CHAS’ Pharmacy Department has become well-known for advancing the responsibilities of Pharmacists, not only in Spokane, but contributing to moving the profession forward nationwide!

One such recent effort which has spotlighted the Pharmacy Department is its’ involvement in the Patient Safety and Clinic Pharmacy Services Collaborative (PSPC).  According to HRSA’s website, the PSPC is “a breakthrough effort to improve the quality of health care across America by integrating evidence-based clinic pharmacy services into the care and management of high-risk, high-cost, complex patients.”

CHAS became involved in the PSPC in October 2010 stemming from a desire to have Pharmacists recognized as providers while tracking measurable patient outcomes.  A barrage of high-risk conditions were considered, but diabetes was selected as the focus because it closely aligned with work that was already being done at CHAS related to the Beacon and Patient Centered Medical Home initiatives.  The ultimate goal of CHAS’s PSPC efforts is to take patients with high-risk diabetes and stabilize them using an integrated care model.  And isn’t CHAS the perfect place to do such a thing?! With Pharmacists and medical providers all under one roof, it was a no-brainer!

Primary Care Providers can refer patients with complicated diabetes to the team, those whose A1cs are too high or those who simply have educational needs.  The model looks like this: a Pharmacist, who also happens to be a Certified Diabetic Educator, meets with the patient and performs a needs assessment which includes documentation of all medications, insulin titration needs, creating an educational plan and goal setting by the patient.  From there, the patient can be seen strictly by one or a combination of the team members which includes a primary care provider, pharmacist, and dietician.  The data measured which includes A1c, adverse drug events, potential adverse drug events and medication reconciliation is reported internally to Quality Improvement and nationally. 

To date, approximately 180 patients have enrolled in this integrated program.  Visits include in-person, over-the-phone, and monthly group educational sessions (see upcoming schedule below). “As predicted, the patient results have been great,” states Pharmacy Director, Heather McNamee.  Kelly Smoot, Pharmacist and Certified Diabetes Educator goes on to say that the team approach has made a bigger difference to patients than she originally thought.  “We’ve gotten a lot of positive patient feedback.  We’ve had a lot of patients lost in care and out of control for years, but now they feel like they have people they can call.” 

Another unexpected consequence of the PSPC program has been the increased role of the Certified Diabetes Educator (CDE).  “I never expected as many combo visits with the provider. It opens the door to help monitor for complications.  A lot of CDE’s don’t get to do this.  I love my job,” says Kelly.  

PSPC services are available in the following clinics: Valley, Maple, and North County, with hopes to eventually offer these at all locations. 

 2013 Diabetes Group Visits
Pre-registration is required.  Patients can call 509.444.8200 to register or for more information.

Valley Clinic

 Maple St. Clinic

 North County Clinic

Ana Johnson Named Pharmacy Technician of the Year!

Ana was nominated and awarded the title of Pharmacy Technician of the Year by her peers at the Annual Spokane Pharmacy Association CE and Awards Banquet held in November!

Congratulations Ana!

Dr. Poncher Named Pacific Northwest University’s Teacher of the Year!

Annually, the students of Pacific Northwest University are asked to nominate a physician who had the most impact on them during their rotations. This year, Dr. Poncher, Pediatrician at our Maple St. Clinic, was chosen as the recipient of the much-deserved title!

Dr. Poncher has been teaching and practicing medicine for over 40 years and loves it every bit as much today as he did the first day he started. “I love teaching. If you don’t enjoy it, you shouldn’t be doing it. I probably receive awards such as this, not because I am that much better of a teacher than other physicians, but because the students can see how much I enjoy teaching, and how much I appreciate the privilege of having them with me!”

4th year medical student, Ashley Meganck, has found Dr. Poncher’s approach to be refreshing. “Dr. Poncher has a mind for detail, a gentle manner with patients and a sense of humor that is never far from the surface. He is a natural teacher whether he is teaching patients and parents about healthy habits or teaching medical students or residents about the 3 most common causes of otitis media. He taught me that a strong basis in medical knowledge, good rapport with patients, and good wine and coffee are all one needs to be successful and fulfilled and most of all happy in my chosen profession; and for that I will be forever grateful!”

He was told early in his career by one of his students that he was too happy and that he needed to act like he had an ulcer when seeing patients. “Look around you at all of these grumpy doctors,” she said. “They don’t want to see you happy. They will accept you more if you look grumpy like they do.” In spite of that advice, Dr. Poncher has remained his positive self and ulcer-free for 40 years.

Dr. Poncher knows that having a passion for teaching is what will help these future doctors be successful. “Going from books to patients is very different than going from patients to books. You can’t just read it – you have to see it and read it. Always remembering that, patients don’t usually read the text books.”

