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 AssistantPeople 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.”