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BREAKING DOWN BARRIERS TO CARE

After Maria Sanchez was diagnosed with diabetes in 1999, she faced challenges managing her chronic disease. Her community clinic made all the difference.

MARIA'S STORY

When Maria Sanchez Torres became a mother in 1999, she faced many of the usual adjustments, like lack of sleep and learning to care for a newborn. She also faced a new health challenge — diabetes. She was diagnosed while she was pregnant with her daughter Andrea, and the diagnosis meant adding insulin injections, blood sugar monitoring and a careful diet to the routine of feedings, naps and diaper changes.

Over the years it became difficult to keep up. The daily rituals and growing cost of medications were too much to handle. She sacrificed as many mothers do, letting her own care lapse. Slowly, her untreated diabetes allowed blindness to creep in. The disease stole her eyesight, and with it, her ability to drive, hold a job and navigate her day-to-day activities.

“Three years ago, I couldn’t take care of myself. That’s when I lost my vision,” Maria, now 51 years old, said. “I lost my ability to drive and to work. My daughter now has to work and go to school, so she doesn’t have time to drive me.”

That’s when Maria was referred to a program in Faribault, Minn., that would offer her the support she needed to manage diabetes. The program – a partnership between hospitals, clinics and local community organizations and the Medtronic Foundation – empowers patients to improve their health through community-based care. Patients can access care coordination and receive support from frontline health workers like community paramedics and community health workers, who offer home visits for those who need them and link patients to additional community resources. For people like Maria, the program has literally been a life saver.

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Meet Maria, her daughter, Andrea, and the community program that changed her life.

"The support from this program gives me hope that she will be with me longer."

Andrea Sanchez, Maria's daughter

Faribault, Minnesota

“I thank God this clinic is here,” she said. “About a year ago, I was admitted to the hospital because of my pancreas and kidneys. The hospital gave me a new prescription that I could not afford. I called the clinic here, and it was able to help me cover all of my new prescriptions from day one.”

Patients like Maria can learn to better manage their care through classes like “Living with Diabetes” in Spanish. The courses help patients set health goals and address concerns, encourage exercise, teach patients how to take their medications and help them understand how to better communicate with their providers about health concerns. Community health workers visit patients at home when they aren’t able to attend clinic appointments in person.

The home visits help Maria continue to manage her care after giving up driving. They also ease the burden on Maria’s daughter, Andrea, who is Maria’s only support at home.

“It’s just me and my mom, but I know I have an extra hand and I’m not alone,” Andrea said. “I am the only one in our family working and I can’t drive her. So they check up on her and make sure she has her medications. They worry about her so I can worry less. The support from this program gives me hope that she will be with me longer.”

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REDUCING BARRIERS TO CARE

Breaking down barriers to care is a top priority, according to community health worker Raquel Rendon, who is one of Maria’s caregivers.

“Our community is very diverse, so it’s different barriers we’re seeing. Our Latino community faces language barriers and they may need help navigating healthcare resources and accessing health insurance,” she said. “We also have Somali residents who face language barriers and they may need help finding affordable housing and navigating the systems.”

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The Faribault program was created after a needs assessment commissioned by the Medtronic Foundation in 2015 uncovered “hot spots” in Minnesota where disease prevalence was higher and the percentage of the population meeting clinical targets for their care was lower, including North Minneapolis, Downtown St. Paul and Rice County, where Faribault is located. The assessment also found low-income residents, immigrants, homeless residents and those with mental health conditions had more difficulty managing chronic conditions.

Partnerships are critical to the program’s success. Coordinated care teams work closely with paramedics and community health workers to holistically address patient needs. Health clinics partner with community-based organizations to reach targeted underserved populations, such as immigrants.

The need for programs like this is not unique to Minnesota. According to the World Health Organization, preventing and managing chronic diseases, also called noncommunicable diseases (NCDs), is one of the world’s greatest health challenges. NCDs like heart disease, diabetes and cancer, now claim 41 million lives a year – more than all communicable diseases like malaria or tuberculosis combined. [i] More than 85 percent of these deaths occur in developing countries.[ii] By 2030, WHO estimates NCDs will account for 70 percent of all deaths annually.[iii]

The threat is so serious that in 2011, for only the second time in its history, the United Nations convened a high-level meeting of world leaders to address NCDs (the first such meeting to address a global health issue occurred in 2001 about the HIV/AIDS epidemic).[iv]  A global effort, which the Medtronic Foundation is a part of, is now underway to reduce the impact of NCDs through prevention and chronic care programs that help patients avoid serious and sometimes fatal complications. The United Nations Sustainable Development Goals call on the global community to reduce premature deaths from NCDs by one-third by 2030.[v]

Collaborations like the one in Faribault are contributing to this goal. With support from the Medtronic Foundation, similar programs have also been implemented in India, South Africa and Brazil. Through local partners in these geographies, the Medtronic Foundation is working to create boundless communities, where lessons and best practices can be shared. The goal is to accelerate improvement in health outcomes and ensure improvements are sustained, while empowering people with heart disease or diabetes get diagnosed and successfully manage chronic conditions.

SOUTH AFRICA

In South Africa, a needs assessment was conducted to estimate the prevalence of cardiovascular diseases and diabetes and the related risk factors in Umgungundlovu, KwaZulu-Natal, Pixley Ke Seme and Northern Cape. Many don’t know they have these conditions, and even those who are diagnosed may not be managing their health effectively. Less than one-third of those being treated for high blood pressure and half of those in diabetes treatment programs are meeting treatment goals.

Beginning in 2016, the Medtronic Foundation supported local partners who trained community health workers in order to strengthen chronic care. The effort aligns with the South Africa Department of Health’s primary care reform to “ideal clinics” and piloting of National Health Insurance in the country. Patients can join support groups and participate in community gardens and village savings and loan programs.