Dr. Poncher’s positive attitude changed the outlook of the medical profession for one of his students, Chad Douglas. After a rotation in family medicine, Chad had become disenchanted with family medicine and his outlook on practicing medicine became grim. That was until he met Dr. Poncher. “What I’ve gained from Dr. Poncher has stuck with me, and I believe, become a part of who I am. So now when I walk into a patient’s room, they don’t just see me, they see a little bit of Dr. Poncher as well. The care that each patient receives and the quality of life that they bear as a consequence is unquestionably a touch better thanks to Dr. Poncher.”

Dr. Poncher plans to continue to teach and practice medicine until he no longer is able. “I have the best of both worlds – children and students. I feel that the only thing better than practicing Pediatrics is providing care to the medically underserved, teaching medical students, and teaching residents, which I have done for the last 40+ years. Fortunately working for CHAS, I am able to do both. Add to that the ability to share it all with a very special wife makes me feel that I am truly blessed.”

Hep C Program Comes to Life at CHAS
April 2012
By Katie Kolbet, Communications

Dr. Ethan Angell, Primary Care Provider - Community Health Association of Spokane

Dr. Ethan Angell and Michelle McCartney, Medical Assistant, are pioneers of sorts here at CHAS.  About 5 years ago while working together in family practice they started to notice a cycle of patients presenting with Hepatitis C.  Sadly, a lot of people don’t realize that they have Hep C until they are in the process of liver failure. There also are not many clinics that accept or know how to really deal with this condition. “We knew there had to be a better way to service patients with Hep C, to be able to build a relationship with them, get them clean (which is a requirement for the program) and help them deal with the side effects of the medications that clears the virus,” states Michelle.

Dr. Angell recalls the main motivation behind the push for the Hep C program. “A few years ago we had a patient who we became very close with.  He was in need of a liver transplant and was sent over to the University of Washington.  Two days before his appointment there, he passed away.” “It was the first funeral Dr. Angell and I attended together,” adds Michelle.

From there, they pushed to get a pilot program started that would help people with this curable disease. In 2009, they were allowed to take on five patients.  All five cleared the virus, meaning no trace of Hep C could be found in their systems. This was a great result and showed the impact that could be made.

The Hep C program is tough to get into and is growing by leaps and bounds. But with Dr. Angell only seeing Hep C patients on Tuesdays and Wednesdays, the demand is growing.  Below is a synopsis of 2011:

• 192 referrals made
• 100 patients attended the educational classes (a requirement for all participants)
• 103 patients met with Dr. Angell
• 20 patients are currently undergoing treatment
• 9 patients are ready to start treatment
• 25 patients completed treatment!

Many of the folks who are seen by Dr. Angell and Michelle are drug addicts – most contracting Hep C from sharing dirty needles or snorting cocaine.  Amazingly, the virus can live on a dollar bill for four days!  And most patients find out they have the disease by the plasma clinic where all blood is screened before a donation can be made.

When speaking about the program, Dr. Angell adds, “this is not something that people can just jump in and out of.” In order to be accepted into the program the patient must remain clean for 6 months, and must be emotionally and mentally stable. Patients must be committed to staying clean, or they are removed from the program.  Then there are others that experience side effects that are too much for them to deal with or and yet others that simply do not respond to treatment.

“There can be terrible side effects from these drugs,” says Dr. Angell.

One of the benefits of treating patients for Hep C, who are also primary care patients, is Dr. Angell and Michelle already know them, there is a trust built, and they can treat the side effects better than a Hepatologist would be able to in most cases.  They are also able to give patients their weekly injections at the clinic, because for some, injecting themselves is a trigger of their prior drug use.

For the Hep C program to successfully continue, Dr. Angell and Michelle know that case management is the key! “We are their medical home, a lot of patients are sad when treatment is over – we are part of their family,” Michelle adds.

Congratulations and appreciation to Dr. Angell and Michelle for instituting such a beneficial program at CHAS!

By Dr. Roberta Knorr,  Pediatrician

Today, there are many points of view when it comes to vaccinating children – Community Health Association of Spokane’s newest Pediatrician, Dr. Roberta Knorr, weighs in on the topic.

The old adage, “an ounce of prevention is worth a pound of cure”, could not be truer in the pediatric world.  There are so many things now days that parents would never do or let their defenseless child do. You would never put your newborn infant in a car seat without buckling him or her up, or let your toddler play in the bathtub without supervision, allow your 4-year-old to cross the street by themselves, or let your 6-year-old ride a bike without a helmet.  It’s the small things that help keep our children out of harm’s way.

Yet 40% of parents in the U.S. declined or delayed vaccines for their children in 2008. 66% of children remain unvaccinated against influenza annually, despite the fact that influenza causes more than 8% of the fatalities during the flu season.  Children 5 years and under are especially susceptible to serious infections and hospitalizations when left unvaccinated.

