Einstein/Montefiore Department of Medicine

Montefiore-NYHRE Clinic: An Innovative Approach to Serving an At-Risk Population

Amy Sacks

(L to R) Alsane Mezon: Medical Assistant; Mercedes Guzman: Clinic Project Manager' Grace Goldfarb, RN: Clinic Nurse; Brianna Norton, DO, MPH: Clinic Medical Director; Franklin Ramirez: Clinic Care Coordinator; Irene Soloway, PA: Clinic Physician Assistant

People who inject drugs are at increased risk of contracting HIV, hepatitis, and other infectious diseases and co-morbidities. And due to the current opioid epidemic, people who use drugs are currently at an unprecedented risk of dying from drug overdose.

But for many people struggling with substance use disorders, the logistics of navigating the complex New York City health care system – from scheduling a doctor’s appointment, to buying a Metrocard, to arriving to the healthcare facility on time – is often a barrier to receiving good care.

Now, a new Montefiore satellite clinic is helping to provide sorely-needed health-care services to this vulnerable population.  The clinic operates in concert with the city’s largest street-side syringe exchange program, run by New York Harm Reduction Educators (NYHRE), a non-profit organization devoted to promoting the health, safety and well-being of marginalized, low-income people who use drugs, their loved ones and their communities. 

Patients who visit the Montefiore-NYHRE Clinic, located at 126 and Lexington Avenue, in East Harlem, can receive treatment for their substance use disorder with medication assisted treatment such as buprenorphine, get tested and treated for HIV and hepatitis C, receive PEP and PREP treatment to prevent the acquisition of HIV, and obtain referrals for specialty care testing or treatment, if needed.

The Montefiore-NYHRE Clinic, the first academic medical center-supported clinic of its kind, is the brainchild of Brianna Norton, DO, MPH, an Assistant Professor in the Montefiore Einstein Department of Medicine (General Internal Medicine) and medical director of NYHRE. Dr. Norton worked closely with MMG leadership and EPIC to bring the new drop-in facility into being.  

“There is a sub-population of people with a great need for health care, but we are unable to reach them and get them into our system,” Dr. Norton said, noting that a majority of NYHRE’s patients are homeless or unstably housed and living in poverty. “We’re taking a holistic, multipronged approach to treating the most marginalized population. If we can engage people in healthcare at a place they already feel comfortable, we can prevent them from dying of opioid overdose, and other substance use related diseases such as HIV, HCV, and endocarditis.”

Since opening in February 2019, the clinic has served more than 50 patients, among them a middle-aged male patient who contracted hepatitis C after turning to heroin during a bout of depression stemming from his divorce.  NYHRE clinicians were able to start the patient on buprenorphine, do a workup for Hep C, and test for other viral illnesses and co-morbidities. Physicians and PA’s wrote prescriptions and entered notes into the EMR system; nurses checked the patient’s vitals and drew blood. The blood specimen was picked up by the Montefiore Einstein Pathology Department for laboratory testing, and clinic staff processed the patient’s insurance information.

“It was amazing,” Dr. Norton said. “These are patients who would not have received healthcare if this clinic were not available - and HCV, PREP, and buprenorphine treatment no less!”

The Montefiore-NYHRE clinic, a satellite of Montefiore’s Comprehensive Health Care Center (CHCC), in the South Bronx, is currently open three days a week, Monday through Wednesday. An extended schedule is planned for the near future.

The unique collaboration between a large academic institution and a syringe-exchange program helps to destigmatize drug use, Dr. Norton explained. “Having Montefiore doctors truly prioritize this population is an important step,” she said.  The collaboration also encourages research studies, such as onsite buprenorphine testing and the use of PrEP to treat women, both of which are currently underway.

Out-of-the-Box Thinking 

This innovative public health program, a year in the making, was no small feat, and one that required thinking outside the box.  

Dr. Norton credits Julia Arnsten, MD, MPH, Division Chief, Internal Medicine, Joseph DeLuca, MD, Associate Division Head, General Internal Medicine, and Matthew McDonough, FACHE, MPH, Vice President, Montefiore Medical Group, as well as the many staff involved for the program’s success.  Montefiore’s Epic team created a category for the clinic, and Montefiore IT services created a network that enables the clinicians to enter notes into the medical center’s Electronic Medical Records system.  Funding from the New York State Department of Health and Mental Hygiene supported the hiring of an administrator, a physician assistant, two nurses, and front desk staff.

Dr. Norton’s passion and tenacity have paid off.

“Through Brianna’s persistence and the support of MMG, we now have the ability to treat patients onsite, at the syringe exchange program, and to bill for those visits” said Dr. Arnsten. The collaborative, multidisciplinary effort, she said, “will help us provide critically needed care to vulnerable patients who don’t have access to traditional medical care settings.” 

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