una vida sana! stfm pre-doc

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¡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• VCU SOM, SON, SOP• 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

Partners

•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

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

Screening events

Check in

Blood test (Cholesterol and blood

sugar)

Blood pressur

e

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 protected]

• Allison Gregory:– [email protected]

• Rishika Kaundal:– [email protected]

una vida sana! stfm pre-doc

Health & Medicine

community health

community partners

community clinics

community engagement

adult hispanic community

communitybased project

health profile

hours of health care