There are far more benefits than risks when it comes to vaccinating children. Children who get vaccinated not only prevent serious illness in themselves, but also help prevent the spread of disease to the elderly and other high risk groups.  The average cost of Influenza management and treatment in the U.S. per year is $126.8 BILLION!  The average cost to achieve herd immunity in the U.S.  (getting the majority of patients immunized and protected against serious disease) per year is estimated to be $21 BILLION.  You chose.

Don’t be like Benjamin Franklin who regretted the loss of his 4 year old son to Small Pox because he neglected to vaccinate him.

Dr. Rutherford is a retired orthopedic doctor. But upon observation, it seemed as though I have a different perspective of what it means to be retired. As he walked in and out of patient rooms with a medical student, he appeared to be as active as any medical staff member. And it was apparent – he truly loves what he does.

Dr. Rutherford has been volunteering at CHAS for the last ten plus years. He can be found one day a month at the Denny Murphy Clinic, in Downtown Spokane. He sees between 8-12 patients each day, depending on the presence of a student. “I love CHAS patients; they might not receive care otherwise, so I am happy to help.” Rutherford said.

In addition to volunteering at CHAS, Dr. Rutherford also volunteers at Dirne Community Health Center, Spokane Guilds’ School, and Project Access (a network of providers who perform services to patients who could not otherwise afford them). Once a year, he travels to New York for six weeks to volunteer his services. Additionally, he spends time training interns, as well as offering continuing education classes for current providers.

When asked why he volunteers, he simply states because it provides something for him that cannot be explained, and that someone needs to help people who otherwise would not be able to get the services they need.

From the time spent with Dr. Rutherford, it is clear that he truly loves what he does, and loves that he can do it around a schedule that is now working for him and his family.

We’d like to take a moment to thank you Dr. Rutherford for all you provide to CHAS and the community at large. Your contributions have benefited so many and your commitment to helping others in need is truly admirable!

Ponstel

By Katie Kolbet, Communications Specialist

If you haven’t met the CHAS Homeless Outreach team consisting of Lee Nelson and Ilze Zarins-Ilgen, you should. They are both amazing people who work extremely hard in the local homeless community. Fortunately for me, in early December, I had the pleasure of spending a day out in the community with this phenomenal duo.

CHAS serves a huge population in Spokane and some of our regular patients are part of the homeless community. CHAS often holds employee sock, blanket and clothing drives. Lee collects these items and hits the streets in search of those in need. On the day I accompanied the team, we visited Shalom Ministries, City Gate, Transitions Women’s Center and House of Charity. We also made stops under bridges, next to railroad tracks and even into urban forests.

While in the forest we met a man who showed me how much of an impact the CHAS outreach team really makes. The man was new to the encampment and his only source of income was food stamps. In his words, he is just “trying to survive”. As with everyone else we met that day, we were welcomed with hugs and stories. “Three adults and a dog in a tent, keeps us warm, but we don’t get a lot of sleep,” he said with a smile.
As we were getting ready to leave, Lee handed out hygiene packs with basic necessities like razors, soap, deodorant, a washcloth, a granola bar, and a pair of warm wool socks. Upon receiving this gift from CHAS, tears welled up in the man’s eyes. . .I don’t know that I have ever seen someone so happy to get a pair of socks. But I know it wasn’t just the socks, it was the kindness and time given to understand an undoubtedly unique situation.

Remember, it’s the small things in life that can make a big difference.

Hello! It´s Dr. Moorman, Pediatrician at the North County Clinic. Welcome to the holiday edition of your children and their health. Please remember that this is a great time of year to get in quickly for a nurse visit for a flu vaccine and maybe even a new toothbrush for their stocking or for travel. Please remember that during travel we encounter all kinds of new wonderful experiences but that also means we contact new germs as well. Please remember to use good hand washing to stay healthy. When soap and warm water are not available, use a hand sanitizing product to help clean your hands. This is especially important when holiday shopping or playing with sample toys at stores that hundreds of children have already handled. Lastly, when sick, remember to cough into your elbow, not your hands, and make sure your children know how to do this so they don’t pass along germs to others.

The holidays are for family and friends and the memories we create. Please help keep those memories healthy and germ free.

Hello!

It’s Dr. Moorman, Pediatrician at the North County Clinic. Summer flew by and it’s already time for back to school! Does your child have everything he or she needs to remain healthy this year?

I put together a few questions to help you figure out if your child is back to school ready. If you answer NO to any of the following questions, give us a call at 509-444-8200 to schedule an appointment.

• Has your child had a Sports Physical completed for athletics?
• Is your child up to date on all of his/her Immunizations? Have your teens and pre-teens received immunizations too?
• Does your child have a new Epi pen or Inhaler for his/her Asthma? The cold and flu season is just around the corner.
• Does your child have fluoride supplements?
• Has your child gotten a Dental check up?

Get this school year started off right. If your child struggled last year with behavior or school work and you need a Pediatric evaluation to help get them the help and services they need this year to thrive, please make an appointment today!

Dr. Dan Moorman

General Health