Javier F. Sevilla- Mártir, MD Associate Professor of Clinical Family Medicine, Director Hispanic/Latino Health and International Medicine and Global Health,

Javier F. Sevilla- Mártir, MDAssociate Professor of Clinical Family Medicine, Director

Hispanic/Latino Health and International Medicine and Global Health, Department of Family Medicine, Assistant Dean for Diversity,

Indiana University School of [email protected]

NHMA , March 29th,2014

1.Describe creation of free clinic ,activities, programs and outcomes designed to improve access to health care services for the Hispanic and other Underserved communities of Indianapolis, Indiana

2.Discuss learning objectives and activities to reflect IPE in an interprofessional team working environment

A community health needs assessment was conducted to guide the development of Indiana University Student Outreach Clinic (IU-SOC) services for the Near Eastside residents of Indianapolis.

The assessment was completed through the collection and analysis of primary and secondary data. Community surveys, focus groups, and key informant interviews comprised the primary data while demographic information from the SAVI database and a chart review of clinic patients provided secondary data.

The analysis and conclusions focused on four main areas: General health

Access to care

Barriers to optimal health

Community interest in health education.

Mental Illnesses and Addictions

Bad Nutrition/Obesity

Smoking

Poor Access

Limited Services

Affordable Prescriptions

Dental & Vision Care

Lack of Healthcare Coverage

Healthcare System Confusion

Accessibility

A total of fifteen clinic summaries were reviewed including all of the clinics held between March 14, 2009 and July 18, 2009.

During these fifteen clinics, 112 patients were seen with an average of seven patients per clinic day (range 12).

IU School of Medicine/Public Health

Butler University Community Outreach Pharmacy (BUCOP)

IU School of Dentistry

IU School of Law

IU School of Social work

IU/UOI Schools of Physical and IU Occupational Therapy

“If health care providers are expected to work together and share expertise in team environment, it makes sense that their education and training should prepare them for this type of working arrangement” Romanow, R (2002)

General Learning Objectives

•Describe and demonstrate effective communication skills with patients and with other healthcare professionals.•Demonstrate an understanding of how to counsel and educate patients about their medical care.•Describe the flow of a medical clinic and the differing roles of the health care team members.•Describe the advantages of an inter-professional working environment and identify his or her role within an interprofessional model.•Discuss issues related to the care of the underserved, including barriers to health care access, common medical conditions, and health disparities.•Identify major federal, state, and local insurance programs for underserved and uninsured individuals.

Student Leadership Learning Objectives

•Identify a need related to patient care or student education at the clinic and design a project to address this need with an interprofessional approach.

•Demonstrate a basic understanding of principles of quality improvement projects and/or epidemiological, public health and education research

During the Clinic Day

1.Interprofessional Orientation – held at the beginning of each clinic day to introduce all volunteers, explain the clinic model and mission, and emphasize the importance of team-based education and patient care

2.Interprofessional Roundtable – led by medical school faculty (who receive CME credits for the activity), volunteers from each school discuss patient cases that required cooperation of several disciplines that day

3.Medical Care Teams – pharmacy and dental students participate on patient care teams directly with the medical students

4.Dental Care Teams – medical students serve as chair-side assistants for dental students

Outside the Clinic Day

1.Interprofessional Events – all volunteers from each school are invited to participate in events, ranging from seminars (domestic violence, medical-legal partnership, etc.) to socials

2.Partners Subcommittee Meetings – student reps from each partner work on a common theme (e.g. education) to implement clinic-wide initiatives

3.Monthly Partners Meeting – designated students from each school meet to review and fine-tune clinic-wide operations

4.Biannual Partners Retreat – student leaders from each school meet for long-term strategic planning and leadership / fellowship building

Operations: policies and procedures

Volunteers: recruitment

Promotions: Outreach to the community

Development: Budget and fundraising

Supplies: inventory and purchases

Research/Records: medical records and research coordination

Education: community health education and integration into curriculum

The assessment of the educational environment of this interprofessional service-learning program is planned for two phases.

Phase I.Preliminary Data: From November 2011 to March 2013, 65 consented students (35 preclinical, 31 clinical students) have completed the survey, and 2 focus groups have been held.•100% agreed or strongly agreed that volunteering was helpful for their medical education, and that volunteering was worth their time.•97% felt that they were a useful part of the team. 97% of respondents reporting that they learned something new from another volunteer•72% recognizing that they had taught something to another volunteer.•While only 63% agreed to the statement that they had “a lot of contact with students of other disciplines” •82% felt that they had “beneficial contact with students of other disciplines,” while only 3% disagreed.

Preliminary Data

•99% agreed or strongly agreed that the clinic impacted their understanding of the social and community contexts of health care. The areas of communication (99%), basic clinical skills (94%), problem solving (89%) and professionalism (85%) were also impacted.

•In focus groups, students have cited specifically the interprofessional environment, the vertical mentoring system, and the community setting as providing learning experiences unique to what has been offered in the traditional curriculum.

•Student leaders value learning about the business of medicine and have cited their professional development through the IU-SOC as their most meaningful experience during medical school.

Preliminary Conclusions: Students report that the IU-SOC provides benefits unique from traditional curricula to their medical education.

More work remains to understand the impact of the interprofessional nature of the clinic on students, accounting for how the interprofessional program has changed over time. Janice L. Farlow, Charles Goodwin, Cristiano Piron, Javier Sevilla-Mártir, Tony Ribera, Alison Loftus, Steve Kirchhoff

Patient education modules

Student education modules

Faculty Development Modules

Quality Measures and health outcomes

Longitudinal Experiences Rosenfield, Oandasan, Reeves, (2011)

• 335 students from IUSM volunteered at the clinic and one or two Family Medicine resident per Saturday• From pharmacy over 150 unique volunteers have given time to the clinic or have attended training to begin

volunteering in Spring 2014. • Dental had 161 volunteers this year put in a total of 1840 hours. • The physical therapy clinic consistently has 10-15 volunteers/Saturday• OT has had 18 volunteers this year. • Social work averages around 30 volunteers each month. • In 2013, medicine saw 1643 patients with a total of 2902 diagnoses. Of these patients, about 20% were new to the

clinic and 80% were return visits. We referred 175 patients to partners such as PT, OT, social work, and dental.

Be proactive

Assess community needs/assets

Networking/collaboration/partnership

Implement /Evaluate

Clinical services to meet the needs of a community demands partnerships and collaborations with the community as well as curricular innovations oriented to better prepare future health professionals enhancing their understanding and ability to work as a interprofessional team to provide better care for our underserved communities.

Service learning/ community service or civic engagement provides and excellent opportunity for interprofessional team approach to community needs as well as a unique team based learning experience