Center for Interprofessional Practice and Education
at Washington University Medical Campus

Summer 2019 Newsletter

News from the Center for Interprofessional Practice and Education & its Community Partners

Select a story below to expand each section.

Together We Can Achieve More: Phase I Curriculum Update

Together We Can Achieve More: Phase I Curriculum Update
Dennis Chang, MD, Chair, CIPE Curriculum Committee

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CIPE needs YOU to help train tomorrow’s health professionals to work more effectively in teams to improve patient outcomes! Our exciting new curriculum requires a full court press of staff, clinicians and faculty across our campus and clinical partners so our 700 first-year learners have the best experience possible.

Details:

For more about this curriculum read below:

Our new curriculum focuses on giving our learners the skills to move from working independently as a health professional to working as a part of a Interprofessional team. Our current health care system makes it extremely challenging to deliver efficient and high quality care but with effective interprofessional teams we can rely on each for support and encouragement as we move toward achieving better health outcomes.

The Phase I curriculum is a kick-off for learners as they embark on this interprofessional journey. This fall 700 learners from 7 different health professional schools will participate in three exciting and interactive sessions. They will learn fundamental communication and relationship skills that they will carry with them throughout their educational and professional careers.

Phase I:

Session I: Social Determinants of Health

September 16-20 & 23 & 24 (Learners attend one afternoon session)

Session II: Collaborative Communication Skills

October 24, 2-5pm

Session III: Client/Patient Perspective

October 29, 2-5pm

Click for more details: Phase I details are emerging

If you volunteer with the Center for Interprofessional Practice and Education (CIPE), you will have the ability to share your knowledge, skills, and experiences with new learners. Because of your dedication and effort they will enter the workforce equipped with powerful tools and a strong desire to collaborate. Additionally, this will be a unique opportunity to interact and engage with clinicians, faculty, and staff from other professions, building a network of colleagues that are dedicated to improving health outcomes in St. Louis. CIPE invites you to join us, because together we really can achieve more. Register Now!

Congratulations 2018-2019 Master Interprofessional Educators!

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Congratulations 2018-2019 Master Interprofessional Educators!

Goldfarb School of Nursing
Deirdre Schweiss
Christopher Guelbert
Kelly Hantack


On June 6, the second cohort of Master Interprofessional Educators was inducted. Christopher, Kelly and Deirdre have completed the requirements to receive this designation. Join us teaching this Fall and learn how you can become a Master Interprofessional Educator!

The Ideal Setting for Interprofessional Practice

The Ideal Setting for Interprofessional Practice
Gloria Grice, Pharm.D., Chair, Steering Committee, CIPE

I have been asked from time to time whether I believe there is an ideal setting for where interprofessional education should best be integrated within the clinical training spaces. Coming from a background in family medicine, I was immersed in both the outpatient clinic and the floors of the hospital. In the outpatient clinic, I worked alongside medical assistants, nurses, physicians, residents (pharmacy and medicine), and students (pharmacy and medicine), as well as office managers and staff to provide optimal patient care to our patients. On a daily basis, I interacted with all these individuals when working with each patient as I optimized their medication management, made recommendations for therapy, triaged various adverse drug reactions, answered medication questions and provided education, to both patients and other clinicians and their trainees.

The continuum of care did not stop at the clinic: It continued to the hospital. Our patients were often admitted to the hospital and we rounded as a family medicine team there. Given that it was the same patients, we were able to seamlessly manage patients in either setting and while transitioning to or from each setting. While the nurses, medical assistants, and staff were different in the inpatient setting, the medical and pharmacy trainees and clinicians remained constant. In the hospital, we intentionally discussed patients, visited them together, and collaboratively designed plans that considered each profession’s expertise and goals, including the patient/family.

I recognize now that I was quite spoiled. I had not only one incredible interprofessional team setting, but two. Having had this experience though, I can confidently answer the question that I get asked all the time. The answer is no. There isn’t anyone particular setting in which interprofessional practice and/or education is best suited or most ideal. This type of practice can be implemented and learned anyplace there are multiple clinicians who work with the same patient. Working together as a team is the goal, whether for acute management or chronic management. Any setting. Every time.

