Interprofessional Education Sites
Interprofessional Practice and Education (IPE) projects are being developed in fourteen Minnesota communities with support from the University of Minnesota Academic Health Center and funds from the Minnesota Medical Education Research Costs (MERC). The intent of the IPE grants is to stimulate long-term partnerships in interprofessional education through the development and support of interprofessional health care practice in partnership with community-based healthcare providers. The program focuses on developing educational experiences that are interprofessional and that demonstrate the positive impact of interprofessional care on community health outcomes. Funding for the IPE projects began in 2004 with two communities; two communities in 2005; five community projects in 2006; and five new community projects in 2007. A brief summary of each of the projects follows.
The challenges and opportunities of creating expert interprofessional teams are shared by all of the developing projects.These projects are moving forward and are creating unique learning situations for health professions students. The projects work in partnership with the Minnesota Area Health Education Center (AHEC) Program Office, Minnesota AHEC Regional Directors and the Minnesota AHEC Faculty Leadership Council to address challenges, bridge resources, and increase collaboration across the state.
Iverson Corner Drug Inc. in Bemidji received funding in 2008 and is establishing their project to address an interprofessional approach to management of homecare patients. Students from pharmacy, nursing, medicine, physical therapy, respiratory therapy and social work will meet weekly with at least one licensed health professional facilitating discussion of participating homecare patient’s cases. Each student will have input in their area of training. They will bring questions related to care back to their preceptor for input following the meeting. They will then send written recommendations to homecare for appropriate patients prior to the next meeting. In addition, for participating patients with specific a diagnosis such as asthma, COPD, coronary vascular disease, a pharmacist will provide a medication therapy management review upon admission to home care. This project already has a functioning interprofessional home health care team in place and will begin integrating students in 2008.
Brainerd received funding in 2006 to focus on childhood obesity. They are targeting obese youth at the grade school-level. The project is focusing on measuring the BMIs of 2nd grade students at a local elementary school. The interprofessional health care team is seeking to engage the school nurse and teachers in this program and hopes to implement the Walking School Bus program for the 2008-09 school year. The scope of this project is still being defined and collection and analysis of data will begin with the 2008-09 second grade class. Disciplines considered necessary for inclusion are: physicians (pediatrics, family medicine, and endocrinology), pharmicists, public health students, nurses, dieticians, teachers, physical education teachers, and a diabetic educator.
Central Lakes Clinic/Cuyuna Regional Medical Center in Crosby was funded in 2008 with a focus on preventative health care for Medicare patients. Preventive care delivery to Medicare patients is thought to be underutilized. According to AMA documents, less then 0.05% of 2005 newly enrolled Medicare patients received the Initial Preventive Physical Exam. Providing the Initial Preventive Physical Exam in a shared visit format, with an interprofessional team of providers, should increase the likelihood of Medicare patients receiving preventive care. The Crosby team consists of a physician, pharmacist, nurse and physical therapist. They welcome students from medicine, dentistry, nursing, physical therapy, and pharmacy to participate. Each team member will bring unique education and screening expertise to the sessions.
The primary goal of this group is to increase public and health professional awareness of the impact of falls in the elderly, and to assess those at risk for falling. The work centers on identifying those at risk for falls through poly-pharmacy medication management, educating on lessening the risk of falls, considering efforts necessary for home and environmental improvements, and measuring outcomes of interventions. The falls committee that was developed will make recommendations to the patient, their physician, and the rest of the patient's health care team, once they have been referred to this committee for review. Team members conduct in-home visits to assess falls risks. Funding was received in 2005. The group has representation from pharmacy, nursing, medicine, social work, and physical therapy. Students from pharmacy, nursing and medicine in the Rural Physician Assistant Program (RPAP) are actively involved. This project also welcomes physical therapy and occupational therapy students. Students attend Falls Committee meetings, help prepare PowerPoint presentations on Falls (one for public and one for health professionals), collect and collate references relating to falls, help develop fall assessment tools/documents, communicate with public health nurse to help coordinate home visits, review medical records prior to home visits, and make home assessment visits with IPE team and make reports to Falls Committee.
Because of the sizable geriatric population of the community, the low income levels of the population, high rates of obesity, and the increase in the incidence of Type 2 diabetes, Fairview Mesaba Clinics (FMC) /Range Regional Health Services (RRHS) identified diabetes as their community-based initiative. Funding was granted in 2005. The Diabetes Education interprofessional team consists of three nurses (two of whom are Certified Diabetes Educators or CDE), two dietitians (one is CDE), a pharmacist, and a primary care provider. Students in RPAP medicine, dentistry, pharmacy and nursing are involved in the project. Students help develop portions of the diabetes education classes and assist with health screens. In 2007, the project expanded to work more closely with the SAGE clinic in diagnosing and educating patients on cardiovascular disease.
Montevideo’s project, funded in 2004, is designed to provide comprehensive community prenatal education. The goals for this program include reduced pre-term labor incidence, improved birth outcomes, health promotion education, and increased access for at risk populations. Team members include a physician, nurses, a pharmacist, a dietician, and a physical therapist. RPAP medical students have been involved in the project so far. Students develop and present information to patients during education classes. Dental, nursing, pharmacy, and physical therapy students are welcomed.
Moose Lake’s Community Geriatric Project focuses on reducing re-hospitalizations among the highest risk elderly population. Elderly inpatients are screened by a dedicated staff member and at-risk elders undergo a comprehensive assessment of their health and medications. The interprofessional team, including providers and students, identifies potentially beneficial interventions and medication changes and communicates them to the patient’s primary physician. RPAP medical, pharmacy, nursing and physical therapy students have been engaged in the project. Students have piloted the chart review tool being used, attended team meetings, and assisted in project planning. Students from physical therapy, occupational therapy, social work, dentistry, and advanced practice nursing are also welcome.
