Monday, July 15, 2024
Call him a modern version of an old-school family physician who is taking health care
directly to the streets of Fort Worth. That’s one way of putting what Dr. Andrew Saverine, a 2016 graduate of the Texas College of Osteopathic Medicine at The University of North Texas Health Science Center at Fort Worth, is doing for those most in need.
A physician at the JPS Health Network, Saverine took his passion for serving the “forgotten areas of health care” as he calls it, and started the Intensive Primary Care Program in 2019. He scours the JPS Emergency Department searching for individuals who use emergency care as an alternative to seeing a regular doctor, an approach he based on a study by the Camden Coalition.
“We do a scaled-back version of that, but we do try and identify patients proactively who are using the emergency room,” Saverine said. “We just try and take care of them, manage all of their chronic and acute diseases until we can get them stable enough to get reintegrated back into the traditional health care system.
Saverine, who was part of TCOM’s Office of Rural Medical Education Program, has always had a passion for helping underserved populations, and even though he is in the ultimate urban setting, it was his time in the ROME program that gave him the needed experience to launch the Intensive Primary Care Program.
“You get underserved medicine training in ROME and it can be applied to any setting,” he said. “You get a lot of more practical hands-on experience and work with limited resources in the rural setting, especially access to specialty care when it’s almost non-existent so you have to learn how to manage complex cases on your own. You don’t know if you will like a rural setting until you are integrated, but I loved it. I wouldn’t mind a bit being in rural practice if I didn’t have such a good thing going here.”
What Saverine has going is one of the most unique and perhaps innovative approaches to delivering health care to those underserved populations. These aren’t house calls, this is health care on the road, in hotels, in the streets or even in abandoned buildings if necessary.
His team consists of one nurse practitioner, a community health worker and a part-time social worker. They will get referrals from emergency room physicians of patients who have made four or more visits over the last six months and then try and meet the patients to establish a relationship and trust with them.
“A lot of people are resistant initially, but once they see we aren’t abandoning them like most of the system has and we are invested in their care, a variable amount become engaged with us,” Saverine said.
Physiological disorders along with substance abuse are the most common diagnoses, with 58% of those patients having both, followed by diabetes and heart failure. The team will do anywhere between three and six visits a day around town but can go as high as nine or 10 if time permits. Saverine is finding the rapport being built with his patients is turning into a major reason for the success.
“It sounds really basic, but it’s care about them,” he said. “Anytime a patient is overutilizing the ER services, it’s because there has been a failure of the medical system because we are reactive in our system instead of proactive. If you show patients that you care about them and their outcomes, that they are more than just a statistic, then the patient – nine times out of ten – will start caring for their own health as well.”
Saverine is not going to the most desired locations in Fort Worth, often those where access to health care is very limited. Some of the locations include housing projects with high-risk homeless individuals, one of which has 126 chronically homeless. He sees those as the most suspicious of the health care system. He’s been cussed at and encountered some physical hostility and those who are in an acute psychosis state, but it’s something he “just lets them get it out.”
Saverine runs a clinic at True Worth Place, a homeless shelter that is also a family medicine rotational spot for TCOM students during the year and where twice a month TCOM students set up the HOME clinic.
“I always have a student with me and I’ve gotten a range of responses to they are terrified to oh wow, this is super awesome,” Saverine said. “It’s usually the folks that are already interested in family medicine or underserved medicine that are the most interested in what we are doing.”
Saverine is wanting the program to continue its growth, starting with the volume of patients he is able to see. Then, taking a page from the Camden Coalition, he wants to use geography for more efficiency to narrow down certain corridors to have more providers go and visit patients.
“I think it is the key,” Saverine said. “We are working on some data to support that, but it’s very clear that the more frequent visits, the more quality time with a patient, the better they do in all the outcomes we have measured. It really is the therapeutic relations.”
Enhancing the capabilities of what his team can do in the home visits is a priority, along with the technology he can use. He envisions moving toward a “hospital at home” type model. The frequency Saverine sees patients varies, something three or four times a week for a few, one every two weeks for others, and just once a month for some. In totality, he says it takes around nine to fifteen months to get them stabilized and not using the ER as their primary provider.
“The ultimate outcome is to get them on top of their health and not coming to the ER all the time,” Saverine said. “The health care system as a whole is data and profit-driven, there is no humanity in it. The most common response I get from other people in the health care industry is ‘God Bless you, I could never do it.’ That’s just the nature of what I do.”
While many in the health care system will go running from this type of health care model and population, Saverine runs towards them and he wouldn’t have it any other way.
From HSC Newsroom - Community by Steven Bartolotta