1. Establishment of an Interprofessional Geriatric Clinic for Family Medicine Resident Education University of Alabama, College of Community Health Sciences, Family Medicine Department Anne Halli-Tierney, MD Dana Carroll, PharmD Robert McKinney, MSW Melanie Tucker, PhD Rebecca Allen, PhD

2. Disclosures We have nothing to disclose.

3. Objectives Describe the development, planning and implementation of an interprofessional geriatric clinic for family medicine resident education and patient care. State the benefits of interprofessional geriatric patient care from each disciplines’ perspective. Identify barriers and challenges to implementing and continuing an interprofessional geriatric clinic.

4. Historical Perspective Development & Planning –Need for ambulatory geriatric care – Consider the population: FM clinic serves 7 county area in west Alabama –6 of the 7 counties are considered some of the poorest in the state –19 to 36% of population in these counties are at or below the poverty line –Interdisciplinary approach was desired Partners/disciplines to invite –Clinic Space considerations Patient care Teaching with a team –Clinic support considerations Staff, billing, etc –Revenue considerations –Educational approach

5. Historical Perspective Planning & Implementation –Spring 2009 –½ day every other week –Multidisciplinary Geriatrician –FM resident Pharmacy –Pharmacy student/resident LPN/MA

6. Historical Perspective Implementation challenges –Space allocated was not sufficient –Scheduling template –Demand for services grew quickly Hire another geriatrician –Resources needed grew Other disciplines expertise needed –Multidisciplinary vs interdisciplinary approach

7. Current Geriatrics Clinic - evolution Implementation in November 2011 –Increased clinic from ½ day every other week to two ½ days per week Initial plan for ½ day teaching clinic and one private clinic but learner demand led to two ½ days teaching Interdisciplinary approach –Disciplines represented in 2011: Medicine, nursing, pharmacy, geropsychology –Social work added on prn basis 2013 –Health coaching/chronic care follow-up added 2016

8. Current Geriatrics Clinic: the players Medicine: Geriatrician, Family Medicine intern on Geriatrics rotation, occasional medical student on interdisciplinary geriatrics elective Pharmacy: Clinical Pharmacist, pharmacy students and pharmacy residents Psychology: Clinical geropsychologist (on call), graduate clinical geropsychology students Social work: Clinical social worker (on call), social work interns Health coaching: Clinical health educator (on call)

9. Current Geriatrics Clinic – Patient care Patient care flow: –All new patients seen by nursing staff, pharmacy, medicine, and psychology learners, social work intern (if needed), and medicine attending Pharmacy student performs complete med reconciliation (emphasis on PIMs and polypharmacy) Geropsychology student performs mental status, depression, anxiety and health literacy screenings Family medicine intern performs medical assessment with eye to ADLs/IADLs, life-space consideration and QOL Social work intern performs psychosocial and needs/resources assessment –Follow-up patients seen by nursing, pharmacy and medicine, with psychology/social work on periodic assessments

10. Benefits of Interdisciplinary Education in Geriatric Clinic Interprofessional Education = students from 2 or more disciplines learning with, from, and about each other Family Medicine resident perspective: disease process, bodily healing, care vs/cost, learning cases Psychology doctoral student perspective: mental health, therapeutic counseling, dementia care PharmD student perspective: polypharmacy, med interactions, cost of pill burden BS/MS social work student perspective: biopsychosocial model, home environment, access to resources

11. A learning environment: “Cross-pollination” Expectations of learners in clinic If learner has question of another discipline, learner is expected to ask a student first (not attendings) Space permitting, learners expected to go with another discipline to assess a patient Learners are expected to put the patient first in their educational endeavors and create a patient centered care plan Learners expected to present their findings to the group and come up with comprehensive treatment plan If time permits learners are encouraged to discuss nuances of their discipline with others –“What I can do and what I wish you knew about me” –“How I learn and how I am trained”

12. Benefits of Interdisciplinary Education in Geriatric Clinic Team based care= optimized patient care in “real time” Learn to work within a team in a clinic Understand, appreciate and respect other disciplines knowledge, skills, and view points/approaches to patient care Learn new ways of thinking Gain new knowledge

13. Barriers/Challenges to IPE in Geriatric Clinic Clinic space to accommodate a large team Clinic space/rooms to accommodate longer patient visits Scheduling Language (jargon) Flow of care in a visit Continuous team turnover (learners) Discipline availability Culture of “MD leader” to be dispelled Buy in of learner as “teacher” of their discipline Buy in of “staff” to incorporate “learners”

14. Outcomes: Is the chaos worth it? Numbers of Learners taught from October 2011 – September 2015: 156 –48 Family medicine residents, 2 medical students –57 Pharmacy students/residents –26 Social work students/interns – 21 Geropsychology graduate students – 2 Nurse practitioner students Popularity of experience among learners –Popular rotation among students –Learners requested increase in clinic time –Learners have requested electives Increase in interdisciplinary collaborations –Effect persists after clinic exposure –Learners recognize benefit of interdisciplinary contributions Benefit for career building –Clinic experience a large plus in internship interviews Opportunities for QI projects, population/education research

15. Current research projects iPad database project: run by psychology: collecting mental health data in database for community sample analysis: 3 posters presented locally/nationally Pharmacy outcomes project: run by pharmacy: collecting data on PIMs/Beers list meds on geriatric clinic patients: poster presented locally/nationally

16. Research Opportunities Student outcomes –Knowledge/comfort working with other disciplines Patient outcomes vs. non-IPE clinics –Subjective feelings –Objective outcomes Case vignettes –Watch students process cases together –Follow-up survey

17. Future Directions Developing a plan to make clinic mobile –Local apartment complex with high density geriatric population, many current UMC patients Considering implementation of Comprehensive Geriatric Assessment –Cognitive, affective, ADL & IADL, nutrition, mobility, safety Adding Nutritionist/students to team Adding Nursing students to team

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