Inside Duke Medicine

Celebrating Lincoln Community Health Center

An in-depth look at the Lincoln Community Health Center.

By Carol Clayton

More than 34,000 Durham County residents utilize Lincoln Community Health Center (LCHC) and its satellite clinics for their primary source of medical care.

Inside the center is a team of people with a common bond that is evident to all who meet them. In one word, this team is a community. And this community is about people caring for people.

As part of our commitment to the community, Durham Regional Hospital (DRH) staffs, funds and operates several departments of LCHC-including Pharmacy, Radiology, Laboratory, Environmental Services and Engineering.

We follow a typical day for the members of the DRH family based at Lincoln who care for so many who need help in our community.

ENGINEERING

The smooth operation of Lincoln starts with Engineering and Environmental Services who keep the center in motion. The first person anyone at LCHC calls if something needs repair is Preston Joyner. He receives every maintenance request-including maintaining the lawn, cleaning grounds, technical malfunctions for equipment, changing light fixtures and heat and air issues. Joyner says he enjoys that he is “really busy,” and has the opportunity to help a lot of people on his 7 to 11 am shift. He often works with his Engineering colleagues based at Durham Regional for issues that require more specialized skills.

ENVIRONMENTAL SERVICES

The Environmental Services team-Nancy Allen, Janet Hughes, Mary Satterwhite (housekeepers), Clarence Price (floor finisher), Valeria Ruffin (housekeeper/supervisor) and James Sessoms (manager)-are responsible for keeping the 60,835 square foot building clean. Nancy monitors the building (cleaning restrooms, emptying trash and handling requests). Janet is responsible for cleaning all offices, conference rooms, break areas and restrooms on the 1st floor. Mary cleans Pediatrics, Specialty and Adult Medicine Clinics, along with Radiology and the Lab. Clarence is responsible for all floor care including carpets and hard surface floors. Valerie, Supervisor, is responsible for cleaning the Dental, WIC, OB-GYN, Social Work/Mental Health Clinics. As supervisor at the facility, she is also responsible for ensuring the quality of cleanliness of the facility meets and/or exceeds the expectations of the patients, visitors and clients. James, evening/night manager for Environmental Services at Durham Regional, oversees the operations at Lincoln and assists the team when there is a need. This team says the patients are their favorite part of working at Lincoln. “I like meeting the patients and getting to know them,” says Nancy as she receives a page to clean a spill.

LAB

Activity never stops in the Lab, which is open Mondays, Wednesdays, Thursdays and Fridays from 9 am to 5:30 pm, Tuesdays from 8 am - 8 pm and Saturdays from 8:30 am - 12:30 pm. Part of the DUHS Clinical Labs, the team serves about 175 patients a day.

When fully staffed, there are three medical technologists and three clinical technicians. The lab serves patients of all ages. Technologists read STAT Cell Blood Counts (CBCs) and urine samples on site. The Lab can process samples to check for proper nutrition.

for expectant mothers, new mothers and infants, as well as blood glucose, pregnancy, viral and bacterial infections.

Samples for comprehensive chemistry tests must be sent to the Duke Core Lab, so the courier picks-up samples several times a day. “Many patients who visit the Lab often have a chronic illness and receive testing frequently, so we really become connected to them,” says Edwin Castro, Lab supervisor. “Ask anyone who works here and they will tell you that our patients are why they chose to work at Lincoln.”

RADIOLOGY

Radiology technologists Amina Al-Amin and Paula Nunley are the Radiology team at LCHC. Both Amina and Paula “do it all” in this fast-paced department. Radiology is open Mondays, Wednesdays, Thursdays and Fridays from 8 am - 6 pm and Tuesdays from 8 am-8 pm. The team administers approximately 25 routine diagnostic and chest x-rays a day for adults and pediatric patients. The ordering physician will receive the report within 36 hours, unless they are STAT orders, which will be sent immediately by courier to Durham Regional for reading. Once a week, the staff performs upper GI series, barium swallows and barium enema procedures when a radiologist is onsite. In addition to administering x-rays, Paula answers phones, schedules appointments and handles all clerical issues while Amina, supervisor, handles administrative duties, including preparing data for grants as well as training students preparing to be radiology technologists.

