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IPA Social Workers: Improving Adherence and Patient Outcomes


CharterCARE Provider Group of Rhode Island (CPGRI) has multiple Care Management programs that service our members throughout the continuum of care.  Our Care Management team consists of five providers, twelve registered nurses, three care coordinators, three social workers and one community health worker.   Jaimie Panek, MSW, has been a member of our team since 2016.
In September 2020, Jaimie received a referral from our nurse care manager Jenn Rossi and Dr. Martin Kerzer for a patient suspected of having lung cancer. This patient was missing appointments with specialists and lab facilities to confirm the diagnosis.  The medical community was under the impression that the patient was simply non-adherent, when in fact the patient was feeling hopeless, tearful, and felt that nothing was working out. The patient had voiced on more than one occasion that she “felt like giving up”.  She lacked an informal support system, needed assistance with activities of daily living, and felt the process of navigating the health system was extremely confusing. 
Jaimie engaged the patient telephonically which resulted in her agreeing to a PET scan, which was scheduled.  Jaimie also arranged transportation as the patient had limited options.  Additionally, Jaimie helped the patient complete an application for activities of daily living services through WestBay Community Action and the patient was enrolled in “Shopping Angels,” a program for food assistance. The support Jaimie provided activated the patient who felt that her “life” was starting to fall into place. She developed a sense of pride for being persistent despite the challenges she was facing.  The patient completed her diagnostic journey and is now receiving radiation treatment for her condition. Currently, she is consistently attending her medical appointments using the transportation resources arranged by Jaimie. The patient is feeling empowered and positive, very different from September 2020.
Jaimie would tell you she is just “doing her job,” but this is so much more than that.  Changing the trajectory of someone’s life by breaking down barriers is how we get results, and why we are so incredibly thankful for our IPA Social Worker team!