PORTLAND, Ore. -- Este año marca el 25º aniversario de un singular programa que ofrece atención a domicilio para algunos de sus habitantes más vulnerables.

"Housecall Providers" (Proveedores de Consultas a Domicilio) ha crecido a tres programas desde que inició, en 1995. En cualquier momento, su brazo de atención primaria da servicio entre 15 mil y 16 mil pacientes. También tiene unos 120 pacientes de hospital y proporciona cuidados paliativos con base en la comunidad a 150 personas con condiciones serias, pero no de muerte, que demandan servicios integrales. La CEO Rebeca Ramsay dice que el personal de guardia está para las necesidades serias de los pacienetes.

"Si el paciente tiene "flu" o cualquier tipo de complicación de su enfermedad crónica, también podemos hacer visitas de urgencia. Así que la diferencia es que vamos al paciente en casos urgentes, en vez de hacer que el paciente venga a una oficina."

En 2017 la empresa sin fines de lucro CareOregon adquirió "Housecall Provideers".

La directora de atención primaria del programa, Dra. Pamela Miner, Directora de Atención Primaria, dice que atienden a personas mayores de Oregon confinadas en sus hogares, personas que enfrentan discapacidades físicas o del desarrollo, y gente con problemas médicos o de salud mental.

Comenta que la capacidad para atender llamadas a domicilio les permite atender a los llamados "superusuarios" - el puñado de benericiarios Medicare que hacen la mayoría de visitantes al hospital.

"Ayudamos a evitar viajes caros al hospital y visitas innecesarias de enfermeras a domicilio. Esto no sólo marca un nuevo estándar en la calidad de la atención que los pacientes pueden esperar recibir en casa; también mejora la salud resultante del paciente, baja los costos de atención a la salud y mejora la satisfacción del equipo de atención."

Miner dice que su equipo toma precauciones COVID-19 en visitas domiciliarias y usa las teleconferencias tanto como sea posible.

"Housecall Providers" empezó a participar en la demostración federal "Independence at Home" (Independencia en Casa) - un modelo de ahorro compartido de Medicare. Aún así, Ramsay dice que es difícil mantenerse financieramente viable y el programa se apoya en donaciones.

Añade que el servicio con base en casa es una opción que mucha gente quiere, y es muy probable que vaya a tener una demanda mucho mayor conforme envejezca la población.

"Hay mucho trabajo por hacer para de veras asegurar que el sistema de financiación de la atención a la salud llegue con nosotros como reconocimiento del valor de este tipo de atención."

September is Health Literacy Month, and a Denver-based group is working to help health professionals break a persistent pattern of discrimination linked to high disparities in maternal death rates.

Danyelle Gilbert, CU Nursing alumna and a member of the Colorado Council of Black Nurses, points to research showing that between 2016 and 2020, nearly all pregnancy-related deaths of Black women could have been prevented through timely interventions - at the patient, provider or system level.

"That report specifically found that discrimination played a role in over half of pregnancy-associated deaths. And approximately 90% of those pregnancy-related deaths were identified as preventable," she said.

Black women in Colorado are twice as likely to die - during their pregnancy, or within one year of giving birth - than the state's overall pregnant population. The leading cause of maternal death overall is self-harm and unintentional overdose. But for Black women, the number one cause of death is heart failure.

Gilbert added that common forms of discrimination facing Black women include simply being dismissed, or not being taken seriously, by health care providers. She says their pain and symptoms are routinely minimized, and there are delays in their care.

"They may face a lack of shared decision making, and poor communication from their health care provider. They just don't feel educated, they are not able to make informed decisions. And all of that is leading to negative health outcomes," she continued.

Gilbert recalls one Black woman experiencing contractions who was turned away to fill out paperwork, even though her information was already on file, and ended up giving birth in a hallway. She said health professionals can do better, in terms of showing patients they are valued.

"And when we value someone, we pour life into them. So when caring for a Black woman, see her. Empathize with her, connect with her. Feel her pain, her joys, her cries. Hear her, because she is both strong and fragile," she added.


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In North Carolina, the gap between Medicaid reimbursement rates and the actual cost of dental care has reached a crisis point, impacting both patients and providers.

Dr. Rafael Rivera, a member dentist with the North Carolina Dental Society and owner of Smile Starters, said the gap is impacting quality dental care around the state.

"It's about 30 cents on the dollar, about 30% of what we should be getting paid for the procedures. And that's not exact, but 30 to 35% somewhere in that range. It's actually a lot worse if you're an oral surgeon in the state treating the patient population," he said.

Those reimbursement rates haven't been updated since 2008. Rivera added that a lack of funding hinders dental practices from attracting and retaining skilled professionals. He said as a result, Medicaid patients often resort to emergency rooms for dental issues-an option that is both more expensive and less effective.

To address these challenges, Rivera suggested expanding the network of Community Dental Health Coordinators. He believes these coordinators could play a crucial role in bridging the gap between patients and dental providers, particularly for those who face language barriers or lack knowledge about available services. He also called for increased funding and safeguards that help dental offices keep up with inflation.

"Our legislator ideally will find a way to not only just put an increase in place, but more importantly have a mechanism that requires them to reevaluate it on a regular basis so that we don't have to go another 16 years before an increase is in place again," he said.

Rivera underscored that this issue extends beyond just dental care, pointing out that data show strong dental health is linked to better overall well-being. Since the expansion of Medicaid, the program has enrolled over 500,000 people.

September is Self-Care Awareness Month and the American Heart Association in Missouri is urging caregivers to take some much-needed time for themselves.

Missouri has around 600,000 family caregivers, many of whom provide unpaid care to loved ones with heart disease, cardiac events and other debilitating illnesses. The emotional and physical toll can be severe, with 21% of caregivers reporting their own health has declined.

Dr. Ravi Johar, chief medical officer for UnitedHealthcare and a board member of the American Heart Association of St. Louis, wants caregivers to understand proper self-care is not selfish.

"It's really important that after an acute event, whenever you've had a chance to kind of catch your breath, sit down and think about exactly what they need and exactly what you need and how much you can give," Johar recommended. "That's not being selfish. That's not, not taking care of them. That's doing the right thing for both of you."

According to the American Heart Association, it is important for caregivers to have someone they can confide in about their fears and doubts; a person who can offer reassurance and emotional support.

A 2023 AARP survey showed nearly 40% of family caregivers spend more than 20 hours a week assisting their loved ones from driving to appointments to providing direct care, many while also working and raising children. Johar stressed the importance of caregivers using time off from work wisely, which includes new mothers with babies in neonatal intensive care.

"The baby's getting the best care in the hospital and there's nothing you can do to help," Johar pointed out. "Go ahead and go back to work. Save that time, go in every evening. Spend all night or as much time as you want with the baby. But save your time off, because when this baby comes home, then you're really going to need to be there."

Doctors also emphasized the critical role of regular exercise, like brisk walks and the need for caregivers of all ages to maintain a heart-healthy diet. The habits help manage stress and boost energy levels.