Small Health Clinic Run by Rutgers Staff Has Big Potential to Change Lives

Andrew Kitchenman | July 10, 2014 | Health Care
Newark wellness center brings together range of professions to serve low-income residents

Eloise Ballena of Kearny didn't pursue treatment for her painful arthritis, but became a client of the Rutgers-FOCUS Wellness Center in Newark after hearing good things about the clinic -- including the staff’s ability to communicate in Spanish.
To find potential benefits from the sprawling merger of Rutgers University and the former University of Medicine and Dentistry of New Jersey, it can pay to listen to 65-year-old Kearny resident Eloisa Ballena.

Until Rutgers opened a clinic on Broad Street in Newark last year, Ballena hadn’t tried to find treatment for the growing pain from arthritis in her hands. But after hearing good things about the Rutgers-FOCUS Wellness Center from a friend — including the staff’s ability to communicate in Spanish — she has sought treatment for the pain and other potential problems, including elevated cholesterol and blood-sugar levels that could lead to chronic conditions.

“Everyone’s very friendly, very personable,” Ballena said of the clinic staff, through an interpreter. “I’ve already referred several friends over.”

The center is providing a unique range of physical and behavioral healthcare under one roof — the type of cross-disciplinary practice that the new Rutgers Biomedical and Health Sciences division is aiming to foster.

Up to 25 patients per day visit the clinic, which is managed by nurse practitioners who are faculty members at Rutgers’ School of Nursing and is staffed by people from the university’s social work, pharmacy, and respiratory therapy programs. It also provides a venue for Rutgers students from each of these areas to gain clinical experience.

While physical and mental (or behavioral) healthcare are generally separated by regulations and payment systems elsewhere in the state, the center offers a combination of both services. Staff members see this as its greatest strength.

Patients frequently resist seeking help for behavioral issues, and if the center referred them to outside social workers, “they wouldn’t see anybody. But because we can walk them over, and they can sit down and talk to a friendly face, they seem to be able to have that counseling session, which helps them significantly,” said Kathy T. Gunkel, the center’s assistant director and a clinical assistant professor at the nursing school.

The center offers a team-based approach, bringing together staff members to consider all of a patient’s health issues — particularly those with multiple or chronic conditions.

“This really is the way I think primary care is going in general,” Gunkel said of integrating primary care with behavioral health, pharmacy, and respiratory therapy. Later this summer, the center also will include a staff member and students from Rutgers’ physician assistant program.

The center serves a largely Hispanic population and is operated in cooperation with its next-door neighbor, the FOCUS Hispanic Center for Community Development Inc., a social-service provider that refers some residents to the clinic. Gunkel estimates that 40 percent of patients speak only Spanish, and roughly 30 percent are undocumented immigrants.

Gunkel takes a pragmatic approach to these immigrants, saying that they will receive better, less expensive care in the center than they would if they delayed seeking treatment until they visited a hospital emergency department. The costs of these emergency visits are borne by taxpayers, who fund hospital charity care, she noted.

The wellness center officially opened in July 2013, after several weeks of treating patients, and is largely funded by a three-year, $1.5 million grant from the U.S. Health Resources and Services Administration. But Gunkel said the center is aiming to broaden its funding sources, including helping enroll patients in insurance offered through the Affordable Care Act, and has received grants from private foundations.

The idea for the center predates the Rutgers-UMDNJ merger, when William Holzemer, dean of the Rutgers College (now School) of Nursing, aimed to have faculty members provide healthcare in Newark. This idea was expanded to other schools due to the HRSA grant program, and with the university merger, the range of programs involved in the center is growing. For example, a business-school student worked on a business plan for the center as a project.

“We all worked together in order to get that grant,” said Gunkel of the HRSA funding, adding that the center leads to patients being the focus of care, rather each provider focusing on his or her own specialty. “And it’s really interesting because in lots of places in medicine, professionals work together, but they work in their silos, and the patient is not in the center. Here the patient is in the center and we all come together with our expertise to help the patient.”

Rutgers Biomedical and Health Sciences Vice Chancellor Dr. Denise V. Rodgers sees the Newark center as having the potential to benefit from an even wider range of the university’s schools, from law students to medical students.

The integration of Rutgers and UMDNJ “is really providing more opportunities where we’re all sitting around the same table at the same time, removed from bureaucratic impediments,” looking for areas to collaborate, Rodgers said.

Rodgers added that it’s essential that those studying for careers in healthcare collaborate with psychology and sociology students in settings like the center, so they can gain a better understanding of the social factors that determine residents’ health, and can aim to intervene at the family or community level. By consolidating different fields of study within Rutgers, she said, it’s “opened up a different landscape” for pursuing “interprofessionalism,” a term for multiple health professionals working together. Rodgers oversees interprofessional programs for the university.

Rodgers said future doctors could benefit from spending time at the center, to “get a feel for a primary-care setting that isn’t necessarily driven by physicians — that is nurse-managed but has a role for a variety of different health professionals.”

Rodgers added that while the center will provide unique opportunities for students to learn about the practice of healthcare, the center is ultimately focused on providing better quality of and access to care for patients.

“If all we do is create a great learning” opportunity, Rodgers said, “we won’t have the quality improvement that we need” to benefit patients in the long term.

Gunkel said the center’s short wait times and focus on health education are drawing patients. She hopes the practice can grow from the 450 to 500 patients it currently serves to roughly 3,000, and that it will become a federally qualified health center.

“I think nurse practitioners in general and nurses are the future of primary care,” Gunkel said. As more and more people are eligible to get insurance and can access primary care, we need more and more primary-care centers, and we don’t have enough physicians, because physicians are not going into primary care. It’s not as lucrative as some other specialties.”

Having all of the staff members see themselves as equal members on a team also has advantages. Pharmacist Mary Wagner enjoys the day each week she spends at the center. “Everyone here is passionate about helping patients, and you come here and you just have a good time because everyone has the same goal, of helping those in need,” she said.

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