared to 119.7 per 100,000 in Georgia and 122.3 per 100,000 nationally.
Augusta also faces a number of demographic hurdles to overcome in improving health. Nearly 27 percent of adults lacked any form of health insurance, which can mean that routine and preventive care is put off and health problems worsen until care is sought in the Emergency Room, as Hope did when he was uninsured. He went to the Emergency Room five times and was hospitalized four times – twice within 30 days of being discharged – between December 2012 and April 2013 before he was finally referred to the clinic, Raborn said.
Part of that was helping him get medications he otherwise couldn’t afford through the heart failure grant from University Health Care Foundation, she said. And part of it was just education, helping him understand his disease, how he would need to change his diet, and how to keep up with his medication, Raborn said. Hope pulls out two boxes of row upon row of individual pill boxes that help him take the correct pills every morning and night.
“When I was sick, I didn’t even know how to do this,” he said.
A big key to University’s approach to making the community healthier is making sure people with chronic illness get that care, said Marilyn Bowcutt, president of University Health Services and executive vice president/Chief Operating Officer of University Health Care System.
“If you’re getting preventative care, you can control symptoms that can lead to more extensive disease,” she said. “Many individuals in the Richmond County area are not probably receiving preventative care and standard health checkups. They may very well have more advanced disease because of it.”
It isn’t only the adults that face a challenge. In Augusta more than one-third of children – 36.6 percent – live in poverty, according to the assessment. Food is also an issue in Augusta – 12.5 percent are low-income and lack access to a grocery store within a mile of their homes, compared to 4.1 percent nationally. University has worked alongside community partners through groups like the Greater Augusta Healthcare Network to look at such basic issues as transportation and how that impacts health, Bowcutt said.
“Can the people get to the health care environment?” she said, “Can they get to the grocery store? What are the things that are possible to access?”
Providing preventative care through its own clinics and working with community clinics should provide greater access to primary care and that in turn is good for University as well. The hospital could be penalized financially if the number of patients readmitted less than 30 days after discharge is significant, and that means keeping them healthy once they leave, Bowcutt said.
“Our goal is to really help the people,” she said. “We would like people to be able to stay out of the hospital.”
As a patient, Hope said it is also imperative for him to do his part as well.
“Doctors can help you but you’ve got to help yourself,” he said.