Dr. Garret Noguchi and Christina Wang, RN care for a client's wound during a CHOW health fair

Community health outreach program expands services to include wound care

The Community Health Outreach Work to Prevent AIDS (CHOW) Project was the first in the nation to offer statewide syringe exchange services. Given the high frequency of wounds associated with injection drug use, CHOW has recently expanded services for their participants to include community-based wound care.

Initially established in 1989 as a University of Hawai‘i (UH) research project, CHOW received funding from the State of Hawai‘i Department of Health (DOH) after legislation was passed in 1993 in support of syringe exchange as a means to reduce transmission of HIV/AIDS and Hepatitis B and C. CHOW utilizes an evidence-based harm reduction approach with over 200 studies demonstrating the effectiveness of syringe exchange programs in reducing HIV, with no increase in drug use.

“With a patient-centered, harm reduction focus, we treat community members compassionately and non-judgmentally using methods that have been proven to reduce injury,” said Penny Morrison MN, RN, UHM Nursing faculty and member of the wound care team.

Community-based care

chow-van_screen-shot-from-videoIn an effort to ensure that an often marginalized population in society has appropriate access to resources and health care, the CHOW van sets up its mobile service at two locations in Honolulu, twice per week. In collaboration with other community-based agencies (DOH and UHM), the CHOW Project offers wound care, HIV and Hepatitis testing, Hepatitis care coordination, Hepatitis A and B vaccinations, legal aid, mental health support, housing support and overdose education.

“The population we serve utilizes the emergency department (ED) for wound care nearly four times as frequently as the national average,” said Christina M.B. Wang, MPH, RN, current UHM Doctor of Nursing Practice (A/GNP) student, and member of the wound care team. “A small but untreated wound can result in sepsis (bacterial infection in the blood) or endocarditis (bacterial infection of the heart tissue). These diagnoses, often the result of intravenous drug use and lack of wound care, are some of the most expensive because they can require Intensive Care Unit management.”

The newly added services include basic wound care, client education, and access to resources to enable clients to help care for their wounds and to reduce the frequency and associated costs of Emergency Department (ED) utilization.

Cost-effective approach

In line with their evidence-based approach, the wound care team tracks the number of clients that seek their services as part of assessing the return on investment calculation. By return on investment, “we mean, we look at the cost of starting and maintaining the wound care program (i.e. supplies, equipment etc.) versus these patients continually seeking ED services. Further, we also calculate cost per person to care for someone with a wound in the community compared to a similar patient seen in the emergency room, to assess sustainability and affordability measures,” said Wang.

Improved access to social services

The core wound care team: Christina M.B. Wang, MPH, RN (current UHM Doctor of Nursing Practice student), Penny Morrison MN, RN (UH Manoa Nursing faculty) and Jessica Ignaitis, RN.
The core wound care team: Christina M.B. Wang, MPH, RN (current UHM Doctor of Nursing Practice student), Penny Morrison MN, RN (UH Manoa Nursing faculty) and Jessica Ignaitis, RN.

Clients’ interaction with health care providers working within The CHOW Project may also be the first entree into the health care system which allows for patients potential linkage to other social services. As a metric of the effectiveness of using this in-community approach, CHOW tracks the number of clients that are connected with various State- and agency-run programs offering drug treatment, housing assistance, vaccinations, HIV and Hepatitis C testing, mental health support, and more.

“Just last year (2015) we exchanged nearly 1 million syringes. That’s 1 million potentially hazardous needles that were exchanged for clean ones; 1 million syringes that were off the streets and disposed of properly,” said Heather Lusk, MSW, Executive Director of CHOW.

The team hopes that with continued donations and funding The CHOW Project’s community-based wound care program can be sustainable and they can continue to serve our community. Since June 2016 they have had over 125 visits for wound care—clearly demonstrating the huge need for this health service.

More on CHOW

CHOW provides services every Monday through Friday at River St. and Vineyard Blvd, with wound care on Tuesdays and Fridays. CHOW also holds a health fair every other month at a local church to encourage CHOW participants to access health and social services. CHOW has a community partnership with the UH John A. Burns School of Medicine HOME project in which HOME provides additional primary care services (beyond wound care) every other Tuesday at the Vineyard location.

Additional community partners include: Institute for Human Services, Queens Medical Center, Walgreens, American Medical Technologies, Hawai‘i DOH, and City & County of Honolulu.