Borinquen Medical Centers (BMC) is a federally qualified health clinic (FQHC) providing comprehensive care and social services to the community of Miami-Dade County. BMC primarily works with underserved populations and with those who speak Spanish or Haitian Creole. With 11 clinical sites across the county, BMC provides a multidisciplinary approach to care and provides services to those in need throughout their community. BMC offers a one-stop shop for patients by continuing to expand their team of multidisciplinary specialists, such as primary care, pediatrics, obstetrics and gynecology, podiatry, nutrition, behavioral health, HIV care, chiropractic care, wellness coaching, clinical pharmacy, and more.
To understand the impact of their work in the community, Fullscript chatted with practitioners at BMC who are facilitating ongoing group visits with an integrative medicine approach. Keep reading to learn more about the work BMC is doing in their community and how they’re helping their patients live healthier lives.
Bringing integrative care to Miami-Dade County
We asked Dr. Deborah Gracia, DO, an osteopathic doctor and Chief Medical Officer at BMC, how she started practicing integrative medicine. “I did my functional medicine training at the Institute for Functional Medicine (IFM), and then I did my integrative medicine training with the University of Arizona Integrative Medicine Fellowship and saw the need at Borinquen. I started building the complementary medicine department to provide these services to our community.”
Dr. Maggie Quinn, ND, a naturopathic doctor at BMC, explained, “I went to naturopathic medical school at Bastyr University in San Diego, CA and did a two-year residency at the University of California Irvine Susan Samueli Integrative Health Institute (UCI). During my time at UCI, I was part of a team that built an integrative health program at a local FQHC in California. I learned a lot about the nuances of integrative medicine in a community setting and how we can best serve our patients by addressing the social determinants of health.”
When asked why it’s important to bring integrative medicine to the underserved in the community, Dr. Gracia explained that “conventional medicine does not have all the answers. Because integrative medicine has a focus on nutrition and the fundamentals of health and mind-body wellness, we can really make a difference in the lives of patients by preventing disease and addressing root causes. This type of medicine should be the way medicine is practiced. Preventative medicine should be accessible to all patients, regardless of socio-economic status. Health is a right, not a privilege.”
Dr. Quinn expressed a similar sentiment. “Integrative medicine is often thought of as boutique medicine, using expensive tests, supplements, and other costly treatment plans. At its core, integrative medicine addresses the foundation of health: nutrition, exercise, stress management, sleep, hydration, purpose, social connection, and spirituality. Integrative medicine has an important role in the community, as far as disease prevention, health education, and the management of chronic disease. Our mission is to make integrative medicine services accessible to all.“
Addressing barriers to patient care
BMC shared some of the most common barriers their community experiences when it comes to accessing healthcare and how they’re targeting these barriers to expand healthcare access and enhance patient outcomes.
Financial
Cost is a significant barrier affecting the accessibility to affordable medical care. BMC is uniquely positioned to help underserved populations in their community who may not have access to quality, affordable healthcare. They explain that, “a part of being a FQHC means that we provide care to patients regardless of ability to pay. We accept many types of health insurance, including Medicaid and Medicare. We also provide sliding scale pricing based on income for appointments, lab tests, and imaging. We have our own pharmacy and provide discount pricing on medications as well.”
Gut health and obesity in children
The gut microbiome is involved in metabolic processes such as regulating growth hormone signaling and how energy is collected from nutrients. (12) The patterns of specific bacteria found in an infant’s microbiome can affect their risk of becoming overweight and obese in childhood. (4)
Language
It’s no surprise that language barriers limit effective communication between healthcare providers and their patients, contributing to reduced patient satisfaction and decreased patient safety and quality of care. (1) BMC meets the needs of their culturally diverse patient population by providing care in English, Spanish, and Haitian Creole, and many of their providers and staff are bi- or tri-lingual.
Transportation
Patients in underserved communities often have limited access to reliable transportation to get to and from visits with their healthcare providers. BMC has 11 conveniently located clinical sites dispersed throughout Miami-Dade County to serve their community. For patients who are unable to travel or prefer to visit with their practitioner from the comfort of their home, BMC also provides telemedicine visits.
