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Una Vida Sana! STFM Pre-Doc

Una Vida Sana! STFM Pre-Doc



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

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 Una Vida Sana! STFM Pre-Doc Presentation Transcript

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