In 2006, the Fairview Mesaba Clinic in Mountain Iron received funding to deliver preventive health and wellness education and obesity management to their selected population. Their goal is to create environments that encourage and support behaviors surrounding physical activity and healthy eating with the aim of reducing obesity. The interprofessional team includes members from medicine, exercise physiology, dietetics, and nursing. The group also works closely with the established Diabetes Resource Team (certified diabetic educator, registered clinical dietitians, pharmacy, and primary care providers). Students from medicine, nursing, and pharmacy are currently participating. Students have been involved in community education, K-12 outreach, provider development, and participated in meetings. Students from dentistry, dietetics, physical therapy, and occupational therapy also welcome.
New Ulm Medical Center’s (NUMC) Community Focus Committee received funding in 2006 for an initiative focused on decreasing the incidence of childhood obesity. The Community Focus Committee includes two physicians, two registered nurses, five medical center staff from various departments, a pediatric dietician, and two community members. Students from RPAP medicine, dentistry, public health, healthcare administration, pharmacy, physician assistants, nursing, dieticians, and physical therapy students have been involved in the project. Students have developed and delivered presentations to community members and grade-school students, developed a marketing plan, and have facilitated support groups. Events and efforts implemented by the group include Family Fitness Night, the Shape-Down program, presentations at schools, the Fit Kids program, and the DAAN program.
The Broadway Clinic in North Minneapolis received funding in 2008 to address the complex set of issues the clinic’s patients present as an interprofessional team. The community of North Minneapolis is a medically under-served, lower socioeconomic community whose members who have fewer resources than average. There is a high prevalence of unemployment in our community. Most patients presenting to our clinic have multiple medical problems all impacted by their economic status and community resources. The Broadway Clinic team will consist of family physicians, a psychiatrist, a pharmacist, a nurse practitioner, a social worker, a dental student, a marriage and family therapist, and a psychologist. All the above are on staff and have extensive training in their field and at least 3 years of education experience. Students from all of the above professions are welcome and will work together to assist with problem identification and to implement solutions.
The Center for Weight Management funded in 2006, a service of St. Joseph's Area Health Services based in Park Rapids, provides bariatric medicine services to patients from both Minnesota and North Dakota. The interprofessional team consists of physicians, dietitians, nurses, exercise specialists, social workers, psychologists, pharmacists and others who work with patients individually and in groups to improve their overall health. This team facilitates both surgical and non-surgical weight management. Students from health care administration and dieticians have participated. Students have helped develop a manager/student assessment survey. The team seeks to engage more students and expand the roles of those students. The team will welcome nursing, pharmacy, dietician/ diet techs, clinical laboratory scientists, surgeons, primary care providers, exercise physiology/physical therapy, and social work/mental health students.
Fairview Northland Medical Center received funding in 2008 to provide interprofessional medication reconciliation and medication therapy management (MTM) for their patients. Northland Medical Center provides care to patients beyond its facilities, including specialists and nursing homes in the area. Physicians, pharmacy and nursing work together to collect, and review patient medication lists, then update the electronic medical record to provide both the next provider and the patient an accurate Medication List. This project focus will enhance the medication reconciliation process by collaborating with local nursing homes and specialists that see patients in the geographic area. The interprofessional team will also develop a MTM practice in the Northland Clinics providing care in Diabetes, Lipid Management, Smoking Cessation, and Blood Pressure Management. These programs will work with the primary care provider, specialists, other special education programs in place and the patients. All members of the health care team will need to be fully engaged, including providers, nursing, pharmacy, and nursing home leadership. The current Medication Reconciliation team includes hospital and clinic representation. The team will expand to include nursing home representation and specialty clinics. This project will provide unique learning opportunities for students in nursing, pharmacy, physician assistant and medicine programs.
The Mid-Minnesota Family Medicine Center (MMFMC) in St. Cloud has identified their Memory Disorders Clinic (MDC) as the focus of the interprofessional education project. Their funding was granted in 2006. The MDC provides early evaluation and treatment for individuals experiencing cognitive symptoms for patients with Alzheimer’s disease and other related dementias. The MDC provides a comprehensive geriatric assessment of eligible patients using an interprofessional care model including a medical social worker, nurse practitioner, medical director, administrator and an occupational therapist. Occupational therapy (OT) students, pharmacy students, social work students, medical students, nursing students, and residents are involved with the group. Students have had the opportunity to observe the assessments by the occupational therapist, social worker, and nurse practioner, and attend the family care conference.
The Lakewood Health System in Staples received funding in 2008 to develop an interprofessional focus on palliative care for those not yet in Hospice care. The intent is to assist and empower individuals to remain active and functional as long as possible. Patients with advanced diseases need and deserve excellent symptom management, capable psychosocial support, assistance with difficult medical decision making, and warm, healing relationships with their professional caregivers. Palliative care is a field developed to help meet those needs of patients and their families. Although palliative care is appropriate for patients at all stages of serious illness, hospice is a specialized form of palliative care directed at patients who are in the terminal stages of illness. An internal interprofessional team consisting of RNs, CNAs, social worker(s), chaplains including a bereavement chaplain, pharmacist(s) and physicians will ensure the team will be successful in addressing palliative care and enabling individuals to stay independent for longer, therefore promoting a better quality of life. Health professions students who will be participating in the team will go through book training, lectures, job position shadowing, etc. These training and education efforts will be given directly by a medical professional from the team.