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Onsite With Temple University Hospital: A Rheumatology ‘Safety Net’ For Region’s Poorest

Located in the heart of the poorest area of the nation’s poorest major city, Temple University Hospital stands as the first line of care for many rheumatology patients who would otherwise have nowhere else to go.

With about 80% to 85% of its patients receiving coverage through Medicare or Medicaid, the North Philadelphia hospital is the largest “safety-net” institution in Pennsylvania, setting it apart from the many other academic health facilities in the region. According to Roberto Caricchio, MD, FACR, interim chairman of Temple’s rheumatology department and director of its lupus clinic, that makes for unique challenges in providing adequate care for patients.

Roberto Caricchio, MD, FACR
Roberto Caricchio

“I trained in Italy and then moved from the University of Pennsylvania to here to retrain and move my lab here, at Temple,” Caricchio told Healio Rheumatology. “The clinical training here took some time for me to cope with specifically, the distress that I witnessed, because I was completely unaware of the difficulties that poor people can have in the United States.”

Caricchio noted that Temple takes pride in its status as the community’s de facto community hospital, providing up to $70 million in free care for the local population in North Philadelphia, funded through state and federal governments, he said.

Temple University’s rheumatology department, with its eight physicians and two nurse practitioners, sees up to 10,000 patients per year, including approximately 600 patients at its lupus clinic. Additionally, all the department’s physicians divide their time between clinical and academic duties.

One of those physicians, Lawrence H. Brent, MD, a professor of medicine and faculty member at Temple University Hospital’s rheumatology department, said the facility provided a much-needed resource for people, as other community institutions that accepted poor and indigent patients, such as the former Philadelphia General Hospital, have closed.

Lawrence H. Brent, MD
Lawrence H. Brent

“Not only do these patients not have the financial means to afford medical care, but often because of their medical history or background, they can be very complicated to take care of,” said Brent, who has been with Temple for 25 years. “Also, many do not speak English. I can speak only a few words in Spanish, but certainly not enough to get a history from someone, which adds another little layer of difficulty in trying to effectively communicate with a patient who doesn’t speak your native language. I enjoy the challenge — that’s why I’ve been doing this for so long.”

In addition to providing care for patients, the hospital’s lupus clinic participates in clinic trials conducting basic, translational and clinical research, particularly focusing on the sex differences in patients with the disease, Caricchio said.

“Out of 10 lupus patients, 9 are females and 1 is male, and I am looking at the hormonal effect on the lupus disease from a basic point of view,” he said. “From a translational point of view, we study common infections in lupus patients as a way to trigger flares.”

According to Caricchio, many of the physicians at Temple — including those working in the rheumatology department and the lupus clinic — have been recognized by their peers as “Top Doctors” in the area, as named in Philadelphia Magazine. They accomplished this, he said, even though many are part-time, and must split their clinical time between an average of 12 patients per session.

“Despite the fact that 80% to 85% of our patients are Medicare and Medicaid patients, we have the recognition of most physicians in the section as ‘Top Doc’ — that is peer-to-peer recognition. That is a testament to what my colleagues are doing here at Temple. That means that we provide top-notch care. Nothing at Temple is easy, but we do provide outstanding care.” – Jason Laday

Changing Times: “In the last 2 decades, rheumatology care has witnessed a total revolution,” Caricchio said. “When I first trained, I would see patients with rheumatoid arthritis who were destined to be in a wheelchair and completely impaired because we could not stop the destruction of the joints.”
Changing Times: “In the last 2 decades, rheumatology care has witnessed a total revolution,” Caricchio said. “When I first trained, I would see patients with rheumatoid arthritis who were destined to be in a wheelchair and completely impaired because we could not stop the destruction of the joints.”
Temple University Hospital
Temple University Hospital
Shorthanded Health Care: “One of the biggest challenges is there are simply not enough of us to take care of the patients we have — and not only in this area, but nationwide,” Brent said. “I give conferences to primary care physicians from all over, including rural Wyoming, and one of the first things I will ask is, ‘Who has good access to a rheumatologist?’ Maybe half the people will raise their hands.”
Shorthanded Health Care: “One of the biggest challenges is there are simply not enough of us to take care of the patients we have — and not only in this area, but nationwide,” Brent said. “I give conferences to primary care physicians from all over, including rural Wyoming, and one of the first things I will ask is, ‘Who has good access to a rheumatologist?’ Maybe half the people will raise their hands.”
Temple University Hospital sign
Research Network: “We are one of six sites in the United States participating in an NIH-sponsored clinical trial studying a synthetic cannabinoid agonist for the treatment of joint inflammation in lupus,” Caricchio said. “Arthritis is present in up to 90% of lupus patients; although this medication does not have the behavior-altering properties of marijuana, it does interfere with the inflammation that lupus induces, with very few side effects.”
Research Network: “We are one of six sites in the United States participating in an NIH-sponsored clinical trial studying a synthetic cannabinoid agonist for the treatment of joint inflammation in lupus,” Caricchio said. “Arthritis is present in up to 90% of lupus patients; although this medication does not have the behavior-altering properties of marijuana, it does interfere with the inflammation that lupus induces, with very few side effects.”