Health Literacy
Health literacy is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” (2) Low health literacy is common, affecting approximately 36% of Americans, and it disproportionately affects certain populations including the elderly, racial and ethnic minority groups, those living with a disability, individuals with limited English proficiency, and those who have received limited education. (3)(4)
To enhance their patients’ health literacy and provide patients with the knowledge they need to play an active role in the health decision-making process, BMC explains that they “provide group medical visits, which address fundamentals of health, including nutrition, exercise, stress management, mind-body medicine, and condition-specific cohorts, such as diabetes, HIV, weight management, and smoking cessation.”
Supporting behavioral change with group medical visits
BMC offers ongoing group medical visits geared towards specific conditions or health concerns such as diabetes, HIV, weight management, smoking cessation, mental health, and pregnancy. “We find that patients who participate in the groups have a better understanding of their diagnosis and treatment, more knowledge on nutrition and a healthy lifestyle, as well as access to social support,” says Dr. Quinn.
BMC’s group medical visits have been shown to be highly successful and are well accepted by patients. Some of the benefits BMC’s patients have experienced following their time in the program include:
- Improved access to integrative medicine services and the latest technology in diabetes and weight management (e.g., continuous glucose monitoring, body composition testing)
- Improved body mass index (BMI), body composition, and diabetes markers (e.g., hemoglobin A1c, glucose, fasting insulin)
- Improved health literacy
- Improved understanding of all of the factors that influence health, including mind, body, and spirit
Patients also take home what they’re learning in the group visits to teach their families. One participant explained, “the program has shown me a lot. Little by little, I’m educating my family about the lifestyle changes.”
“This has been a life-changing experience. With this program, it was therapy; it was education. Even when I did fall off the bandwagon, I was able to get back on without hesitation or skipping a beat because I had the knowledge. I can use this forever,” explained another participant.
Implementing group programming: tips for practitioners
When asked about their recommendations for practitioners interested in introducing group medical visits to support behavioral change, Dr. Gracia and Dr. Quinn gave the following recommendations.
Use a team care approach
“We find that one of the biggest challenges with getting groups started is patient recruitment. However, we find that if the patient’s provider is informed and advocating for the group, the patient is much more likely to join. All providers and staff must be informed of the group and actively recruiting. We take time during our provider meetings to update all providers on the ongoing groups.”
Create a base curriculum
“Designing a curriculum is a great way of adding a creative and personal touch to a program. Also, all groups, regardless of the group type, will have similar fundamental principles to discuss–for example, nutrition, stress management, exercise, and sleep. If you build the base curriculum later, you can tailor it to address specific conditions. The base model can be replicated and repurposed.”
Don’t try to do it all yourself
“Invite other providers to be guest speakers, especially if you are addressing a condition that may require patients to see a variety of providers. For example, in our diabetes group, we have guest speakers for pain management, clinical pharmacy, podiatry, and endocrinology.”
The bottom line
BMC offers group medical visits emphasizing integrative medicine approaches to underserved patients in the Miami-Dade County community. This successful program has helped support chronic disease management and provided patients with the tools and education to help them make lasting behavioral changes.
- al Shamsi, H., Almutairi, A. G., al Mashrafi, S., & al Kalbani, T. (2020). Implications of language barriers for healthcare: A systematic review. Oman Medical Journal, 35(2), e122.
- Elbashir, M., Awaisu, A., el Hajj, M. S., & Rainkie, D. C. (2019). Measurement of health literacy in patients with cardiovascular diseases: A systematic review. Research in Social and Administrative Pharmacy, 15(12), 1395–1405.
- National Center for Education Statistics. (2003). The health literacy of America’s adults. https://nces.ed.gov/pubs2006/2006483.pdf
- Schillinger, D. (2021). Social determinants, health literacy, and disparities: Intersections and controversies. HLRP: Health Literacy Research and Practice, 5(3).
