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Keep on Truckin’

“When Dr. Michael Clark said he’d line me up with a health coach, I wasn’t sure what that meant, but I was open to it,” says Danny, recalling his January 2012 physical.

Minutes later he met Nicole Nelson -- one of four RN Health Coaches at Sanford Thief River Falls Clinic. Experienced and well-trained, these professionals are key to Sanford’s highly successful Medical Home Program.

Launched in 2011, Medical Home helps patients who struggle with chronic conditions such as high blood pressure, diabetes, heart disease, depression and asthma. Without good management, these conditions can spiral out of control causing complications, frequent medical care and reduced quality of life.

“Nicole was friendly and easy to talk to. She also took the time to explain everything, including what I was at risk for,” says Danny. “A heart attack or stroke was not the direction I wanted to go.”

Mapping out a plan

Danny and Nicole developed a care plan based on Danny’s goals. Top on his list: lower blood pressure. The plan included at-home blood pressure monitoring, faithfully taking daily medication and checking in with Nicole periodically. Danny liked texting, but sometimes he called or stopped in, too.

“We create accountability,” says Nicole. “A relationship based on trust and open communication helps a lot, too.”

Danny’s path wasn’t easy. Because his blood pressure was resistant to medication, he needed several tests to rule out possible causes such as kidney problems. To Danny’s surprise, Nicole coordinated his care.

“Dr. Clark told me I’d save a lot of time and hassle by having a health coach. He was right,” he says.

When tests showed no abnormalities, Danny’s medical team continued to adjust his medications. Within three months his blood pressure fell to an acceptable level.

“I was relieved,” says Danny. “Honestly, I’m not sure I could’ve gotten there without Nicole.”

Nicole’s help didn’t stop when Danny’s blood pressure improved. She still checks in with him to make sure everything’s on track. And anytime he has questions or concerns, he knows where to turn.

“Having a health coach is like having a security blanket,” he says.

Working toward a second goal

In a technique called motivational interviewing, Nicole discovered Danny was ready to move toward another important goal: stop smoking. She connected him with a smoking cessation specialist at Sanford.

“That’s another important aspect of Medical Home,” says Nicole. “We connect patients to the resources they need to help them succeed.”

A two-pack-a-day smoker for years, Danny is now down to a half pack. After he snuffs out smoking, he has another goal: “I’d love to get off all blood pressure medications.”

Nicole grins and gives him a thumbs-up.

“It’s entirely possible,” she says.

Looking to the future

Today more than 2,000 patients benefit from the Medical Home Program at Sanford Thief River Falls. Currently available in Family Practice, the program will likely expand to Pediatrics and OB in the coming year.

“The growth is not at all surprising,” says Nicole. “Patients love the one-on-one help. Doctors like it, too. It’s a patient-centered team approach that really works.”

As for Danny’s future, he sees green lights all the way. “Good health is so important,” he says. “I need it for my job, but it’s important for other stuff, too, like hunting and going to Minnesota Vikings games.”

Giving back

Danny spends long hours driving a semi through the darkness of night, traveling to small northern Minnesota towns like Warroad and Greenbush and delivering milk. Logging up to many miles a week, he has plenty of time to think.

His ponderings led him to great appreciation for Medical Home and the help he received from Nicole. “She helped me improve my health like no one else had,” he says. In response, he gave a financial gift to Sanford Foundation, naming Nicole his Guardian Angel. Today she proudly wears the pin on her nursing uniform.

“Nurses go above and beyond in helping their patients, but rarely get thanked,” he says. “This was my way of saying thank you, Nicole. You did an awesome job.”

Posted Date: September 2012