Located in the heart of the poorest area of the nation’s poorest major city, Temple University Hospital stands as the first line of care for many rheumatology patients who would otherwise have nowhere else to go.

With about 80% to 85% of its patients receiving coverage through Medicare or Medicaid, the North Philadelphia hospital is the largest “safety-net” institution in Pennsylvania, setting it apart from the many other academic health facilities in the region. According to Roberto Caricchio, MD, FACR, interim chairman of Temple’s rheumatology department and director of its lupus clinic, that makes for unique challenges in providing adequate care for patients.

Roberto Caricchio, MD, FACR
Roberto Caricchio

“I trained in Italy and then moved from the University of Pennsylvania to here to retrain and move my lab here, at Temple,” Caricchio told Healio Rheumatology. “The clinical training here took some time for me to cope with specifically, the distress that I witnessed, because I was completely unaware of the difficulties that poor people can have in the United States.”

Caricchio noted that Temple takes pride in its status as the community’s de facto community hospital, providing up to $70 million in free care for the local population in North Philadelphia, funded through state and federal governments, he said.

Temple University’s rheumatology department, with its eight physicians and two nurse practitioners, sees up to 10,000 patients per year, including approximately 600 patients at its lupus clinic. Additionally, all the department’s physicians divide their time between clinical and academic duties.

One of those physicians, Lawrence H. Brent, MD, a professor of medicine and faculty member at Temple University Hospital’s rheumatology department, said the facility provided a much-needed resource for people, as other community institutions that accepted poor and indigent patients, such as the former Philadelphia General Hospital, have closed.

Lawrence H. Brent, MD
Lawrence H. Brent

“Not only do these patients not have the financial means to afford medical care, but often because of their medical history or background, they can be very complicated to take care of,” said Brent, who has been with Temple for 25 years. “Also, many do not speak English. I can speak only a few words in Spanish, but certainly not enough to get a history from someone, which adds another little layer of difficulty in trying to effectively communicate with a patient who doesn’t speak your native language. I enjoy the challenge — that’s why I’ve been doing this for so long.”

In addition to providing care for patients, the hospital’s lupus clinic participates in clinic trials conducting basic, translational and clinical research, particularly focusing on the sex differences in patients with the disease, Caricchio said.

“Out of 10 lupus patients, 9 are females and 1 is male, and I am looking at the hormonal effect on the lupus disease from a basic point of view,” he said. “From a translational point of view, we study common infections in lupus patients as a way to trigger flares.”

According to Caricchio, many of the physicians at Temple — including those working in the rheumatology department and the lupus clinic — have been recognized by their peers as “Top Doctors” in the area, as named in Philadelphia Magazine. They accomplished this, he said, even though many are part-time, and must split their clinical time between an average of 12 patients per session.

“Despite the fact that 80% to 85% of our patients are Medicare and Medicaid patients, we have the recognition of most physicians in the section as ‘Top Doc’ — that is peer-to-peer recognition. That is a testament to what my colleagues are doing here at Temple. That means that we provide top-notch care. Nothing at Temple is easy, but we do provide outstanding care.” – Jason Laday

Changing Times: “In the last 2 decades, rheumatology care has witnessed a total revolution,” Caricchio said. “When I first trained, I would see patients with rheumatoid arthritis who were destined to be in a wheelchair and completely impaired because we could not stop the destruction of the joints.”
Changing Times: “In the last 2 decades, rheumatology care has witnessed a total revolution,” Caricchio said. “When I first trained, I would see patients with rheumatoid arthritis who were destined to be in a wheelchair and completely impaired because we could not stop the destruction of the joints.”
Temple University Hospital
Temple University Hospital
Shorthanded Health Care: “One of the biggest challenges is there are simply not enough of us to take care of the patients we have — and not only in this area, but nationwide,” Brent said. “I give conferences to primary care physicians from all over, including rural Wyoming, and one of the first things I will ask is, ‘Who has good access to a rheumatologist?’ Maybe half the people will raise their hands.”
Shorthanded Health Care: “One of the biggest challenges is there are simply not enough of us to take care of the patients we have — and not only in this area, but nationwide,” Brent said. “I give conferences to primary care physicians from all over, including rural Wyoming, and one of the first things I will ask is, ‘Who has good access to a rheumatologist?’ Maybe half the people will raise their hands.”
Temple University Hospital sign
Research Network: “We are one of six sites in the United States participating in an NIH-sponsored clinical trial studying a synthetic cannabinoid agonist for the treatment of joint inflammation in lupus,” Caricchio said. “Arthritis is present in up to 90% of lupus patients; although this medication does not have the behavior-altering properties of marijuana, it does interfere with the inflammation that lupus induces, with very few side effects.”
Research Network: “We are one of six sites in the United States participating in an NIH-sponsored clinical trial studying a synthetic cannabinoid agonist for the treatment of joint inflammation in lupus,” Caricchio said. “Arthritis is present in up to 90% of lupus patients; although this medication does not have the behavior-altering properties of marijuana, it does interfere with the inflammation that lupus induces, with very few side effects.”