3 services to aid those with chronic illness

In 2016, the Saint Alphonsus Health System greatly expanded its capacity to provide high-quality health care for people who have chronic illnesses.  After hiring 10 new providers — including six physicians, two nurse practitioners, a pharmacist and a social worker — Saint Alphonsus opened three new consultative outpatient services including a:

· Geriatrics Clinic – for older people who have several chronic conditions

· Palliative Care Clinic – for adults of any age who have serious chronic illnesses and who need additional help for their symptoms, emotional distress, family support, advance care planning and spiritual comfort

· House Calls Program – for people who have chronic illnesses and insufficient care because they have great difficulty traveling to health care facilities 

These new specialized services all focus on providing patient-centered, team-based, comprehensive care for patients and their families who are dealing with chronic illnesses and receiving complex care. For each new patient who comes to one of these services, the team begins with a comprehensive assessment of all of their health-related needs, including medical, pharmaceutical, emotional, social and spiritual. The team then meets with the patient and family to inquire about the patient’s health-related goals, i.e. what’s most important to the patient.

Members of the care team then develop a comprehensive plan of care and recommend specific steps for attaining the patient’s goals. With this plan, tests are performed, prescriptions are modified, new treatments are started, needed equipment and supportive services are obtained, healthy patient behaviors are encouraged, and help with emotional distress, spiritual needs and advance care planning is offered. Because of this coordinated, focused care plan, most patients’ health begins to improve after a few visits.

During this process the team continues to communicate with the patient’s referring provider and to establish a plan for continued improvement going forward, under that provider's care. In some cases, if the patient and the referring provider request, the team also arranges or provides further care for the patient and family.

 

 

Additional available services

To further enhance the care of people with chronic conditions, Saint Alphonsus has also developed five additional programs which include:

· an inpatient palliative care service

· an advance care planning program

· a free, community-based, patient self-management series

· a professional education series

· a system for bringing needed healthcare services to patients who are at high risk for serious health-related problems in the near future.

Where to find us

The Geriatrics and Palliative Care Clinics are located at 5966 West Curtisian Avenue. Providers can make referrals to these clinics or to our House Calls Program through their electronic medical records or by calling the Saint Alphonsus Resources Center at 208-367-DOCS (3627).

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