Salud Family Health Center

1
Salud Family Health Center

• Commerce City, Colorado

2
Where were going

• The City
• The Clinic
• The Patient

3
Commerce City

• Quality Community for a Lifetime
• Founded March 24, 1970
• Current population approximately 45,000
• Median annual income 42,635
• Property crime index 182 and Total crime index
  164
• The 4/3/07 vote its all about pride

4
(No Transcript)
5
Common homes in South CC
6
Reunion

• A Shea Homes community since 2002
• The name Reunion was chosen to represent a deep
  appreciation for the past, a sense of wonder
  about the future, and a commitment to living
  every moment to the fullest.
• Source of the name change debate?

7
Rocky Mountain Arsenal National Wildlife Refuge
A chemical weapons arsenal for the US army
during WWII
After the clean-up in 1992, became the largest
contiguous open space in the Denver metro area
Leased out after the war for the development of
chemicals and pesticides
Trails, catch and release fishing, tons of
wildlife
8
Dicks Sporting Goods Park
Home of Colorado Rapids Soccer
Seats up to 26,000
Opening Day 4/7/07
Will NASCAR be next?
9
The Salud Clinic

• Reducing barriers to health care

10
Stats on the Salud Clinic

• Over 80 Hispanic in Commerce City
• Whos paying
• Sliding Fee Scale 50
• Medicaid 30-- reimbursing at a higher rate
• Medicare 4
• Private Insurance 12
• Other Public Insurance 4 (CICP)
• Cost of a visit earn less than 250 of the
  poverty linecopay is 7.00

11
Services available through Salud

• Family Medicine, Pediatrics
• Obstetrics and Gynecology--Delivery at University
  Hospital or Platte Valley Medical Center in
  Brighton
• Colorectal screening, mammography, colposcopy
• Ultrasound, X-ray
• Immunizations
• Dental visits
• Mental health
• Pharmacy
• Mobile health unit
• Book program
• Referrals cannot be sent to most University
  clinicsno insurance

12
Most common diseases seen at the clinic

• Bulk of most days spent on
• Well child checks
• OB check ups
• Hypertension
• Diabetes
• Gastroesophageal reflux disease
• Upper respiratory illness
• Obesity

13
Within ½ Mile of the Salud Clinic
14
Walmart being close is not such a bad deal for
our patients
15
Mrs. Guadalupe L.

• 43 year old delightful Mexican woman
• Lives in an apartment with her husband
• Has 3 grown children over 20 years old
• Has diabetes mellitus for at least the past 10
  years (her records only go back to 1997)
• Current HbA1C 9.8
• High creatinine/microalbumin ratio in her urine

16

• What she is supposed to be taking
• Novolog 70/30 65 units in AM, 45 in PM
• Metformin 2 tabs twice daily
• Lisinopril 5 mg daily
• Aspirin 81 mg daily
• What she is taking
• Novolog 70/30 40 in AM,
• sometimes 30 in PM
• Sometimes metformin, aspirin
• and lisinopril
• She states that she is non-compliant
• because the meds are making her
• nauseated at night for the past 2 months

17

• Turns out she hasnt menstruated since 12/17/06.
• Urine HCG
• Lisinopril is Class D in pregnancy
• Aspirin is Class C in pregnancy
• She also is 43 years old
• Has had DM gt10 years,
• consistently uncontrolled
• She is now getting her first prenatal care at 15
  4/7 weeks
• She and her husband are both pleased with the
  pregnancy and are not interested in therapeutic
  abortion

18

• I attempt to get fetal heart tones with the
  Doppler without success.
• My preceptor attempts fetal heart sounds with the
  doppler without success.
• Having an ultrasound in clinic, we send her over
  and get an immediate read.
• 14 3/7 week fetus without movement or heart tones.

19

• She cannot afford a D E, so she has to wait
  until the fetus passes on its own or she needs an
  emergent D E for complications.
• We provide as much support and explanation as we
  can, but ultimately our only option is to wait.
  We schedule her for a follow up visit in 2 weeks
  for her general well-being (and to discuss birth
  control).

20
Random Tidbits I learned at Salud (and some of it
is culturally relevant)

• The core of the earth rotates more quickly than
  the rest of the earth (1 extra every 400 years)
• The population with the highest rate of Rh- is
  the Basque region of Spain (35-55)
• Mexican people refer to a week as 8 days, 2
  weeks as 15 days and a month as 22 days.
• Mexican belief that trauma leads to cancer

21
Where we were
1. Commerce City- Not just a stinky town
2. Salud Clinic- Healthcare for the
underpriviliged
3. Mrs. Guadalupe L- Uncontrolled DM and IUFD
Plus random tidbits of information for no good
reason
22
Resources

• http//en.wikipedia.org/wiki/Thumbs_down
• http//www.ci.commerce-city.co.us
• http//www.saludclinic.org
• http//www.fws.gov/rockymountainarsenal/