Clarion Experience

Clarion Experience
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Four students from local health profession programs competed in the Clarion Interprofessional Case Competition this past spring: Chanelle Chua (MD), Erika Cook (OT), Danielle Winston (nursing), and Alex Scott (MD).

Somewhat on a whim, and with some interest in healthcare QI, I ended up as one of the student leaders for the WashU Institute for Healthcare Improvement (IHI) student chapter last year. Because we have not previously competed in the Clarion Interprofessional Case Competition, I made it my project to make sure that we put a team together. In partnership with the Health Profession Leadership Council we compiled a team of two medical, one nursing and one occupational therapy student. We came in not knowing exactly what to expect from each other and were pleasantly surprised by the lively team dynamic that we all quickly settled into. The charge to help solve the homelessness crisis in Hennepin came as somewhat of a surprise to us, as the prior year’s cases had much stronger health safety and improvement ties, rather than principally public health ones. Nevertheless, I think the breadth of the topic allowed everyone on the team to have a strong input rather than favoring one member.

Our planning meetings provided an opportunity to open-up to each other about our backgrounds, education, and future careers. Until the third meeting I had no idea what an OT did because it had never come up in any of my courses! Moreover, when we do talk of the roles and responsibilities of the interprofessional team in a lecture or exercise it is focused not on the human side of the practice of medicine, but on rigid formulary of organizational responsibilities. What I really took away from our informal planning discussions was an appreciation for the humanism within each of our roles.

The day of the competition came and went without a hitch. We were eliminated before the finals but our disappointment was a bit abated because the winning teams had pitched very similar ideas to our own. Even having lost I walked away with more knowledge and appreciation than I would have imagined coming in. The presentation is available online. To learn more or learn how to participate in the coming year, contact Alex Scott at arscott@wustl.edu.

Sling Health

Sling Health: Launching Medical Technology Entrepreneurs
Aadit Shah, B.S. Candidate in Biomedical Engineering, McKelvey School of Engineering Class of 2020, University Scholars Program in Medicine

 

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Interested in getting involved with early-stage biotechnology ventures?

Sling Health is a national network of nonprofit medical technology incubators that enables students to become entrepreneurs and create technologies for pressing clinical issues. We bring together top students in business, engineering and medicine (audiology, medicine, nursing, occupational therapy, pharmacy, physical therapy). The students collaborate to address problems submitted by healthcare professionals, and Sling Health provides the necessary infrastructure, training, and mentorship to create improved medical devices and software. You can see more information in Sling’s one-pager.

Our teams are always looking for clinical problems at the forefront of medicine. If you have noticed a problem that affects the quality of or access to healthcare, please submit that problem to Sling. Additionally, if you are interested in playing an active role guiding teams as they solve problems, consider serving as a mentor within our program.

More information can be found on our website at stl.slinghealth.org or by contacting us at info@stl.slinghealth.org.

Here's What We're Reading: Book Review

What we’re reading: Book Review David Hilfiker, MD: “Not All of Us Are Saints: A Doctor’s Journey with the Poor”
Ann Schmidt, MPH ’20 Candidate, Intern, Center for Interprofessional Practice and Education at Washington University Medical Campus.

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We rely on experts to provide us with guidance and expand our knowledge of a specific field. Needing to gain a deeper understanding of poverty medicine, I looked to an expert on the subject. Dr. David Hilfiker went beyond practicing poverty medicine; he submerged himself into the world of his patients. I read his book, “Not All of Us Are Saints: A Doctor’s Journey with the Poor,” in which he shares his experiences living and working in an impoverished neighborhood in the District of Columbia. I was hoping to gain a better insight into the challenges clients and patients may be facing and identify effective strategies to help improve their health and lives. I will share how Hilfiker’s book attempts to shed some light on a place where the traditional medical model has too often failed.

