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What do I do when I get home?

A Friday Story

Dear Friends,

Every year more than a million people come to our Medical Center with a variety of illnesses, diseases and medical problems ranging from simple situations to complex conditions. Many of them are hospitalized, treated and discharged. They leave with a list of instructions, a handful of prescriptions, frequently a need for supportive services – and more often than not – dilemmas they will only realize when they get home.

Hospital stays and medical treatments are disorienting – returning home can turn out to be just as disconcerting. Many patients can't remember exactly what the doctor told them about their medications and don't understand how and when to take them. Many patients – and their families – are not aware of the rights and assistance they can receive from the health care system.

One elderly woman wouldn't leave her house because she was afraid she would miss taking one of her 15 different medications.

A 35 year-old-man with emotional problems was being denied services by Bituach Leumi, Israel's social security administration – and they imposed a large fine on him for not keeping an appointment.

Both turned to Hadassah for help – as have thousands of others in the three years since we created two unique community outreach programs – The Drug Information Center and Kivunim, The Patient Information Center, known in English as "Directions." Each center has assisted nearly 4,000 people from throughout Israel. Not all of them had been treated at Hadassah, but all of them knew we have the only centers of this kind in Israel. Incidentally, both services are free.

We all learn by experience – both individual and institutional. Watching his elderly parents try to deal with their multitude of medications, Prof. Yosef Caraco, Head of Hadassah's Clinical Pharmacology Unit in the Department of Internal Medicine, thought about how to help the countless other older people whose children were not physicians. And so the Drug Information Center was born. Eshel, the Joint Distribution Committee's Association for the Planning and Development of Services for the Aged in Israel, provides the financial support; Hadassah the professional staff and the office at the Medical Center.

Remember the woman who was afraid to leave her house? She contacted the Drug Information Center. As with every person who calls or writes, the clinical pharmacist asked detailed questions about her condition and about her life and created a chart itemizing all the information. "Sometimes just looking at the chart tells you where the problem is," says Dr. Bruria Raccah, Pharm.D, the clinical pharmacist who manages the Center.

In this case, the chart revealed the woman was taking medications every 15 minutes. It's no wonder she didn't want to go out – how could she? The pharmacist told her how to organize her pills – and her life. Now she only takes her pills twice a day and enjoys her renewed mobility.

And as with all patients, the advice was followed by a letter with the same information to her and her family doctor. "We want to strengthen the patient's relationship with their family doctor," Ms. Raccah says. "We want to help them improve their lives."

The most common questions are "How often should I take my medications and is it safe to take this combination of pills?" The Center's staff looks at the assembled data and answers the callers – but they don't stop there. If there is negative interaction, they recommend alternatives; sometimes they suggest a newer medication or a more specific one – cautioning the patient not to make any changes without consulting with their family doctor.

Remember the young man who was having trouble with Bituach Leumi? His father turned to Kivunim for help – and the Center staff immediately responded, going right to the top. They contacted the management of Bituach Leumi, convinced them to drop the fine and arranged for the young man to receive the services he rightfully deserves.

Staffed by members of Hadassah's Department of Social Work Services and trained volunteers, Kivunim was conceived to provide patients with a centralized source of information and assistance, with offices at both Hadassah-Ein Kerem and Hadassah-Mt. Scopus. "Many people are not aware of their rights and entitlements within the health care system – and don't even know how to find out about them," says Kivunim Director Alma Fridlender, a social worker with a Master's degree in Public Health. Bureaucratic difficulties such as those the young man encountered often leave them without the help they need.

Sometimes patients are referred by hospital personnel – nurses, physicians or social workers. Sometimes patients and families initiate contact themselves; sometimes people come from faraway places in desperation. All come to a warm and welcoming place where staff members conduct personal interviews, assess their needs, advise them of their rights and help them access the available services. Working with a specially-designed resource data base, they provide information about the broad spectrum of community resources, such as home healthcare providers, nursing homes and rehabilitation centers.

Kivunim believes that follow-up is essential. Two weeks after the initial visit, the volunteers contact the patients to find out how they are coping at home and check whether they are receiving the services and benefits that they are entitled to by law. Kivunim is funded by the Hadassah Medical Organization, Keren Mashov and Eshel.

****

"Hadassah should be very proud of this effort," Prof. Caraco says. "There are so many medical problems that can be prevented, so many situations that affect peoples' lives and their quality of life."

We are very proud – not just of The Drug Information Center and Kivunim – but of all the other services we offer to the community. We often remark that we at Hadassah are part of a very large family – a family that includes our staff and their families, our patients and their families. Like families everywhere, our concern extends beyond the Hadassah world we inhabit to the community where we live. And like families everywhere, we reach out to our neighbors to connect their family with ours in every way we can.

Shabbat shalom,
Shlomo

Prof. Shlomo Mor-Yosef
Director General
Hadassah Medical Organization

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