Written by Tanya Terry
Although systemic barriers in healthcare preventing marginalized groups from receiving equitable care are deeply ingrained within the structure of the healthcare system, there are things individuals can discuss with their doctors or other providers to help ensure better outcomes.
Dr. Mayuri Dasari, senior medical director at Oak Street Health, MI-2 Region, shared that about 30-40% of the patients seen at Oak Street end up being diagnosed with diabetes. Similarly, she stated about 30%-35% of Oak Street patients are diagnosed with heart failure.
According to Dasari, most of these patients have not received very good care because of barriers to access. Therefore, she added, their conditions are usually not well controlled.
Dasari said: “The name ‘heart failure’ is such a misnomer. When we hear that it just sounds so morbid. While it is a very morbid condition, there are different stages of heart failure, from the very the very beginning – with pre-heart failure, where a patient has risk factors to developing heart failure but aren’t quite there yet. The next stage would be Stage B heart failure, where patients don’t really have symptoms like shortness of breath, difficulties catching their breath or things like that. But, they do have some underlying structural changes to their heart, where it’s starting to show that there’s signs of heart failure. Then, in Stage C and D the symptoms are far more progressive and can often lead to hospitalizations and flare-ups.”
Dasari pointed out for many local seniors a major problem is access.
“It’s not just access to healthcare, but access to healthy foods and safe places to exercise, being able to afford medications and transportation to get to medical appointments,” Dasari added. “Many of my patients have financial struggles. They’re often navigating multiple of these chronic conditions all at the same time. That all adds to stress. So, our focus is to help patients navigate through these complex situations.”
Care teams at Oak Street include a social worker, a behavioral health specialist and a community health worker to help patients navigate obstacles. Patients may be, for example, connected to a food pantry, enrolled in benefits that offer support in accessing a gym membership or getting healthier foods or get help working with pharmacists to get prescriptions.
According to Dasari, it is the job of a physician at her clinic to identify when patients have various barriers, such as not being able to hear well or not having any time left on their phones. These patients are referred to community health workers, who may do door knocks, help them set up appointments or schedule a van to take them to a medical appointment.
Dasari shared that Oak Street and many other centers use an online consultation platform called RubiconMD that seeks to remove barriers to specialty care by virtually connecting primary care clinicians to board-certified experts who can provide recommendations. This helps physicians provide care quickly and saves patients months of trying to find a specialist.
“For example, if I have a patients with diabetes and I’ve done my due diligence by adjusting their medications, but they maybe need a little help, and I want to send them to an endocrinologist-rather than having the patient go to see one, I’m now going to place a call to be counseled. So, now I get a new recommendation saying: ‘This is how you want to adjust this patient’s medications to help control their chronic conditions.”‘
Dasari pointed out that area clinics such as Hamilton Community Health Network clinics and Oak Street Health are committed to helping patients be proactive when it comes to good health, rather than seeing them only when they are sick.
“A lot of our patients come from communities where they may have had a negative experience with health care systems in the past – or just a lack of experience all together. So, the way we approach it is with a lot of trust, and that takes time…Many of my patients just historically are from marginalized communities where they have been dismissed, or ignored in the health care setting. So, my job is to how up with respect, emphathy and consistently show them I am not just there to diagnosis their condition. We’re looking at the patient as a whole to show them they deserve that quality of care.”
