by Salmaan Kamal, MD, PGY-2

“How much is it?”
“About one hundred and fifty dollars for one month.”
“Doc, I can’t afford that!”

I was a junior resident volunteering at a free clinic near UAB Hospital. I sat in front of Ms. Gutierrez, a warm, soft-spoken woman in her sixties. She recently moved to Alabama from Florida, and she was seeking a primary care doctor to help manage her diabetes. She was knowledgeable about the disease and eager to modify her diet, but one barrier remained to her care. She was an undocumented immigrant without access to insulin.

Unfortunately, this is a common challenge in the state of Alabama, where there are over 600,000 patients with diabetes. Of these, about one in six is estimated to be without health insurance, which leads to even the cheapest forms of insulin exceeding one hundred dollars per month. As a result, many patients find themselves self-rationing insulin or not purchasing it altogether, leading to ED visits and life-threatening complications that worsen health outcomes and drive up health costs.

Fortunately, leaders at UAB addressed these issues in 2012 by creating the Providing Access to Healthcare (PATH) Clinic with the help of an HRSA grant from the federal government. The clinic is a free, interdisciplinary patient-centered medical home that provides free insulin and health care to uninsured patients with poorly-controlled diabetes.

The clinic staff includes nurse practitioners, resident physicians, optometrists, diabetes educators, physical therapists, wound care specialists, mental health providers, and social workers. All clinicians meet at the beginning of each clinic for a ‘‘huddle,’’ during which each patient is discussed briefly and the primary emphasis for the visit is determined. This patient-centered and team-based approach has led to proven reductions in ED visits, decreases in health care costs, and improvements in quality of care in a 2015 study. As a result, UAB Medicine continues to fund the clinic to this day.

I sent a referral to the PATH clinic for Ms. Gutierrez, thankful that she had a realistic option for her diabetes care moving forward. I am reassured that she will obtain the insulin that she needs and that her diabetes control will improve with time. Hopefully, I’ll see her at the clinic soon.

Names and details changed to preserve patient privacy.