Called to improve a system that has abandoned the poor, Dr. David Hilfiker and his family chose to forego the comforts of middle-class life to live in a poverty-stricken neighborhood of Washington, D.C. He previously practiced in a rural area of Minnesota, where he was the local general practitioner, and often wore the hat of various specialists. He was surprised to find his patients in Washington, D.C., had the same ailments and conditions as his patients in Minnesota. Patients presented with hypertension, diabetes, depression, and substance abuse, but the outcomes were drastically different. Patients in Minnesota got better, but in Washington, D.C., they did not. He needed to determine why treatment was successful in one place but not other. He discovered these patients needed far beyond what conventional medicine was able to provide and was often helpless to provide any meaningful aid.

Hilfiker described the separation between himself and his patients as being a great bottomless abyss or dense fog, unable to be crossed. He would never be able to experience or relate to their situation. Hope is lost for many, often at a very early age. Their circumstances were so dire, there was little hope to rise above it and live even a remotely normal existence. Additionally, they faced many barriers: lack of education, terrible shelter conditions, lack of access to health care, no transportation, no financial resources, the lure of drugs and alcohol, and no supportive community.

Hilfiker’s experiences highlight that health is determined by many factors, and is not merely the presence or absence of disease. Hilfiker found the circumstances of the lives of people he served were a far greater risk to their health than the common medical conditions they presented with. We will never begin to understand all the factors that influence an individual’s health, and we may not always have the tools and resources to address the challenges they face, but we can begin to change the way we approach health by considering what it is clients and patients really need to be successful on their journey to health and well-being. We can share the hope and promise of a healthier future by forming an interprofessional community to rally around clients and patients. Sharing resources, skills, and assets can act as a powerful force to eliminate the barriers and moving toward a healthier life.

Hilfker, D.(1994) Not All of Us Are Saints: A Doctor’s Journey With the Poor. Hill and Wang, New York; Harper Collins Canada Limited, Toronto.

Multifaceted Approaches to the Opioid Epidemic: St. Louis Edition

Multifaceted Approaches to the Opioid Epidemic: St. Louis Edition
Presentation at St. Louis College of Pharmacy, May 15, 2019
Ann Schmidt, MPH ’20 Candidate, Intern, Center for Interprofessional Practice and Education at Washington University Medical Campus.

Opioid-related harms and overdose deaths have been increasing at alarming rates across the United States. A panel of local experts united to discuss the complexity of the ongoing opioid epidemic and offered insight into the successes and challenges of developing and implementing an effective response. Panel members represented multiple fields and offered unique perspectives on how to address this national crisis. The panel included individuals working in the community setting as well as researchers from local institutions.
 
All presenters highlighted the scope and severity of the problem. Response strategies need to tackle supply and demand issues. This includes a combined effort of limiting the availability of medications for misuse through safe medication practices and proper storage and disposal, the use of alternative pain treatment and management, and using harm-reduction strategies. Throughout the presentation, access to evidence-based treatments and effective long-term management of opioid use disorder was a primary solution for combating the problem of demand. Presenters offered safe medication practices and more convenient prescription drug disposal as solutions for reducing supply. Presenters provided insight into the barriers they have faced when trying to achieve these goals. Additionally, the panel discussed the roles of law enforcement, prescribers, and other health care providers in the opioid crisis and how those roles intersect.
 
The opioid epidemic is a public health crisis with far-reaching effects. Experts representing a variety of fields, including pharmacology, anesthesiology, neuroscience, health policy, psychology, sociology, and criminal justice came together to share findings and provide guidance moving forward with the continuing effort to prevent opioid-related harms and overdose deaths. Panel members presented how their specific work relates to the opioid epidemic. The following is a summary of the main topics discussed.

The following graph shows the trend of opioid overdose deaths over the past two decades:

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Both prescription medications and illicit drugs have contributed to the increase in overdose deaths over time. Recently strong synthetic opioids have caused a sharp increase in incidence of overdose deaths.

Primary solution: Treatment for opioid addiction and dependence using Medication-Assisted Treatment (MAT).

