October 25, 2013
Patient case takes health care students on an interprofessional learning journey
The patient case begins with a referral from a dentist:
Patient “Gregory” is a 31-year-old male seen in the UW Dental Urgent Care Clinic for tooth pain in a tooth that has obvious decay. We were unable to provide dental treatment to “Gregory” today due to his elevated blood pressure. He was prescribed Amoxicillin for an abscess and asked to return once his hypertension is controlled. Please evaluate Gregory for hypertension. We will provide the necessary dental treatment after his blood pressure has been reduced.
Teams of health sciences students huddled to plan the course of care for Gregory.
The exercise, titled Providing Care across Settings, was the second in the new Foundations of Interprofessional Practice curriculum, a seven-session, year-long series. Students from across the health professions schools work together in the same teams solving real health challenges. The curriculum is part of the Interprofessional Education Initiative: Vision for a Collaborative Future, launched last year by the UW Board of Health Sciences Deans. The initiative promotes progressive integration of collaborative learning across the UW’s six health sciences schools —dentistry, medicine, nursing, pharmacy, public health and social work. (Read about the first session in UW Today.)
In the second session, held Oct. 10, nearly 600 health sciences students and some 50 faculty members participated in the “Gregory” exercise, in locations across the UW campus. The exercise helped students communicate and practice as a team in guiding the patient to appropriate healthcare professionals. The goal: provide safe, timely, efficient, effective and equitable care.
Jennifer Danielson, assistant professor of pharmacy, led the interdisciplinary team developing the case. Other case development team members included Kimberly Huggins, affiliate instructor of oral medicine in the School of Dentistry; Megan Moore, assistant professor of social work; Elizabeth Kaplan, attending physician in medicine; Karen McDonough, associate professor of medicine; and Brenda Zierler, professor of biobehavioral nursing and health systems in the School of Nursing.
“This was the first time we’ve developed such a case with both the dental and social work faculty–a groundbreaking project for health sciences at UW,” Danielson said. “We purposefully highlighted the expertise of dentists, social workers, pharmacists, nurses, and dietitians in this exercise so that everyone could ‘see themselves’.
Together, student groups representing diverse health disciplines discussed Gregory’s medical, socioeconomic and psychosocial history.
Gregory is unemployed and doesn’t know the date of his last physical exam. He rates his health as fair and his oral health as poor. He eats lots of fast foods. His family has no history of hypertension. He does have a history of drug use (meth, but has been clean for the past two years.) He has smoked 5 to 10 cigarettes per day for a decade.
One group of students determined that Gregory needed many services and designated the most appropriate healthcare professionals to handle care:
- Thorough physical exam (physician, physician assistant, nurse)
- Hypertension control (physician, physician assistant, pharmacist)
- A primary care medical home, with dental care included (physician, dentist, physician assistant, pharmacist, nurse, social worker)
- Full dental work-up with X-rays (dentist)
- Smoking cessation (dentist, physician , physician assistant, nurse, pharmacist, social worker, hotline)
- Toxicology screening to stay sober (physician, physician assistant)
- Stability evaluation for housing, employment, insurance, drug use (social worker)
- A more thorough social history (dentist, physician, physician assistant, pharmacist, nurse, registered dietician, social worker)
- Patient education (all health care professionals)
- Dietary counseling (registered dietician)
In the scenario, Gregory missed his follow-up appointment and did not pick up his medications. The teams tried to understand why this occurred.
The groups also discussed possible barriers to Gregory’s healthcare: unemployment, drug use, and lack of money, transportation, and understanding of his disease.
Danielson queried the class, “In dealing with barriers, Who else can help?”
Students piped up: “A social worker could help the patient explore affordable health care coverage resources and transportation options.”
“Gregory needs education about the medication, side-effects and how to minimize the side effects. We need to talk to him about his long-term quality of life.”
A dental student summarized her team’s conclusion:
“If the hypertension is resolved or controlled, the patient would return to the dentist for follow-up and be treated as a normal patient. Otherwise, the dentist would need a medical consult if the hypertension remains high.”
Gregory’s case was officially closed, but the interprofessional teamwork had formally begun.