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Network team removes barriers to care for woman with diabetes

September 2016

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Brittany Symonds, PharmD
MTM pharmacist
“Brittany has been a lifesaver in many ways,” says Anita, 67. Anita’s multiple chronic diseases and related complications had created barriers to care and landed her in the hospital. She needed specialized help to get her health back on track.

That’s where Brittany Symonds, Medication Therapy Management pharmacist, Fairview Physician Associates (FPA) Network, stepped in. She serves as part of a network team that came together to help Anita.

“Talking to Brittany and getting my medications straightened out has been important,” says Anita. “I don’t think it would have been possible without her help.”

Diabetes diagnosis brings difficult new reality
Anita was used to being active. She worked locally for 35 years until back surgery and a hip replacement caused her to retire. A diagnosis of diabetes during a hospital stay last December sent her health into a downward spiral.
The problem began when she tried to renew the diabetes medication after a post-hospital rehabilitation stay. Because of mobility limitations, Anita was not able to see her physician, David Brockway, MD, Richfield Medical Group. She went without her medication for several months.

“My blood sugar went sky high,” says Anita. “I ended up back in the hospital.”

In addition to Brockway and Symonds, Anita’s team included Shannon Whalen-Saraswate, Fairview clinical product navigator.

The “perfect storm”
“After a particularly difficult hospitalization, Fairview’s navigator identified her as a high-risk patient and reached out to our clinic care coordinator,” says Brockway.

FPA Network care coordinators work with patients of independent member clinics. As registered nurses and social workers, they serve as part of a team to address such barriers as complex medical care, psychosocial problems and social service needs.

“In cases like Anita’s, we just have to chip away at the details until we uncover the real reason for the problem,” says Melody Anderson, RN, FPA Network care coordinator.“

For Anita, multiple factors conspired to create what Symonds called “a perfect storm.” Barriers to care included medication cost and mobility issues preventing Anita from visiting her doctor. Symonds worked with Anita by phone, reducing the number of clinic visits needed, and helped her find less expensive medications through a mail-order source.

Care coordination and MTM—“the best things”
Anita calls care coordination and medication therapy management “one of the best things Fairview instituted. If I hadn’t had Brittany, I don’t think I’d have my diabetes under control and feel as well as I do today.”

For more about care coordination, contact Karen Mulder, RN, FPA director, network clinical services, kmulder1@fairview.org.

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