CLEVELAND (AP) — The Iraq vet fitted a blood-pressure wrap around the Vietnam vet’s arm, checked the gauge and announced, “Nice blood pressure today. Right in the range we want.”
Andrew Bisbee, a former Army medic, then checked his patient’s heart, throat and swollen feet.
“I know I’m not a spring chicken anymore,” said the patient, Gerald Bowles, 65, of Cleveland.
Bisbee, 28, grinned at the patient he calls “Mr. G,” and told him, “Hey, I hope I look half as good as you when I’m older. I hope I look a quarter as good.”
The recent exam took place in Bowles’ apartment in Cleveland, where Bisbee also checked his patient’s other vital signs, medical appointments schedule and stock of medications, taking notes he would pass along to a team of doctors and nurses at the Louis Stokes Cleveland Veterans Affairs Medical Center (VAMC).
Some folks might have figured that home medical visits long since went the way of rotary phones and typewriters.
But for the past two years, a pilot project at the VAMC has utilized the experience of former military medics to improve the health care of area vets at home.
These “patient navigators” guide veterans through a home-treatment program that offers such services as instruction on medication management, health coaching, basic medical testing and coordination of care with VA hospital resources.
“The idea is that there’s a very small portion of patients that account for health care costs, and home visits can be a really important part of helping people to stay well and out of the hospitals,” said Dr. Brook Watts, the Cleveland VAMC chief quality officer who applied for a $3 million VA grant for the four-year program.
Watts said that nationally about one percent of patients — largely those with chronic diseases “at high risk for bad outcomes” — represent 20 percent of health care costs. Nearly 20 percent of the VA patients in this area fall into that high-risk/high-cost group, she added.
A second goal of the program is to provide the opportunity for former military medics to use their expertise in the civilian world.
“Thousands of former military medics and corpsmen leave the military each year and can’t get jobs in the private sector,” Watts said.
“What we’re trying to do here is meet the needs of our health care system and at the same time provide much-needed jobs for veterans, leveraging the skills that they have,” she added. “It’s a win-win.”
Currently two patient-navigators — who have received 240 hours of training and are supervised by a nurse — handle 200 patients within a 25-mile radius of the VA hospital near University Circle. The former medics also are part of a team that includes a physician, nurse practitioner, psychologist and social worker.
(In another program, three other former medics have been working in the hospital’s emergency room for the past four years.)
Watts noted that the expertise of former military medical personnel meshes well with the role of being a patient navigator.
The job can entail going into a lot of different neighborhoods, some good, some bad, and “you have to have a real sense of awareness. You have to know how to take care of yourself, and be comfortable in difficult situations,” she said. “To me, the people who have been out in the field in Iraq or Afghanistan, have shown that they have that skill set.”
Additionally, there is an added advantage to a vets-helping-vets approach in home visitation, particularly when “many of our patients have real social challenges,” according to Watts.
“What has been really remarkable is that because our medics are veterans, they have a very basic foundational bond with veterans, and have been able to help us reach patients that no one else in the health care system could,” she said. “They can build a relationship based on shared experience. It’s not rocket science. It makes sense.”
Bisbee, of Parma, who was deployed to Iraq in 2009, also said military experience can help a patient navigator. (The other patient navigator is Air Force Reservist Marie Spencer.)
“It creates a bond, you know, because veterans trust other veterans,” he said.
That bond often was evident in his recent visit with Bowles. When the old vet mentioned his trusty old P-38, a Vietnam-era can-opener for Army field rations, Bisbee noted, “when I was in, there were no more cans. Everything was plastic, tear-open, easy access.”
Bisbee said his work as a medic in a combat unit attached to the 10th Mountain Division in Iraq was “pretty much the greatest privilege I’ve ever known. Just to be called ‘Doc’ by those guys. But you have to earn that title. It’s a huge physical and mental burden.”
He wanted to continue to work in medicine after he left the Army in 2011, and came to Cleveland with another medic from his unit to study nursing at Cuyahoga Community College. “My goal is to be some sort of health provider, make medical choices, because that’s what I did in the military,” he said.
When he found out about the patient navigator program, he signed on.
Like the Army, “in this job these guys are high-intensity patients,” Bisbee said. “A lot of times they’re out there with no family or friends, so we go above and beyond to get things done for these patients.”
If that means providing transportation and being a companion for a vet’s medical appointments, or delivering healthy food from a local food bank, so be it.
A few times a home visit has been a life-saving experience, such as the patient who nearly slipped into a diabetic coma, or the vet with chest pains that Bisbee recognized as signs of a “an incredibly bad heart failure.”
Having been a medic helps in those situations, according to Bisbee. “It gives me the ability to identify and recognize what is a life-or-death scenario, and gives me a sort of calm perspective,” he said.
But mostly “it’s the little things that medics do. If you put in the little pieces of work, that means a lot to the patient,” Bisbee said.
Bisbee wrote a summary of attributes that medics bring to the job of patient navigator, including “the aptitude to learn critical thinking/practical skills in a short time frame” and the ability to “practice this knowledge and skill set in the most stressful and important of all times: A wounded comrade.”
He noted, “A military medic has cared for a multitude of illness, injury, and all other medical needs of soldiers. Medics find ways to get things done, by any means, for their patients.”
And when it comes to a shared military experience, Bisbee said, “The veteran medic is NOT assuming that they empathize/understand all the battles, all experiences and all the struggles that other veterans have had.
“It is more encompassing a role as an ally in the battle against chronic disease and hospitalization that the veteran patient can relate/bond with.”
Watts hoped that the pilot project, one of five at VA sites nationally, grows in the future.
“We want this to be a program that spreads within the VA, and truthfully within the wider health care system,” she said. “There are thousands of former corpsmen and military medics being released from the service who need more paths for jobs, and we have a need for these sort of services, and we need to find a way to bridge it together.
“I hope it catches on.”
Bowles shares that sentiment.
Prior to the home visit program Bowles had to go to the VA hospital complex near University Circle for treatment. “I don’t drive, and it made it kind of hard for me to get down there,” he said.
“I used to have a lot of problems with my legs,” he added. “I couldn’t do a lot of walking.”
Bowles said the home visitation program has been “very helpful for me. Very helpful.
“When he (Bisbee) comes by, he checks my vitals, makes sure I have all my medications, (and) my medications are up to date,” he added.
Bowles said he feels healthier now “because I have somebody to come check on me. All vets should be able to get into it, not just the ones that are sickly, but all of them. ‘Cause, I put it like this, we deserve it.”
Bisbee nodded, and said, “You sure do, Mr. G.”
Information from: The Plain Dealer, http://www.cleveland.com