Online Program

Interprofessional collaboration improving the health of urban poor

Monday, November 2, 2015

Suzanne Cashman, ScD, Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA
Anita Nivens, PhD, RN, FNP, School of Nursing, Armstrong Atlantic University, Savannah, GA
Janet Buelow, PhD, College of Health Professions, Armstrong Atlantic University, Savannah, GA
Pat Baber, RSM, St Mary's Community and Health Centers, Savannah, GA
Greg Knofczynski, PhD, Armstrong Atlantic University, Savannah, GA
Paula Tilman, DNP, RN, ASCNS, Memorial Health University Medical Center, Savannah, GA
Saint Mary’s Health Clinic (SMHC) was established in 2005 as a free clinic offering low-income vulnerable adults a basic primary care medical home. Through strengthening an academic/health care delivery partnership, in 2012 SMHC began developing into an interprofessional collaborative (IPC) practice model; this required several expansions, including adding health educators and social workers as well as creating an interprofessional team culture, developing student patient advocacy teams focused on social determinants of health, and obtaining specialist physician consultants and monitoring patient outcomes.

 The setting is a community hospital sponsored free clinic working collaboratively with a state supported university and serving low-income, vulnerable clients. The practice moved from a traditional primary care practice to an IPC practice through expanding and then developing and participating in a series of team workshops. To gauge effectiveness of changes and to monitor progress, we collected extensive baseline data on patients’ clinical indicators and continued to collect these data annually for three years. We also assessed interprofessional team readiness and developed quality improvement subgroups. We revised original intervention plans as outcomes and processes indicated a need.

 Preliminary findings revealed clinically significant changes in diabetes and hypertension patient outcomes, increased staff satisfaction and enhanced interprofessional competencies. While only one clinical indicator reached statistical significance, i.e., LDL readings among patients with diabetes (p=.04) many processes improved, including the percent of patients failing to keep appointments (by 22%).

 After only 2 ½ years, an interprofessional primary care team has been developed that includes students as patient advocates and links to physician specialists. The interprofessional team has been able to assist complex, high need patients to improve their health and quality of life. We highlight lessons learned from: helping low-income, vulnerable populations manage chronic disease, developing a unique interprofessional collaborative model, incorporating students as  advocates and overcoming challenges with university-practice collaboration.

Learning Areas:

Administer health education strategies, interventions and programs
Advocacy for health and health education
Chronic disease management and prevention
Clinical medicine applied in public health
Implementation of health education strategies, interventions and programs
Provision of health care to the public

Learning Objectives:
Describe development of an interprofessional collaborative team caring for urban poor Discuss elements of a successful academic/health care partnership Explain how students can become part of a care team through focusing on advocacy Identify opportunities for addressing social determinants of health affecting an urban poor patient population

Keyword(s): Public/Private Partnerships, Underserved Populations

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been principal/co-principal investigator or evaluator of several federally funded or state funded grants focusing on the delivery of health care services to members of underserved populations. My interests include the development of effective interprofessional teams and on quality improvement as well as on academic/community partnerships to build capacity and improve service delivery.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.