Day 2 Patient Case Discussion

Interprofessional Health Education 2011-12 Curriculum Day 2 – Patient Case Discussion

Summary of IPE Day 1: Irene P. Hendricks-Eagan is a 58-year-old woman who presented to the [your institution] Medical Home with “a toothache and back pain” on [insert Day 1 date]. At this visit, she reported that she had not seen a primary care provider for approximately two years. She also does not remember the last time she has seen a dentist because of difficulty finding affordable health insurance coverage. Mrs. Eagan’s late husband worked as an electrician and she used his insurance until four years ago when he passed away in a car crash. Because her part time job as a teacher’s aide did not offer health insurance, she attempted to purchase a private plan. However, because of her prior health conditions, she was not able to find an affordable plan and began paying for doctors’ visits out-of-pocket. After losing her job due to state budget reductions, she was no longer able to afford her mortgage. Mrs. Eagan was forced to leave Fresno and move to San Francisco County with her cousin in low-income housing. Upon learning of the Healthy San Francisco program, she enrolled in a medical home. Since her toothache became unbearable, she made an appointment to see a dentist.

At the appointment, the dentist determined that she had severe dental caries on tooth numbers 2, 3, 14, 18, and 28—with #28 requiring extraction. It was found that Mrs. Eagan also has periodontitis exacerbated by her poorly controlled diabetes. Before performing dental work, the dentist referred Mrs. Eagan to primary care and. A follow up appointment was made in one week for extraction of tooth #28. She kept the appointment and underwent the procedure. The dentist prescribes Ibuprofen 600mg every 6 hours as needed for pain after the extraction. While Denti-Cal no longer covers preventive care for adults, tooth extractions for painful or infected teeth remain covered. Therefore, the cost of Mrs. Eagan’s did not sustain any out-of-pocket expenses.

At the medical home visit, Mrs. Eagan met with physician, to discuss pain management and her overall care plan. She also met with pharmacist for medication management. The pharmacist discussed medication side effects and adherence strategies. The nurse discussed lifestyle and nutritional modification for diabetes control, and the physical therapist discussed an exercise plan to help alleviate her back pain and improve general health. Although Mrs. Eagan has a long history of smoking two packs of cigarettes per day, she was not ready to talk about quitting during this appointment.

Today’s Date: It is now four months later and Mrs. Eagan visits your dental clinic again complaining of severe tooth pain and swelling. Mrs. Eagan reluctantly comes to the student dental clinic today due to a painful tooth infection and a fever that has lasted for the last three days. Upon assessment, she is found to have a fluctuant abscess in the lower left vestibule, associated with tooth #18. Mrs. Eagan has slightly elevated blood pressure (150/90), but it is within acceptable limits to perform the incision and drainage of her abscess. After the appointment, she is referred to primary care for follow-up of her diabetes management.

PMH: Diabetes – Diagnosed 2007 Hypertension – Diagnosed 2005 Dental Caries – Diagnosed on IPE Day 1 Extraction - Tooth #28 10/5/2011 Periodontitis – Diagnosed on IPE Day 1 Chronic Back Pain – Diagnosed on IPE Day 1 Post-menopausal FH: Mother – Diabetes, Deceased 2005, Age 77, lost all teeth at the age of 47, wore dentures most of her life. Father – Hypertension, Deceased 2002, Age 74 SH: Husband deceased due to car crash, 2007, has 2 children who live out of state. Smokes 2 packs of cigarettes a day for 25 years Denies use of alcoholic beverages Lives with her cousin in San Francisco in low-income housing Allergies: NKDA

Medications: Rx (as of last visit on IPE Day 1) Metformin 1000mg PO BID Hydrochlorothiazide 12.5mg PO Daily Lisinopril 20mg PO Daily

OTC ( patient reported today): Tagamet 200 mg PO after meals Advil 2-3 liquid gel-caps PRN tooth pain Q 6 hours 1. Based on the patient record above, please prioritize in order of importance all of your concerns for Mrs. Eagan. These can include health and socioeconomic concerns. (7 minutes)

2. For each of the conditions or health concerns listed above, do you think that any one profession should be the main profession to manage treatment and/or perform counseling? Do you think any health concerns/conditions should be managed by all of the health professions? Which ones? Why or why not? (8 minutes) 3. There are some holes in Mrs. Eagan’s patient profile above. What information would you like to get from the patient? What lab values will you need to obtain for her visit with primary care? (5 minutes)

4. As a group, develop a rough patient care plan regarding 3 to 4 of the health concerns you listed above (25 minutes). 5. Brainstorm how the curriculum at your institution would need to change in order to prepare students to work with this patient as a team. (8 minutes)

6. What are some barriers to interprofessional collaboration in this patient case? How can you overcome these barriers? What barriers does interprofessional education have at your institution? (7 minutes)