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BRAZIL

In Brazil, nearly one-third of adults have high blood pressure and about 6 percent have diabetes. Long wait times at clinics, a shortage of specialists for consultations, and limited access to electronic medical records to track patient care and test results makes it difficult to provide effective chronic care. These issues in turn make it difficult to engage patients in their treatment plan and ensure ongoing follow-up to achieve clinical goals.

The Medtronic Foundation partnered with local organizations in 2015 to train health care workers to provide noncommunicable disease care, with emphasis on home-based and community care. It partnered with Brazil’s Ministry of Health to align its efforts with national health goals, support reorganization of the health system and implement electronic medical records.

In the regions of Teofilo Otoni and Vitoria da Conquista, the program provides blood pressure checks and A1C tests for diabetes, wellness programs, exercise classes and family health support, and it serves as a model for helping underserved people with chronic conditions access primary care.

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INDIA

In India, the Medtronic Foundation and local partners in Udaipur, Rajasthan and Shimla are working to improve diabetes and high blood pressure diagnosis rates through screenings and outreach from frontline health workers, who are called Accredited Social Health Activists, or ASHAs. Once patients are diagnosed, the ASHAs encourage them to return for follow-up care and participate in one-on-one or group meetings to help them manage their ongoing care needs. ASHAs use an innovative mobile app to track risk assessments and referrals, and provide health information. 

DELIVERING REAL RESULTS

Evidence suggests the results of programs like these are better care, fewer complications and lower costs. The WHO estimates every $1 spent on programs to help people manage or prevent NCDs – such as accessing and staying on cardiovascular and diabetes medications – will return at least $7 by 2030.[vi]

“Part of the problem stems from a misconception: governments tend to accept deaths from NCDs as unavoidable – but they are not,” wrote Michael Bloomberg, WHO Global Ambassador for Noncommunicable Diseases, in a report released in 2018. “A different future is possible. We can turn the tide on NCDs and the suffering they cause. What’s more, a relatively small investment can help prevent enormous costs.”[vii]

WHO estimates that for $1.27 per person per year spent on addressing NCDs in low and middle-income countries between  now and 2030, more than 8.2 million lives could be saved, 17 million cases of heart disease and stroke could be prevented and the rate of premature deaths could be reduced by 15 percent.[viii] The WHO has proposed a series of steps to reach this goal, such as increasing physical activity, reducing salt intake, and providing drug therapy and counseling for patients with diabetes and high blood pressure who are at high risk of having a heart attack, stroke or other cardiovascular event.

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IMPROVING INDIVIDUAL LIVES

Back in Faribault, Raquel says community programs like these not only improve health, they also build confidence and boost the spirits of those living with chronic conditions.

“We don’t come with judgement or tell them what to do, we’re there to help them accomplish their goals,” she said. “That really gives people meaning. It helps them gain confidence again and feel empowered to be able to care for themselves.”

She recalled one patient whose life was transformed through the program.

“She was just a meek, quiet woman when I met her and she needed a lot of assistance. She kept fainting and was overdosing on her insulin because vision loss made it difficult for her to measure the right doses. As a result, she ended up in the hospital all the time,” Raquel said.

Raquel helped her learn to make syringes and gave her an adapter for the syringe so she couldn’t overdose. She found out the patient wasn’t sticking to her diet because her teeth hurt, so Raquel helped her access a dental program and she received dentures. Then Raquel helped her get new glasses to improve her eyesight.

In the end, these steps improved her health and her well-being.

“I’ll never forget the day she came in and I could tell she was a different person,” Raquel said. “I almost didn’t recognize her in her new glasses and with a big smile. She was full of life. She told me, ‘I just don’t know how to thank you. You’ve helped me turn my life around.’ That’s why I do this. That’s why our work matters.”

 

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[i] Saving lives, spending less: a strategic response to noncommunicable diseases. World Health Organization. http://apps.who.int/iris/bitstream/handle/10665/272534/WHO-NMH-NVI-18.8-eng.pdf. May 21, 2018. Accessed July 11, 2018.

[ii] Saving lives, spending less: a strategic response to noncommunicable diseases. World Health Organization. http://apps.who.int/iris/bitstream/handle/10665/272534/WHO-NMH-NVI-18.8-eng.pdf. May 21, 2018. Accessed July 11, 2018.

[iii] Hunter DJ, Srinath Reddy K. Noncommunicable Diseases. N Engl J Med 2013; 369:1336-43.

[iv] World Health Organization. Global Status Report on Noncommunicable Diseases. http://apps.who.int/iris/bitstream/handle/10665/148114/9789241564854_eng.pdf;jsessionid=C6EEC98F675845279604AF803E75B9DD?sequence=1. 2014. Accessed July 11, 2017.

[v] Sustainable Development Goals (SDGs). World Health Organization. http://www.who.int/mental_health/suicide-prevention/SDGs/en/. Accessed July 24, 2018.

[vi] Saving lives, spending less: a strategic response to noncommunicable diseases. World Health Organization.   http://apps.who.int/iris/bitstream/handle/10665/272534/WHO-NMH-NVI-18.8-eng.pdf. May 21, 2018. Accessed July 11, 2018.

[vii] Saving lives, spending less: a strategic response to noncommunicable diseases. World Health Organization.   http://apps.who.int/iris/bitstream/handle/10665/272534/WHO-NMH-NVI-18.8-eng.pdf. May 21, 2018. Accessed July 11, 2018.

[viii] Saving lives, spending less: a strategic response to noncommunicable diseases. World Health Organization.   http://apps.who.int/iris/bitstream/handle/10665/272534/WHO-NMH-NVI-18.8-eng.pdf. May 21, 2018. Accessed July 11, 2018.