Una Vida Sana! STFM Pre-Doc


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PowerPoint presentation from STFM's 2012 Conference on Medical Student Education

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  • --Population increase likely under-estimated due to undocumented individuals. --This demographic shift is likely to long-standing, and I believe will continue to increase.
  • --LCME: Liaison Committee on Medical Education --ACPE: Accreditation Council for Pharmacy Education --ANCC: American Nurses Credentialing Center
  • --Community events: Imagine Festival --Government events: mobile Mexican Consulate Ventanilla de Salud
  • --COM eligibility screening provides more info re: pts ’ day-to-day life
  • --Notably large % of those screened are male
  • Likely seeing a lot of people w/ pre-clinical concerns, and we are probably selecting for healthier individuals.
  • Una Vida Sana! STFM Pre-Doc

    1. 1. ¡Una Vida Sana! Assessing and Improving the Health Status of Richmond’s Hispanic Community Through Health Professional Student Service Learning
    2. 2. <ul><li>Mark Ryan, MD </li></ul><ul><ul><li>Department of Family Medicine, VCU School of Medicine </li></ul></ul><ul><li>Allison Gregory, FNP-BC </li></ul><ul><ul><li>Department of Family and Community Health, VCU School of Nursing </li></ul></ul><ul><li>Rishika Kaundal, MD </li></ul><ul><ul><li>Chesterfield Family Medicine Residency Program </li></ul></ul><ul><li>Sallie Mayer, Pharm.D., MBA, BCPS, CDE </li></ul><ul><ul><li>Department of Pharmacotherapy and Outcomes Science, VCU School of Pharmacy </li></ul></ul>
    3. 4. ¡Una Vida Sana! <ul><li>¡Una Vida Sana! (UVS) is a multi-disciplinary service learning program with a focus on providing cardio-metabolic disease screenings to the Hispanic community in Richmond, VA </li></ul><ul><li>Currently supported by a grant from VCU’s Council on Community Engagement </li></ul>
    4. 5. Background <ul><li>City of Richmond’s Hispanic community has increased from 5,704 (2000 estimate) to at least 13,000 (2010 estimate). </li></ul><ul><li>Large proportion first generation immigrants. </li></ul><ul><li>Similar changes in surrounding counties. </li></ul>
    5. 6. Barriers to health care access <ul><li>Richmond City Latino Needs Assessment, 2008: </li></ul><ul><ul><li>65% “very worried” about access </li></ul></ul><ul><ul><li>Recommended increased access to and hours of health care services </li></ul></ul><ul><ul><li>Explore use of mobile clinics </li></ul></ul><ul><ul><li>Extend weekend and evening hours </li></ul></ul><ul><ul><li>Expand promotora programs </li></ul></ul>
    6. 7. Health professional interest <ul><li>SOM: LCME requires increased service learning opportunities, encourages student participation </li></ul><ul><li>SOP: ACPE encourages community engagement, integrating service learning. </li></ul><ul><li>SON: AACN requiring increased inter-professional collaboration and cultural competence. </li></ul>
    7. 8. Health professional interest <ul><li>Interest from students for increased service learning opportunities, and opportunities to work with Spanish-speaking communities. </li></ul><ul><li>Student interest developed independently of school requirements. </li></ul>
    8. 9. Program design <ul><li>Develop mobile, community-based project to provide cardio-metabolic disease screenings. </li></ul><ul><li>Cross-disciplinary team with academic and community partners. </li></ul><ul><li>Workshops to teach students necessary skills. </li></ul>
    9. 10. Coalition Building <ul><li>Generation of the idea: </li></ul><ul><ul><li>Identify a community and a need. </li></ul></ul><ul><li>Assessing student interest </li></ul><ul><li>Identifying potential partners </li></ul><ul><ul><li>SON, SOP, Office of Language Services, community clinics and health promoter programs, Hispanic Liaison Office </li></ul></ul><ul><ul><li>School of Social Work, School of Dentistry </li></ul></ul>
    10. 11. Coalition Building <ul><li>Early meetings </li></ul><ul><ul><li>Determined each partner's needs, goals and values. </li></ul></ul><ul><ul><li>Developed of a working group to address specifics. </li></ul></ul><ul><ul><li>Emphasized on student leadership and student ownership. </li></ul></ul><ul><ul><li>Consider liability and coverage. </li></ul></ul>
