Getting the Perfect Fit

The Department of Family Practice and Community Medicine works with rural healthcare services to provide important research assistance.

by Cindy Foster

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Before Hildago Medical Services opened in Lordsburg, New Mexico, in 1995, area residents knew that if they wanted a dentist, a cardiologist, or a surgeon, they were looking at a drive that might range from 60 to 150 miles before finding one. Hildago Medical Center began as a community effort to pool much-needed resources in a health commons model where it’s possible to get coordinated care. That concept of providing comprehensive healthcare—“one-stop shopping”—for medical, mental, and dental healthcare needs, has garnered national attention. Locally, it has grown to a 150 person enterprise in ten locations in the southwestern corner of the state.

For years Charlie Alfero, Hidalgo Medical Services CEO, traveled to UNM on a monthly basis, with a “grocery list” in hand, looking for healthcare professionals. However, as the clinic grew, the need to conduct research that could help the clinic’s patients became clear. Diabetes and its complications, for instance, “is always in the top five reasons people visit us,” he says. Rural patients can find it hard to get pertinent information on managing their disease, obtain the foods they need, or even sign up for a convenient exercise class. His staff wondered if complication rates would fall if those barriers were addressed. He added “research assistance” to the list.

UNM’s Department of Family Practice and Community Medicine had the expertise to design and complete the evaluation of that kind of research. LA VIDA, a community-based diabetes intervention program, was the result.

The program targets the Hispanic population in Grant and Hidalgo counties, aiming to remove barriers patients encounter when trying to control their diabetes. It also aims to reduce the side-effects that long-term diabetics face. At its core are Hidalgo Medical Services promotoras—local community health workers fluent in Spanish. They began working with their clients to solve a wide range of problems—from lack of transportation, to inability to pay for food, medication, and healthcare, to lack of knowledge about diabetes risk factors. The promotoras also began creating an array of culturally appropriate community services focused on improving diabetes-related health behaviors.

A recent analysis of LA VIDA data shows these efforts are paying off for some fourteen hundred participants. “It has been awesome,” says Alfero. “We are finding that research project participants’ blood sugar levels have gone down, and stayed down.” Which led his people to wonder, could the same model help reduce teen pregnancies?

“The promotoras actually had the idea for the study,” says Kristine Tollestrup, associate professor in UNM’s Department of Family and Community Medicine. She provided the academic expertise to coordinate a new program entitled GUTS (Growing Up Together Strong).

Funded by the U.S. Department of Health and Human Services, the program is designed to decrease repeat pregnancies in teen mothers, while increasing their high school graduation rates, and the immunization rates of their infants. Each teen mother and her family members receive a network of assistance services tailored to individual needs from the promotoras. They’ve done everything including creating parenting and grand parenting classes, locating safe and supportive homes for the girls and their babies, arranging daycare so moms stay in school, and finding transportation for pediatrician visits. A preliminary analysis of data from the first two years has found no repeat pregnancies among participating teen mothers.

“Invariably, when working with communities, the first request is to find healthcare providers. Later, there’s an interest in educational links. Finally, after trust is built and basic healthcare needs have been tended to, communities request partnership in evaluating their programs or measuring outcomes,” says HSC Vice President for Community Health Arthur Kaufman.
“No one knows better than community members what their health problems are,” he continues. “When we go into that community and actively listen to their concerns, it is possible to design research programs that expand our knowledge while making a difference in the health of communities throughout the state.”