Member Spotlights
Women’s Care Center, Drexel University
By Illysa Schrager
The Women’s Care Center (WCC) of Drexel University College of Medicine (DUCOM) has been providing health care services to women and men across Philadelphia for more than 16 years. The WCC provides comprehensive reproductive health care, including gynecology, obstetrics, family planning services, and cancer screenings to a culturally diverse, minority, urban and underserved population. WCC is mission driven and focuses on ‘best practice’ based clinical services for underserved women and men, as well as education and research. WCC’s primary health center site is located in Philadelphia’s Center City, at the crossroads of three neighborhoods – Chinatown, North Philadelphia, and the downtown business district that is largely made up of a growing population of young adults – which means this site serves a wide variety of clients. Their second service site is located in the Student Health system at Drexel University, and focuses on family planning services and the needs of the young, collegiate population, many of whom are making their first independent health care decisions when visiting WCC.
Drexel’s Department of Obstetrics and Gynecology is built on a foundation of collaborative practice. WCC providers include physicians and advanced practice nurses; they all hold faculty appointments within the department. No matter the “level” of the provider, the faculty appointment ensures that all providers are involved in faculty meetings and have dedicated education time, which is very unusual in an academic setting. In this model, all WCC patients see the same providers and specialists during their visits, no matter if they have commercial or public insurance or are undocumented or uninsured. WCC is the clinical site for Drexel’s residents in Obstetrics and Gynecology. In addition to seeing their assigned medical providers, WCC patients also meet with medical students, counselors, and researchers. During a patient’s first visit at one of the WCC health centers, she/he is given a letter outlining WCC’s areas of practice, the services offered, as well as their research and education mission. Staff receives regular feedback that patients appreciate learning and understanding what the WCC health centers have to offer them from the very beginning.
At WCC’s primary site, there are approximately 20,000 patient visits annually, representing about 12,000 unique clients, a third of whom are seeking family planning care specifically. The vast majority of patients in the WCC are women; however, as WCC has increased family planning services over the years, they have begun to serve more men through programs such as Title X. WCC is a Title X sub-recipient agency of the Family Planning Council of Southeastern Pennsylvania.
Administrators at WCC actively seek various funding streams to provide their patients with the most robust coverage possible. WCC is a Healthy Woman provider site; they provide breast and cervical cancer screenings through the program. WCC also receives generous, ongoing support from local businesses in Philadelphia such as TD Charitable. WCC is also a grantee of NFPRHA’s ParaGard as emergency contraception pilot project. WCC now has ParaGard available during all clinical hours as an emergency contraceptive method. The project has allowed the health center to develop a “campaign” for provider education and patient-specific information, something they had aspired to do but had not had the support to initiate in the past. Like so many family planning providers across the country, WCC is challenged by having to administer a multitude of programs and funding sources/grants, both small and large, all of which are needed to provide care, but are quite an administrative burden. WCC staff says that their most significant challenge, however, is maintaining fiscal responsibility, particularly balancing their costs and revenue. As costs of tests, supplies, and services continue to rise, they continue to seek funding to support the critical, and growing, need for services and activities.
WCC is known for developing and implementing unique models of care and clinical services; they were one of the first ambulatory care sites to implement on-site Rapid HIV testing (in 2003). In 2006, WCC changed their Rapid HIV testing model from a counselor-centered model to a fully integrated service. All staff was trained to offer testing at any point in the flow of the patient’s care; this not only increased WCC’s testing, but also improved the generalized acceptance of testing significantly. Today, they continue this practice with expanded related services and with robust linkage to care for those who test positive.
In the Greater Philadelphia region, demographics have changed significantly over the last two decades spurring WCC to assess and change services available to specific populations. Most notably, their refugee and immigrant populations have expanded rapidly. The most recent national census confirmed that Philadelphia has the largest and fastest-growing immigrant population among peer regions; this population now comprises about 11.5% of the city’s total population. Nearly 75% of Greater Philadelphia’s labor force growth since 2000 is attributable to immigrants. However, for this population, the barriers to accessing quality reproductive health care are significant; such barriers can prevent successful acculturation and integration into the community. In 2008, WCC developed their Immigrant and Refugee Women’s Health Services (IRWHS) program, and it has continued to expand significantly since. The primary ethnic group served in the program is Asians (who make up almost 40% of Philadelphia’s immigrants); staff has found that the women coming from Asia have very low medical screening rates. This is also true for recent refugee arrivals from Iraq, Nepal, Bhuton, and Eritrea.
From their refugee and immigrant populations, WCC has learned more about global health and how to better prepare for unexpected medical and cultural complexities. More than 80% of women seen in the IRWHS program have never had a Pap test and have very limited knowledge regarding contraception. Services provided to these diverse populations must include intense sensitivity to culture and have culturally appropriate methods for discussing information about sexuality and reproduction. Clients may have never provided a medical and/or social history before, so reassurance around the sensitive information that they are provided is vital to form trust. WCC staff has developed tools for the medical students to use such as “Pearls for Taking a Medical and Social History,” and have developed many culturally specific patient education documents for use in both of their health centers. WCC is currently in the process of expanding services in the IRWHS program to screen and treat victims of torture. As staff continue to face challenges when serving patients with limited English proficiency (LEP), WCC is developing more education materials to support the efforts. The costs of LEP interpretation services are significant and growing as the community in need continues to evolve. In addition to the direct costs of phone interpretation and the development of translation services, WCC has absorbed costs due to the extended counselor and provider time needed to provide culturally and language-specific services and resources.
Over the years, WCC has actively sought to develop strong community partnerships; they have found that these collaborations have enhanced care for their clients and have become invaluable to the staff. They have worked closely with the South East Asian Mutual Assistance Associations Coalition (SEAMAAC) for many years, and have dedicated clinical “sessions” for clients referred from the organization. SEAMAAC identifies women in the community who need care, performs health education, and escorts clients for family planning and gynecological care. The clinical “sessions” allow SEAMAAC to bring groups together to the health center rather than plan for individual appointments for each person. The partnership with SEAMAAC continues to be successful; clients that begin in the clinical “sessions” return for their individual annual exams at a high rate and also regularly utilize other Title X family planning services. WCC and SEAMAAC staffs are in constant communication to coordinate care, which is integral to the success of the partnership.
WCC providers pride themselves on their mission-focused operation and established relationships in the community; they support research that stimulates learning and welcome testing new models of care as their community and the health care economy continues to evolve. They follow the charge from the medical school and the university, while championing Title X family planning services. WCC staff says, “We try to change the old perception of ‘clinic’ to one where we are known as the most interesting place to work and the most dedicated of care givers.”