    11. 12. Coalition Building <ul><li>Organizational meetings </li></ul><ul><ul><li>Identified sites. </li></ul></ul><ul><ul><li>Identified and coordinated student participation and faculty coverage. </li></ul></ul><ul><ul><li>Determined necessary equipment, assessment and risk prediction tools, and housekeeping needs. </li></ul></ul><ul><ul><li>Scheduling. And more scheduling. </li></ul></ul>
    12. 13. Participants <ul><li>VCU SOM, SON, SOP </li></ul><ul><li>VCUHS Office of Language Services </li></ul><ul><li>City of Richmond Hispanic Liaison Office </li></ul><ul><li>CrossOver Ministry: already a known resource within the community. </li></ul><ul><ul><li>Promotoras </li></ul></ul><ul><ul><li>Clinical care/volunteers </li></ul></ul>
    13. 14. Venues <ul><li>Churches and faith communities </li></ul><ul><li>Community events </li></ul><ul><li>Government events </li></ul>
    14. 15. <ul><ul><li>Hispanic Liaison Office </li></ul></ul><ul><ul><li>Local churches with Hispanic ministries </li></ul></ul><ul><ul><li>CrossOver Ministry Health Center </li></ul></ul><ul><ul><li>CrossOver Ministry’s Lay Health Promoter Program </li></ul></ul>Partners <ul><ul><li>Health promotion and education </li></ul></ul><ul><ul><li>Referral for further care to area clinics and/or CrossOver Ministries </li></ul></ul><ul><ul><li>Interdisciplinary service-learning </li></ul></ul><ul><ul><li>Cultural competence </li></ul></ul>Results Event organization and flow Screening events V i r g i n i a C o m m o n w e a l t h U n i v e r s i t y Check in Blood test (Cholesterol and blood sugar) Blood pressure Body Mass Index (BMI) Framingham analysis Education Patient survey Consultation Referral
    15. 16. Project goals <ul><li>Hold events every 2 months. </li></ul><ul><li>Establish new model of service learning, and determine the validity of the approach. </li></ul><ul><li>Develop a health profile of the adult Hispanic community, especially regarding cardio-metabolic risks. </li></ul>
    16. 17. Project goals <ul><li>Patient satisfaction measures </li></ul><ul><ul><li>Developed a patient survey to assess how well the project meets the community’s needs. </li></ul></ul><ul><li>Learner impact/satisfaction </li></ul><ul><ul><li>Used a previously-developed survey that includes measures of cross-cultural awareness and cultural competency. </li></ul></ul><ul><li>Enhanced impact for promotoras . </li></ul>
    17. 18. Results <ul><li>Approximately 365 total screened </li></ul><ul><ul><li>306 included in analysis </li></ul></ul><ul><ul><li>Average age: 36.8 yrs </li></ul></ul><ul><ul><li>Approximately 50% male:50% female </li></ul></ul><ul><ul><li>10% self-identified as smokers. </li></ul></ul><ul><ul><li>96% self-identified as Hispanic/Latino </li></ul></ul>
    18. 19. Results <ul><li>These results suggest that in the patients we have screened there is not yet a high burden of established disease, but that we are working with a community at risk of developing cardio-metabolic disease in the future. </li></ul><ul><li>Low rate of smoking in the screened population. </li></ul>
    19. 20. Results <ul><li>Approx 10% patients referred for further care; of them to CrossOver. Higher percentages in smaller events than larger. Range 8-33%. </li></ul><ul><li>Few referrals were successfully completed at the beginning, partly due to patients lost to follow-up, and partly due to patients who did not qualify for free clinic services. </li></ul>
    20. 21. Preliminary Patient Survey Results <ul><li>These results indicate that we are accessing a community that is medically underserved and that lacks meaningful primary care access. </li></ul><ul><li>There are indications that patients are seeking services beyond what our program can provide. </li></ul>
    21. 22. Student Impact <ul><li>Over 50 students have participated, including 8 student leaders. </li></ul><ul><li>Average 19 students per event. Events 4-6 hours long. </li></ul><ul><li>There are over 100 students with a current interest in participating in UVS events. </li></ul>
