Two Partners HealthCare professionals, one passion: Connecting patients to community–based primary care
Author: Partners HealthCareBernice McField-Avila is a Partners HealthCare primary care access project coordinator at Mass General Hospital.
Author: Partners HealthCareBernice McField-Avila is a Partners HealthCare primary care access project coordinator at Mass General Hospital.
“When I can place a patient in a primary care setting when they need it, at the time they need it and in a language that they can understand — that’s my best day,” said Josefina Roques, a primary care access coordinator at Brigham and Women’s Hospital (BWH). Those sentiments were echoed by her peer Bernice McField-Avila, a primary care access coordinator at Mass General Hospital (MGH), when she said, “Being able to assist patients from every ethnicity, socioeconomic status and cultural background, to find a primary care physician they are comfortable with, makes doing this work a pleasure more than a task.”
McField-Avila and Roques moved to the United States 12 and 19 years ago, respectively. They were both trained as doctors in their countries of origin — McField-Avila in Honduras, Roques in the Dominican Republic. They speak English and Spanish, and they share a passion for health care and helping patients get access to primary care.
In fact, between the two women, they have connected nearly 3,800 people to community-based primary care through Partners HealthCare’s Primary Care Access Project (PCAP). PCAP began five years ago as Massachusetts moved toward coverage reform, and the need to connect patients to primary care in their communities, to engage people in their health care and to reduce emergency room visits.
Connecting patients to primary care is not an easy task. McField-Avila and Roques consult with patients who struggle with multiple, complex illnesses, as well as language and cultural barriers. Many patients have lacked a primary care provider for many years — or never had one. McField-Avila helped a 70-year-old man get a primary care doctor after he had a fall. The man never had a primary care provider in his life. He had a difficult time understanding why he needed one now, especially at his age, but in time he was convinced by Mcfield-Avila that he did.
Educating patients about the importance of primary and preventive care can be challenging. People may not understand why having a doctor — when you feel fine — is important. McField-Avila and Roques prevail by providing informed and culturally competent guidance to both English and non-English speakers. They relate to the patients from unique and empathetic perspectives, as they are both minorities and immigrants who once had to navigate a new country and culture. Because of their personal experiences and their education, medical and linguistic expertise, they feel comfortable crossing from one culture to another, talking with both patients and providers. They bring the total enrichment of their lives to their work. They are the connection between patients and primary care.
No matter the challenges, making the patient and community-based primary care connection is what drives McField-Avila and Roques. “Every time you serve a patient, it can bring you happiness or sadness,” Roques said. Happiness, for example, is the patient who was transferred to the United States from the Dominican Republic by her employer, and came into the Emergency Department for high blood pressure. Roques connected her with community-based primary care three years ago. Since then, she has had many interactions with her doctor, has kept her illnesses under control and has remained out of the Emergency Department.
Then there are the cases that get away, explained Roques. “Sometimes we try to approach the patient, and because they have other problems that are so daunting like being homeless, they are not ready to address their health care needs.” And sometimes the window of opportunity is so small, critical connections can be missed. McField-Avila explained, “When I work with someone with substance abuse, and they have a clear moment — when they are absolutely ready for care and I struggle to find the right place for them and press for an immediate appointment only to have the person slip back into the addiction and disappear, not return my calls — that’s hard.”
McField-Avila and Roques know that the patients have to be ready for care. They have to be able to read the patients and know when to go forward and connect them to care, and when to back up and wait. For those who are not ready, they wait. Roques said that sometimes people who she tried to help, but weren’t ready, will call her back a year later and say, “I’m ready now.”
A similar project has also been in effect at the North Shore Medical Center (NSMC) the past five years. Among NSMC, BWH and MGH, more than 8,200 patients have been connected to community-based primary care.
