A new student-run wound clinic at the University of Miami Miller School of Medicine opened to provide essential care to people who inject drugs, a historically underserved population. Goals include addressing health issues earlier, offering important educational opportunities for the medical students, and potentially saving the health care system money.
The Infectious Disease Elimination Act (IDEA) Needle Exchange Program at UHealth spurred creation of the wound clinic. “The focus of the needle exchange program is we don’t want them to share needles or reuse needles. If they do … they can get skin abscesses and those can get infected or inflamed,” said Jason Onugha, student project manager for the Mitchell Wolfson Sr. Department of Community Service (DOCS) Wound Care Clinic.
The IDEA Exchange was the first legal syringe exchange program in Florida and currently serves about 500 people. “We now have an innovative, student-run DOCS Wound Care Clinic at the Exchange,” said Hansel Tookes, M.D., M.P.H., assistant professor of medicine in the Division of Infectious Diseases at the University of Miami Miller School of Medicine.
Abscesses and cellulitis are common among people who inject drugs. “We hope to decrease the prevalence of these conditions by empowering our participants to use a new, clean syringe each time,” Tookes said. The clinic team will treat early wounds to avoid progression to more severe and costly complications such as endocarditis.
Multidisciplinary Medicine and More
Internists and students will take patient histories and perform physical examinations. Surgeons, dermatologists and emergency medicine physicians will treat skin abscesses, generally through incision and drainage.
The scope of services goes beyond acute treatment. “We also see people with chronic wounds that are not healing. So we address that as well,” said Onugha, a second-year UM medical student. In addition, “not only are we trying to address the wound care, but recognize that [these patients] also have a lot of other comorbidities. So we are doing health screenings and connecting them to local partners for their primary care.”
Even though a wide range of physicians participates in the clinic, it’s truly student-run. “It was conceived by UM students, designed by UM students as part of the DOCS program, and is managed — staffed, supported, etc. — by UM students,” Tookes said.
Creating a More Comfortable Medical Home
Getting this population into a traditional health care setting can be challenging. So the clinic also aims to engage patients in a setting designed to be more comfortable for them, with the ultimate aims of promoting regular medical care and better outcomes. “People who inject drugs are a very stigmatized population. They feel comfortable here, and they can be more open in our environment,” Onugha said.
“They are so stigmatized by the health care system nationwide that they often neglect seeking care until there has been significant progression of disease, with sometimes grave complications,” Tookes said. “Meeting the community ‘where they’re at’ will help introduce them to the University of Miami health care system that they have come to trust via the IDEA Exchange and develop therapeutic relationships on their terms.”
The Miller School of Medicine is the ideal setting “because we have the specialists and the only legal syringe exchange in Florida,” Tookes said. “We are on the front lines of the opioid epidemic because of progressive public health leadership and broad institutional support. The U is saving the lives of people who inject drugs every day. I couldn’t be more proud of my alma mater.”
Fertile Research Potential
The wound clinic could provide a lot of insight into the challenges of diagnosing, treating and monitoring the health care of people who inject drugs. Tookes predicted that the most interesting and impactful research will be the cost effectiveness of treating this population before there is significant morbidity and mortality associated with their wounds. The effectiveness of case management and referral to primary care could also save a significant amount of health care expenditures, he added.
The clinic officially opened on September 28. “It’s pretty exciting,” Onugha said. “We’re up and running and getting more patients.”