    22. 23. Student Impact <ul><li>The impact of participation in UVS upon students was measured using a survey designed by the Center for Healthy Communities of Wright State University. The survey was used with their permission. </li></ul><ul><li>The survey includes two parts: </li></ul><ul><ul><li>23 questions, administered separately pre- and post-participation, which addresses civic, cultural, and social issues, and post-graduation work placement. </li></ul></ul><ul><ul><li>9 questions addressing broader community issues, administered post-participation, designed as retrospective pre/post questions. </li></ul></ul>
    23. 24. Student Impact <ul><li>In the separate pre/post surveys (N=9 matched surveys), students expressed agreement that healthcare would “always be improved by the increased practice of multidisciplinary care teams” and were more likely to consider working at a community health clinic after graduation. </li></ul>
    24. 25. Student Impact <ul><li>In the retrospective pre/post reflective questions (N=17 surveys), students reported increased knowledge about: </li></ul><ul><ul><li>Community resources </li></ul></ul><ul><ul><li>Health delivery systems </li></ul></ul><ul><ul><li>Community health care needs and barriers to care </li></ul></ul><ul><ul><li>Responsibilities of other members of the healthcare team </li></ul></ul><ul><ul><li>The impact of socioeconomic status on health/illness </li></ul></ul><ul><ul><li>How to work with patients of varying levels of healthcare knowledge. </li></ul></ul>
    25. 26. Student Impact <ul><li>“ hands on experience working with underserved populations is an invaluable experience that can't be taught in a classroom ” </li></ul><ul><li>“ this cannot be taught in class, you have to experience it ” </li></ul>
    26. 27. Student Impact <ul><li>Multidisciplinary care teams mimic real-world practice and enhance interdisciplinary approach. </li></ul><ul><li>Participation highlighted lack of medical school training regarding nutrition, community resources and access to primary care. </li></ul><ul><li>Participation provided early, real-world experience in patient counseling regarding nutritional and lifestyle interventions. </li></ul>
    27. 28. Student Impact <ul><li>Limits of the survey: </li></ul><ul><ul><li>Risk of bias in the pre/post retrospective/reflective questions. </li></ul></ul><ul><ul><li>Small number of matched pre/post surveys available for review. </li></ul></ul><ul><ul><li>Length of the survey (many incomplete). </li></ul></ul><ul><ul><li>Is survey design the best fit for our student participants. </li></ul></ul><ul><ul><li>Inability to assess which students (SOM/SON/SOP) were more likely to complete surveys, meaning that we cannot assess if positive changes were more likely in one school than another. </li></ul></ul>
    28. 29. Challenges <ul><li>Appropriate sites with sufficient patient access and participation. </li></ul><ul><li>Incomplete referrals: </li></ul><ul><ul><li>Patients who do not come to CrossOver for their financial screening and/or appointments. </li></ul></ul><ul><ul><li>Patients who do not qualify for services at CrossOver, and lack of information on alternatives. </li></ul></ul><ul><ul><li>Have increased resources and support to better address this issue, both from UVS and community partners. </li></ul></ul>
    29. 30. Challenges <ul><li>Sufficient faculty volunteers to meet student interest and patient needs. </li></ul><ul><li>Medical interpreter coverage. </li></ul><ul><li>Patient misunderstanding of the group’s capabilities. </li></ul><ul><li>Difficulty coordinating the participating groups’ schedules, and assessing resource needs. </li></ul><ul><li>Are we reaching the communities that most need our services? </li></ul>
    30. 31. Future plans <ul><li>Strengthen the project’s service learning structure. </li></ul><ul><ul><li>Enhance UVS student group’s role. </li></ul></ul><ul><li>Increase capacity: </li></ul><ul><ul><li>For students </li></ul></ul><ul><ul><li>For the community </li></ul></ul><ul><li>Increase community input. </li></ul><ul><li>Increase the services offered. </li></ul><ul><ul><li>Nutrition information, financial screening </li></ul></ul><ul><ul><li>Flu vaccinations </li></ul></ul><ul><ul><li>Additional health screenings </li></ul></ul><ul><li>Identify additional event sites. </li></ul>
    31. 32. Contact information <ul><li>Mark Ryan: </li></ul><ul><ul><li>[email_address] </li></ul></ul><ul><li>Allison Gregory: </li></ul><ul><ul><li>[email_address] </li></ul></ul><ul><li>Rishika Kaundal: </li></ul><ul><ul><li>[email_address] </li></ul></ul>