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To ensure wounded warrior's needs are met throughout their recovery, the Warrior Care Clinic at Walter Reed National Military Medical Center, at Bethesda (WRNMMC) continues to provide support and improve access to care.

Formerly at Walter Reed Army Medical Center (WRAMC), the clinic is now located on the third floor of WRNMMC's Building 8, and is open to wounded warriors of all military services. With nearly 30 staff members - including primary care managers, nurse practitioners, pharmacists and administrative staff - the clinic offers pain management, medicine management, intravenous therapy, and minor wound care, said Col. Wendy Campbell, officer in charge of the clinic.

"[We're] making sure they have everything they need to help them in their healing process," Campbell said.

Having an expanded clinical space, the clinic now offers acute care for outpatient's non-medical attendants; however, warriors remain their focus, she said. Those here on orders to care for an outpatient, who are not eligible for care here, can come into the clinic if, for example, they are injured while lifting their patient. Those non-medical attendants who are eligible are instead seen at the Medical Home clinic.

"Our treatment room space is dramatically larger and really provides the opportunity to do quite a bit as far as acute care and intravenous therapy," she said.

Each month, the clinic sees about 650 warriors, many of whom are in severe condition, she said. Each warrior at the clinic is assigned a primary care manager and a nurse case manager, who helps track their appointments, whether it's for specialty care, or care within the clinic.

"Any kind of appointments they may have, the nurse case manager, as well as the squad leader in their company, assists with making sure they're getting to their appointments and getting their appointments scheduled," said Campbell.

Typically, primary care managers are responsible for about 1,200 patients; however, in the warrior care clinic, primary care mangers are each responsible for about 200, and each of the nurse case managers is assigned about 20 patients.

"Having that small number they're responsible for allows those primary care managers to provide the upmost in care," she said.

The clinic also uses a multidisciplinary approach, in which each warrior's team of primary care managers, nurse practitioners and their squad leaders meet regularly to ensure they're tracking towards recovery, she added.

An added convenience, the clinic's open layout is beneficial to patients and staff, allowing warriors to move around easier, and providers can better track patients moving from room to room, she said. Since the clinic moved to WRNMMC, all warrior care staff are now under the same roof, easing the flow of communication, she added.

In addition to providing close oversight, and ensuring the warriors make it to their appointments, the clinic's anesthesiologist, Dr. Chris Spevak, is an advocate for decreasing the use of opiods - medications considered "prescription narcotics." Spevak, whose regiments include acupuncture, helped bring the use of opiods in the clinic down considerably, as of July.

"In the last couple of years, research has shown if you initially treat pain effectively, you can prevent the rewiring of the brain and prevent chronic pain," he said. "Treating acute pain as close to the time of injury with the appropriate medication is just one part of this multidisciplinary approach."

Using this concept in a team approach, he added, the challenge has been treating complex pain conditions with multiple co-morbidities, including traumatic brain injuries (TBI) and post-traumatic stress disorder (PTSD) in both the acute and chronic phases, he said. "Our team feels strongly that the needs of both the wounded warrior and their family be addressed by a unique holistic, multimodal, interdisciplinary approach."

The clinic uses non-opiod medications, physical modalities, chiropractic as well as cognitive and behavioral modalities, hypnosis and biofeedback from the time of injury throughout their transition out of the treatment facility, he said. He also believes it's important to educate warriors, helping them as they cope with the effects of both acute and chronic pain.

Additionally, the clinic has two clinical pharmacists on hand to help track medication each warrior is prescribed, preventing unwanted reactions. They also ensure warriors understand their prescriptions during a 30-minute appointment with them.

The clinic also uses an Electronic Medical Management Assistant (EMMA), which helps especially those with TBI who may struggle with memory loss. The web-based system selects and delivers medications as scheduled at the appropriate time and amount.

To further help warriors with medications, the clinic's pharmacists have established a new system with the Pharmacy in the America building to decrease wait time, said Melissa Tiedeman, a clinical pharmacist in the clinic.

After the warriors are seen by their provider, they meet with the pharmacists, who can write their prescriptions and print them at the pharmacy, said Tiedeman. By the time they get to the pharmacy, about 20-30 minutes later, they show their priority card and pick up their medications.

"We've had a lot of positive feedback about that," she said.

Clinical Pharmacist Lobat Mohajeri and Tiedeman agreed working with warriors in the "one stop shop" is gratifying.

"It's the most rewarding job I've ever had," said Mohajeri.

"They're so optimistic," said Tiedeman. She enjoys seeing them throughout their recovery, and seeing them when they're doing much better and their pain is resolved.

Once a warrior is near the end of their treatment and is in transition - be it "back to the fight," another specialty in the military or into the civilian world, Campbell said the clinic also supports each warrior throughout their transition as well.

"It's a lot to keep track of, but it's truly what we're here for. The whole idea is to make sure these warriors are assisted in their healing process," said Campbell.