“We find life-threatening issues daily,” says Amina Al-Amin. “If Lincoln were not here, a lot of people couldn’t have access to medical care. We are often the difference between life and death.”

PHARMACY

With a staff of 19, including PRN and part time employees, the Pharmacy is the largest DRH department at LCHC. Pharmacy fills nearly 700 prescriptions a day and manages the strict drug formulary.

Lincoln Pharmacy controls costs by handling reimbursement programs including Medicaid, Medicare (43 different prescription drug plans) and special grants. Other cost controlling activities include accessing free drugs for patients through drug manufacturers’ indigent care programs and optimizing the use of discounted 340B pricing for medications.

The total market value of free drugs accessed by Lincoln Pharmacy for patients in 2007 was $5.39 million. “We do what we can to get as much of a reduction in price as possible for our patients and organization,” says Lynn Robbins, PharmD, Pharmacy director.

Cross training and position rotation is key to the Pharmacy. To increase focus, and reduce stress and the opportunity for errors, the pharmacists and technicians change their station every two hours. For the pharmacist, this means rotating between filling prescriptions, counseling patients about all new prescriptions, “floating” to handle questions as they arise, and working on projects such as quality control or medication literacy. This week, pharmacist Hazel Richardson was working with Durham Medicare Rx Network partners to coordinate a Medicare Part D Enrollment Fair at the center to help patients select or change to appropriate prescription drug plans.

The Pharmacy is also a leader in the national trend to increase the scope of responsibilities for pharmacy technicians. Each technician is cross-trained and rotates through five positions a day, including obtaining patient information, entering prescription orders into the computer, preparing new medications, refilling medications for the pharmacists to check and distributing refilled prescriptions to patients with offers for counseling by the pharmacists. Hortense Jones, technician supervisor, presented this model at the American Association Pharmacy Technicians this year.

Pharmacy is a leader in safety, and implemented the first statewide program for benchmarking of medication errors and near-miss data for community health centers in North Carolina. There is no mandatory reporting of data or centralized database for community health centers, so Lincoln Pharmacy structured the first data collection and collaborative initiative as a model for other states.

In April 2008 the U.S. Health Resources and Services Administration (HRSA) identified Lincoln Pharmacy as one of 34 leading pharmacies in the nation for Patient Safety and Clinical Pharmacy Services. Lincoln Pharmacy was the only community health center in the Southeast recognized as a model practice.

Through a HRSA collaboration, Lincoln Pharmacy staff are helping teams of healthcare providers across the nation replicate their specific safety practices to improve health outcomes and reduce adverse drug events.

LCHC Fast Facts

-LCHC is the community’s main provider of primary care for low-income and uninsured patients. More than 75 percent of LCHC patients are uninsured and more than 80 percent are at or below the national poverty level.

-LCHC is one of the first community health centers in the nation to achieve accreditation by the Joint Commission on Accreditation of Healthcare Organization (JCAHO), and a leader in ensuring adherence to national patient safety goals and medication management standards.

-The center offers a wide range of services including adult medicine, pediatrics, adolescent, dental, behavioral health and prenatal care, a service of the Durham County Health Department.

-LCHC supports five satellite clinics that make up the Lincoln Network: Health Care for the Homeless Program at the shelter; Wellness Center at Hillside High School; HIV Early Intervention Program at the health department; and two neighborhood clinics in collaboration with the Duke Department of Community and Family Medicine - Lyon Park and Walltown.

-Radiology, Laboratory and Pharmacy departments have partnerships with University of North Carolina-Chapel Hill, Campbell University, Vance Granville Community College, Wake Technical Community College and Durham Community College. Students from these programs come to Lincoln to gain training and learn from some of the best.

Photos by Tom Wooters