Endocrine clinic adds new staff


Fountain Health has recently added endocrinology nurse practitioner Lunette Castillo to its staff, with intention to increase access for their patients and work to lower healthcare costs.

Ms Castillo has over seven years of community experience in the US working with the management of common endocrine disorders and brings a wealth of knowledge to Fountain Health’s multidisciplinary approach to patient care.

Fountain Health specialises in endocrine disorders, with half of patients living with diabetes. Board-certified endocrinologist Dr Annabel Fountain, Medical Director, works closely with Ms Castillo to optimise health outcomes for their patient population.

Last year, legislation passed which allowed licensed nurse practitioners to diagnose, provide medical management and to write prescriptions for common conditions under the supervision of a physician in Bermuda.

“Fountain Health has been moving towards a multidisciplinary team, which is appropriate for many endocrine diseases, especially diabetes,” said Dr Fountain. “We are proud to have the first nurse practitioner in Bermuda, outside of the hospital.”

Along with allowing Dr Fountain to focus on more complicated patients, and give adequate time to her other roles as president of the Bermuda Medical Doctors Association and on the Board of the Bermuda Health Council, Ms Castillo’s appointment opens access to patients by reducing waiting times to be seen.

It also brings education and support for people living with chronic disease such as diabetes under the same roof. The cost of seeing Ms Castillo is also lower.

This means that those who may not have the financial resources to attend a specialist physician frequently have adequate specialist support between physician visits.

“Bermuda spends a lot of money on healthcare and we are looking for solutions to lower healthcare costs while maintaining its quality,” said Ms Castillo. “Using nurse practitioners to the fullest extent of their license and allowing them to follow evidence-based guidelines will help with lowering overall healthcare costs while also maintaining quality or, in some cases, improving its overall quality.”

She added: “It has been proven time and time again that nurse practitioners improve quality outcomes and reduce overall healthcare costs. I am excited that Bermuda has gotten on board with the international healthcare community in allowing nurse practitioners to practice and prescribe.”

Ms Castillo has extensive experience with diabetes prevention, Type 1 and Type 2 diabetes, gestational diabetes, and has helped patients to reverse their Type 2 diabetes through self-management education, lifestyle changes and medication management.

In December 2018, Fountain Health was approved for Standard Health Benefit coverage for diabetes education. This means that for people seeing the nurse practitioner for diabetes education, the cost is covered by all insurance, with no out-of-pocket co-payment.

According to Ms Castillo, for patients and the healthcare system in Bermuda, it is great to be able to have qualified nurse practitioners do mid-level practitioner management.

“I work with Dr Fountain to provide evidence-based care to patients with diabetes, thyroid disease, obesity, pituitary adenoma and other common endocrine diagnoses,” she added. “If Dr Fountain is away or busy, patients can still get their prescriptions refilled, labs ordered, test results and get answers to their medical questions.”

Currently, nurse practitioners can’t bill insurance companies directly for all things that they are board certified to perform. Prevention of illness is a key factor in lowering healthcare costs, and Fountain Health is keen to see incentives in the health system to support preventive care. Only the diabetes education given by qualified nurse practitioners is currently given full coverage by insurance to approved providers and there is little to no reimbursement for extra preventive care, such as foot exams for diabetics or educating patients about smoking cessation, or contraception and pregnancy planning during the medical visit.

Dr Fountain added: “Hopefully Bermuda’s health system will soon fully support adoption of international practices and guidelines to decrease healthcare costs, improve outcomes and increase access for patients. This requires adequate reimbursement for preventive care.”

As a board certified endocrinologist and specialist in internal medicine, Dr Fountain launched Fountain Health in 2017. Fountain Health also sees patients with other hormone disorders such as thyroid cancer and thyroid nodules, pituitary and adrenal tumours, adrenal failure, osteoporosis, fertility issues and polycystic ovarian syndrome.

Fountain Health is located 63 Victoria St. For more information about Fountain Health, contact 232-2027 or e-mail info@fmg.bm or visit their Facebook page.

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Published May 22, 2019 at 6:53 pm (Updated May 22, 2019 at 6:53 pm)

Endocrine clinic adds new staff

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