Posted in the Gettysburg Times • February 23, 2018
BY MARY GRACE KELLER Times Staff Writer
Mobile health service may be the future of patient care in Adams County.
Douglas Brown, a prehospital physician extender, has seen a lot in his first year with Adams Regional Emergency Medical Services (AREMS). A prehospital physician extender is basically a physician assistant who works with emergency medical services (EMS), or a "paramedic-plus."
Brown presented his ideas on how to expand the agency's services during a meeting with community leaders Thursday.
A few months ago, Brown assisted a family who recently moved from another country and did not have access to a primary care provider, so they called 9-1-1 when their child was sick with a runny nose and cough.
On another call, a diabetic emergency was quickly remedied by a dose of glucose, Brown said. The patient recovered and told paramedics a ride to the hospital was unnecessary. Brown said when no hospital transportation is provided, AREMS does not make money and has to absorb the cost of treatment.
Brown has noticed some patients call an ambulance just to get a ride to the hospital for a routine blood check because they have no other means of transportation. He said AREMS has several of these "frequent fliers."
After experiencing these calls and others, Brown thought there had to be a better way to serve the community. His research led him to mobile integrated health care. In cities across the U.S., paramedics and emergency medical technicians (EMT) are making "house calls" to people who require medical attention, can't get to the doctor, but don't need to visit the emergency room.
Brown and other members of AREMS believe this could be a way to use the resources AREMS already has to provide better care that is cost effective for patients and first-responders alike.
"We're interested in helping the community stay healthier," Brown said.
One way some agencies provide mobile health services is through community paramedicine.
Brown defines community paramedicine as an organized system of services provided by licensed EMS professionals that is integrated into local healthcare. Community paramedic is an official title that requires the completion of a formal education program with an internationally-standardized curriculum.
Wanting to utilize the paramedics and EMTs already within AREMS, Brown is leaning toward the mobile integrated health model, which is similar but does not require community paramedic status specifically. This model brings together multiple care providers and is dependent on community needs, according to Brown.
Brown said any AREMS staff who gets involved with the program would receive some type of additional training.
With mobile integrated health care, AREMS could help keep the elderly, under-served, and chronically ill patients out of the emergency room, Brown said.
Brown said the service is just in the idea stages currently and he is seeking input from potential stakeholders. People came to the meeting from WellSpan, Healthy Adams County, Keystone Health, Pennsylvania Interfaith Community Programs Inc., Transitions Healthcare, Gettysburg C.A.R.E.S., and more. The group generally agreed the service would be beneficial to Adams County.
"There's a lot of transportation issues that could be solved with this kind of model," said Vickie Corbett of United Way of Adams County.
When it comes to funding, Brown said the program would probably need grant assistance to lift off. He hopes they would eventually be self-sustaining by billing insurance.
AREMS expects to receive a donated ambulance from a former EMS agency near York that could be used for mobile integrated health services, according to Brown.
Brown cited success stories of similar programs: In Colorado, Eagle County Paramedics reduced health care expenditures $1,279 per patient visit through its service; in St. Louis, Mo., emergency room and EMS volume decreased 11 percent. There are also these types of services available in Pittsburgh, Harrisburg, Lancaster, York, and Hanover, Brown said, so AREMS would focus on Adams County initially.
"It's very much, what do we need in this community?" Brown said.
He invites those potentially interested to contact him as he tries to answer this question. Brown can be reached at email@example.com.
Posted in The Frederick News-Post • May 8, 2013
By Brian Englar News-Post Staff
After putting off the pursuit of his dream job for years, physician assistant Doug Brown has now been sidelined by a lack of funding.
The Mount Airy resident gained little personal fulfillment from his first career in the computer software industry. He had some medical background from volunteering with fire departments and had tossed around the idea of becoming a physician assistant — he even looked into some programs.
"I worked with some of those guys in the service, and they're sharp guys, and practical and easy to get along with," Brown said. "I thought I'd want to be one of those guys."
The challenges associated with going back to school and changing careers in midstream kept the idea on hold for six years. But after the 9/11 terrorist attacks, Brown said he was moved by the heroism and selflessness he saw and was ready to make the leap.
"I felt to myself 'I'm wasting my life,'" he said. "I thought I had to make a positive difference in people's lives on a daily basis. That was my purpose."
He earned his undergraduate degree at Hood College and completed the physician assistant program at Shenandoah University in Winchester, Va., where he lived away from his wife while working as a paramedic and taking classes.
Brown has been fulfilling his purpose and living his dream as a physician assistant at the Loudoun Free Clinic in Leesburg, Va., providing medical care to the uninsured.
"If we were not able to get care for them, they would not get any care at all," he said.
Brown said he enjoys building relationships with his patients, offering them something more than the assembly-line approach he believes is common in the medical field.
"That is not what I like to do with medicine at all," he said. "You learn about your patients and take the time to sit down and talk with them, because a lot of times you'll find out things that you never would have found out that are really affecting their health."
Building those relationships can be especially challenging when a language barrier is involved. About 70 percent of his patients are Hispanic, Brown said, so he has to lean heavily on Spanish-speaking staff members and volunteer interpreters. But it is worth the extra effort, he says — he really gets to know the people he's caring for.
"Once you do that, the patients love you, and I love them," he said.
Some of his most memorable patients have been those with terminal illnesses, Brown said. After working with them and taking thanatology courses at Hood, he has discovered a passion for helping people living out their last days and has volunteered at several hospices.
"I will do anything to see that a dying patient's wishes are fulfilled," he said. "I would work in a hospice in two seconds, but Medicare does not pay P.A.s to work in hospices."
Issues at the clinic have forced Brown to take a leave of absence until September, when he expects his position to be funded again. He says it is not easy to be away from his patients.
"I'm really disappointed about this," he said. "I feel like I am blessed to be able to give those patients, or anybody, the basic level of health care I think every person deserves."