Volume 56, Number 1 - Winter 2010

 

By Georgianna Farren, MD

Note: Each issue of Marin Medicine includes a self-reported update from one local hospital or clinic, on a rotating basis.

Marin Community Clinics (MCC) is a nonprofit community health center with clinics in Greenbrae, San Rafael and Novato. The Novato and San Rafael clinics are new facilities. An application is pending for federal stimulus funding to relocate the Greenbrae clinic, currently housed in an aging double-wide trailer on the grounds of Marin General Hospital. 

The three clinics combined serve approximately 18,000 uninsured and publicly insured children and adults living in Marin along the Highway 101 corridor. Rising unemployment has led to increasing numbers of uninsured residents, and MCC is adjusting to this influx of new patients with some trepidation. Serving a greater proportion of sliding-scale patients could impact our budget adversely, and a shortage of adult primary care physicians limits our capacity to meet the growing need. Nonetheless, building on a foundation of planned, sustainable growth, MCC is working diligently to increase its services. 

In recent years, our offerings have expanded in several ways. New clinical services, such as dentistry and psychiatry, allow our patients to meet their medical needs in an integrated and comprehensive setting. We have also expanded our reproductive health services and our community education programs.

We began providing dental services in 2008 at our San Rafael clinic. Open Monday through Saturday with six operatory chairs, the clinic focuses on pediatric dentistry and employs two full-time dentists. The pediatric focus allows for effective implementation of prevention and early intervention strategies. Our pediatricians refer infants to enhance parental education about brushing and food-and-beverage choices. Dental care is also provided to pregnant women so they can begin healthy practices even before delivery. The dental program will soon be expanding to include another site.

Two years ago, MCC added reproductive health services, including routine Pap tests and mammograms, as well as contraceptive and reproductive counseling and treatment. We participate in FamilyPACT, a state program that provides payment for reproductive medical care for the uninsured, allowing visits at no cost to eligible patients. 

In addition to providing these services at our three clinics, MCC nurse practitioners staff two other reproductive health clinics for teenagers. The Teen Tuesday clinic in San Rafael offers confidential drop-in services with counseling provided by Huckleberry Youth Program. The Novato Youth Center has a similar Teen Monday clinic, as well as additional hours for reproductive health care for all age groups. These two locations allow teens to receive education, counseling and health care without the discomfort of sitting in a waiting room with babies, children, and potentially their neighbors.

MCC is also engaging in an exciting new community education program. The San Francisco Bay Area Affiliate of Susan G. Komen for the Cure has funded two promotora positions for Spanish-speaking women to help increase awareness of breast health issues and refer for breast exams as appropriate. These promotores circulate at fairs, community meetings, and local gathering places to promote breast health and services. Such outreach activities expand care outside the “four walls” of the clinic into homes, neighborhoods and local gathering places.

A few months ago, we launched a behavioral health program with part-time adult and child psychiatrists, as well as licensed clinical social workers and a program coordinator. One emphasis of this program is to screen for early depression and offer patients an evidence-based approach to depression treatment. Our psychiatrists and social workers communicate closely with our primary care clinicians to coordinate patient care. The program is partially funded by a Prevention and Early Intervention Mental Health grant administered by the County of Marin. For more severely mentally ill clients, Marin County Community Mental Health and MCC are collaborating to expand a longstanding partnership that jointly provides for the medical and psychiatric care of clients served by both agencies. 

Access to specialty care is extremely challenging at most community health centers, and MCC is no exception. With a grant from Kaiser Permanente and generous donations of time from numerous local physicians, chiropractors, podiatrists, acupuncturists, and physical therapists, we are gradually increasing our ability to meet our patients’ specialty needs. We are currently completing agreements with local hospitals and other organizations to provide additional access for specialty services. Many local physicians volunteer time at MCC or through Operation Access for same-day surgery for the uninsured. Others agree to see referrals in their office.

In a changing landscape of health care, it is hard to predict whether reform at the national level will improve the coverage of uninsured or inadequately insured Americans. The national discussion stands in stark contrast to the recent cutbacks in Medi-Cal coverage. In July, Medi-Cal discontinued coverage for a number of “optional” services for adult patients, including dentistry, chiropractic and podiatry. These are essential services for health maintenance and prevention, and they are not affordable to most of our patients. If not provided, there will be an adverse health impact on individual patients, on health care costs in the community, and most importantly, on the health of our population. 

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Dr. Farren, an internist, is chief medical officer for Marin Community Clinics.