n 1977, the College of Physicians and Surgeons and Presbyterian Hospital formed a clinic to serve the healthcare needs of the Washington Heights community. Twenty-five years later, the success of the effort is seen in the 66,000 patient visits the clinic handles every year. Doctors see some 15,000 to 17,000 patients annually at the Associates in Internal Medicine, or the AIM clinic.
Besides treating such a large patient population, the clinic has taken the approach of combining a faculty clinic with a training opportunity for medical residents. In this way, AIM provides the latest advances in medicine and clinical research to the inhabitants of the neighborhood, the majority of which are minorities. AIM gives the community residents more healthcare options than they had before and access to the best doctors.
We are closing the gap for minority healthcare, says Dr. Rafael Lantigua, P&S professor of clinical medicine and AIM medical director. Eighty-five percent of AIMs patients are minorities. Of them, 70 percent are Latino, 20 percent are African-American, and 10 percent non-Latino white.
Besides giving the community access to physicians in the division of general medicine in what is now New York-Presbyterian Hospital, AIM serves as a training ground to educate residents and interns. What we have here is total integration between our faculty practice and the clinic, says Dr. Walter Palmas, assistant professor of clinical medicine and an attending physician at AIM.
AIM has around 25 full-time faculty members, approximately 125 residents, two nurse practitioners, and four social workers, most of whom speak both Spanish and English to make communicating with the patients easier. Many of the staff are native Spanish speakers and others have learned Spanish, an effort that is greatly appreciated by patients, Dr. Palmas says.
The clinic offers outpatient and inpatient care as well as subspecialty referrals to help the continuity of care. AIM has two primary locations, one on the second floor of the Vanderbilt building and the other in the Russ Berrie Medical Science Pavilion.
Approaching mental illness in a primary care setting has become a new focus for AIM. Approximately 12 percent to 15 percent of the patients seen at AIM have mental health problems, a number that is twice the rate of more affluent clinics in the United States. To reach a larger number of patients, AIM is making an effort to put mental health care into the hands of the primary care physician. The clinic has a psychiatrist on staff, Dr. Adriana Feder, assistant clinical professor of psychiatry (in medicine), who besides seeing patients teaches residents in the clinic how to recognize mental health problems and how to treat or refer them. Doctors at AIM are now asking each patient, Are you feeling sad or depressed? and Do you have decreased interest in your activities?
In its endeavor to meet the healthcare needs of the community, AIM also includes clinical research as part of its mission. Research done within the minority community usually leads to an understanding of the unique needs of that population. The clinic is particularly suited to let patients know about clinical studies to see if they are interested in participating, Dr. Lantigua says. Doctors inform patients of the variety of clinical research opportunities available at Columbia-Presbyterian Medical Center.
Community residents already are participating in the home glucose-monitoring program, called Ideatel, or the Informatics for Diabetes Education and Telemedicine clinical trial. Led by Dr. Steven Shea, Hamilton Southworth Professor of Medicine and Epidemiology and director of the division of general medicine in P&S, Ideatel is an electronic house call home glucose-monitoring system being tested to see if telemedicine will improve care for elderly diabetics. Data are collected through computers installed in study participants homes and sent over the Internet to AIMs computer system where doctors can examine the information.
In a study like this one, AIMs history and its ties to the community have been very helpful. We are able to overcome the usual obstacles to recruitment because we are a trusted source, says Ideatel co-investigator Dr. Palmas. Ideatel has recruited 1,400 patients, 720 of whom are from New York City, in the two years since the project was announced. At AIM, we can do high-quality research and at the same time provide the best care for an underserved population, Dr. Palmas says.
AIM provides medical care that approximates as much as possible a private practice, yet also provides the latest advances in medicine through its affiliation with a teaching hospital, says Dr. Carmen Ortiz-Neu, P&S clinical professor of medicine, one of AIMs 25 staff physicians. AIM is an exciting and unique place because we emphasize total care of the patient, which is clearly important for the patient and also very rewarding for the physician.