  • Most commonly prescribed MAT medications:
    • Methadone
    • Buprenorphine
    • Buprenorphine with naloxone (Suboxone)
  • Challenges:
    • Effectiveness of treatment
    • Access to treatment
    • Drug disposal

Effectiveness: Medication-Assisted Treatment (MAT) using methadone, buprenorphine, or Suboxone is the preferred treatment for opioid addiction and dependence compared to non-Medication-Assisted Treatment options. These medications are designed to reduce severe withdrawal symptoms, which may interfere with treatment success. Primarily addressing physical withdrawal, buprenorphine and methadone are limited in the long-term management of opioid use disorders, which may require the addition of psychotherapy. Without comprehensive treatment and well managed withdrawal symptoms, individuals remain at risk for relapse.

Researchers are working to better understand negative withdrawal symptoms and accompanying depression and anxiety. Research is being conducted to determine if a new pain relief medication with an improved side effect profile could be developed, limiting the negative and addictive effects associated with currently available medications.

Access to treatment: Presenters working in the community expressed concerns over access to treatment particularly for underserved and high-risk populations. These populations include pregnant women and new mothers, in addition to many others lacking the resources and experiencing barriers to care. Presenters cited financial stress, delays in treatment approval, and loss of insurance coverage as common barriers.

There has been an increase in financial support and other resources from the federal government. Participants voiced concern about the distribution and allocation of these resources. There was discussion around the social determinants of health and how these factors influence access and treatment.       

Drug disposal: Proper disposal of unused medications is crucial in preventing opioid diversion. Collection of unused medication is becoming easier, but barriers remain. More convenient and accessible drop off locations need to exist, but the cost of disposal remains a barrier. There are options for at home disposal. Patients can be provided substances that neutralize leftover opioids when picking up a prescribed opioid at the pharmacy. Patients need to be educated on the risks and dangers of keeping unlocked, excess medications in the home and be provided easy options for disposal, as disposing of medications into the sewer system is discouraged.

Legal aspects of the opioid crisis:

Roles of law enforcement, prescribers, and health care providers: Professionals working closely with the various aspects of the opioid crisis have experienced a shift in roles. Law enforcement officers are now administering life-saving medications such as naloxone and providing emergency medical care to those experiencing an overdose. Law enforcement is holding prescribers legally liable and accountable for prescribing practices resulting in harm. Pharmacists have taken an active role in surveillance and enforcement. There has been a change in how those suffering from substance use disorders are viewed and the approaches used to manage their care, shifting from criminal focused to recovery focused.          

Collaborative and multifaceted approach:

Prescription Drug Monitoring Program (PDMP): PDMPs link pharmacies, state insurance programs, healthcare licensure boards, state health departments, law enforcement, and providers together to share information pertinent to prescribing practices and patient behavior. These large systems, all impacted by the opioid crisis, have struggled to communicate with each other. PDMPs are a state-run solution for the disconnect in communication.

Sharing sensitive information with different users and agencies creates the opportunity for input error, may lead to misuse of information, and potentially jeopardizes the security of personal health information. Some participants raised concerns about misuse of data when PDMP data is combined with other datasets, such as criminal records.

However, PDMPs are information-sharing tools that can aid in detecting overprescribing and are designed to reduce the rate of overdose death attributable to commonly prescribed opioids. Obviously, the possession and use of heroin and other illicit forms of opioids is more challenging to track and monitor.

Opioid-related harm and overdose death is a public health crisis. The panel combined voices from multiple disciplines that share a common goal, successful response to the crisis. A unified and collaborative approach is crucial to achieving this goal.

Panel Members

Ream Al-Hasani, PhD, Assistant Professor, Pharmaceutical Science, St. Louis College of Pharmacy & Anesthesiology, Washington University in St. Louis

Liz Chiarello, PhD, Assistant Professor of Sociology, Saint Louis University

Brandon Costerison, Project Manager for the MO-HOPE Project, National Council on Alcoholism and Drug Abuse – St. Louis Area

Alicia Forinash, PharmD, Professor of Pharmacy Practice; St. Louis College of Pharmacy

Jose Moron-Concepcion, PhD, Associate Professor, Anesthesiology, Washington University in St. Louis

Amy Tiemeier, PharmD, Director of Community Partnerships, St. Louis College of Pharmacy

Melanie VanDyke, PhD, Associate Professor of Psychology, St. Louis College of Pharmacy and St. Louis Behavioral Medicine Institute