Michigan College of Optometry Interprofessional Wellness Clinic: Focus on Diabetes

The Interprofessional Wellness Clinic held at the clinic of the Michigan College of Optometry at Ferris State University is an interdisciplinary patient care and educational project that has been in existence since January 2004. The objective of this endeavor is to develop an interdisciplinary collaborative clinic utilizing optometry, nursing, and pharmacy students and faculty to facilitate the understanding and appreciation of the contribution of each profession to the total management of diabetes. Additionally, each patient receives discipline-specific education and management from each profession, resulting in a much improved understanding of their disease state, medications, modifying factors, and personal support from multiple disciplines. This article describes how the Interprofessional Wellness Clinic functions, the impact of collaborative interdisciplinary interaction and learning, and the benefits of such a clinic to patients, students, and faculty of the clinic. Received: 2/16/2011 Accepted: 03/28/2012 Published: 04/17/2012 © 2012 Luplow. This open access article is distributed under a Creative Commons Attribution License, which allows unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction In the United States, 18.8 million Americans have been diagnosed with diabetes and an estimated 7 million people in this country have undiagnosed diabetes (CDC, 2011). The combined total (25.8 million) of those with diagnosed and undiagnosed diabetes is 8.3 percent of the nation’s population (as of 2010). Diabetes preferentially affects the elderly population. It is estimated that 26.9 percent of Americans 65 years of age and older are diabetic (CDC, 2011). Additionally, 35 percent or 79 million adults in the United States age 20 and older are considered to have prediabetes with blood sugar levels or glycosylated hemoglobin A1c levels higher than is considered normal yet not sufficiently elevated to be considered diabetic (CDC, 2011). Given these statistics, it is not surprising that the costs related to diabetes are substantial with an estimated $116 billion in direct medical costs and $58 billion in indirect health-related costs in the United States alone (CDC, 2011). With rising healthcare costs, it has become progressively evident that efficiency for both patients and practitioners must be increased significantly. As such, interprofessional healthcare is a trend in the delivery of health-related services which is becoming increasingly common. The efficiency provided by an interprofessional healthcare setting is of vital importance to the healthcare system in general as the full spectrum of care can be more effectively delivered to patients. This becomes more crucial in a climate which is facing an increasing shortage of providers in certain geographic regions. In interprofessional healthcare, communication between practitioners becomes the key element which places the patient as the focus of the healthcare system (HealthForceOntario, 2010). H IP & Michigan College of Optometry EDUCATIONAL STRATEGY 1(2):eP1021 | 2 Canada has become a leader in the implementation of interprofessional care and is often looked to by others as a system to model in employing similar techniques elsewhere. A study in Ontario cited the need to provide integration between the education of healthcare providers and the health services that will ultimately employ those healthcare professionals after graduation. Those providers and institutions involved in the study identified fundamental and essential competencies needed by providers, students, and their respective institutions. Also, the functions and responsibilities of each discipline within the interprofessional care group were firmly established to better define the roles of each profession in the system (HealthForceOntario, 2010). The United States has been advancing the interprofessional healthcare movement with a rapid increase in the availability of interprofessional healthcare services. With the growth of this model of healthcare delivery, it is imperative that it be embraced by educational institutions and the end users of graduating healthcare providers, the healthcare system itself. One of our goals in the establishment of the Interprofessional Wellness Clinic is to expose our students and local healthcare providers to one model of interdisciplinary care. This is designed to enhance understanding and to motivate potential implementation of an interprofessional healthcare delivery arrangement on a larger scale. In many ways, diabetes is an ideal medical condition on which to focus a multi-disciplinary model of healthcare delivery. It is a very common condition, making patient recruitment relatively straightforward. Since diabetes affects multiple organs and body systems, various healthcare providers are required to evaluate, treat, and monitor the disease. Additionally, with the utilization of the appropriate healthcare providers, many of the complications of diabetes can be avoided with proper care and patient education. With the delivery of care in one facility utilizing multiple healthcare disciplines, there is an economy of scale reduction in costs to patients and insurance carriers. Conducted in physically separate clinical settings with the various disciplines needed in diabetic care and education, patients can readily miss crucial aspects of total diabetic treatment and support. This is due to multiple variables including excessive cost, availability of care in a rural area, lack of preventative chronic care facilities, sometimes insufficient inter-provider communication, and transportation issues. These factors are in addition to the sheer overwhelming nature of the coordination of care and navigation of insurance issues for the patient (Zgibor & Thomas, 2001). A clinic was instituted in a primary care center at an academic Veterans Healthcare System clinic utilizing the concept of the Shared Medical Appointment (SMA). In the SMA model, multiple patients in a clinic see multiple interprofessional healthcare providers. In this quality improvement study, diabetic patients with known cardiovascular risk factors were examined and/ or counseled by an internist, nurse practitioner, nurse, pharmacist, and psychologist. This was a relatively substantial departure from the multiple single-practitioner visits that had been the traditional style of patient examination and counseling practiced previously at this facility. In this model, measured outcomes indicated that there were both reduced diabetic and cardiovascular risk factors after examination and patient education at the clinic. There were, however, logistical obstacles that needed to be overcome for the clinic to run as efficiently as possible. The success of the clinic was deemed to be of significant enough proportion to continue the diabetic clinic as well as to institute similar clinics in other patient care areas. This was designed to increase efficiency and efficacy of total patient healthcare and did accomplish that goal (Kirsh et al., 2007). Ferris State University, the home of the Michigan College of Optometry, is located in Big Rapids, Michigan. It is situated in a rural area with a reasonably large patient population considered to be less than adequately cared for regarding many health issues. This is in part due to a generalized shortage of healthcare facilities and providers but also due to varying levels of impoverishment. This results in an inability on the part of some patients to pay for healthcare services and supplies. This was part of the target patient population of the clinic. Any other patients who are diabetic are also encouraged to utilize the services of the clinic whether or not they have health or vision insurance. One of the initial goals of the Interprofessional Wellness Clinic was to go into the community and perform diabetic screenings. The purpose was to identify those potential patients who had elevated blood glucose levels relative to the amount of time since the patient had last eaten. Patients who demonstrated high blood sugar levels were referred to the clinic. The clinic also depended on referrals from the other allied health proH IP & ISSN 2159-1253 Health & Interprofessional Practice | commons.pacificu.edu/hip 1(2):eP1021 | 3 fessional education programs at Ferris State University as well as local healthcare providers. At this time, the clinic receives patients primarily from word of mouth referrals, repeat patients, healthcare provider referrals, and recommendations from health screenings which are still occasionally offered. In this specialty clinic at the Michigan College of Optometry, we utilize the diabetic eye examination as a means to attract patients to the clinic. Regular ocular examinations are necessary for these patients and we deliver value-added care that is provided by nursing and pharmacy students and faculty. From a patient care perspective, the objective of the Interprofessional Wellness Clinic is to offer multidisciplinary evaluation, treatment, and education to each diabetic patient. The ultimate goal is to provide the patient with comprehensive diabetic care from optometry, nursing, and pharmacy. Each discipline is also responsible for educating each patient completely in the context of the given discipline and the total health of the individual. This education is given with regard to the degree of the effects of diabetes on each patient. This is followed by offering guidelines concerning the means by which the patient is able to further control the effects of diabetes or prevent subsequent damage from occurring. However, some studies and meta-analyses indicate that such education, while accomplishing reductions in hemoglobin A1c and blood sugar measurements, generally produce only modestly improved results (Gary, Genkinger, Guallar, Peyrot, & Brancati 2003; Deakin, McShane, Cade, & Willi