A Pharmacy Student–Facilitated Interprofessional Diabetes Clinic With the Penobscot Nation

Abstract

BackgroundAmerican Indians/Alaska Natives have a greater increased risk for diabetes than non-Hispanic whites. Lifestyle interventions are effective in preventing and treating diabetes, and an interprofessional approach is important in diabetes management.Community ContextThe Penobscot Nation has a health center with a wide range of services. Our goal with the Nation was to 1) establish an interprofessional, student-facilitated diabetes clinic in the health center; 2) assess the clinic’s preliminary impact.MethodsRelationship building and problem solving was instrumental in working toward the first goal. A survey was developed to assess satisfaction with the clinic. The clinical outcomes, mean and median values of HbA1c, were calculated at baseline (spring 2013) and were used to establish 2 groups of patients: those with controlled levels (<7%) and those with uncontrolled levels (≥ 7%). HbA1c was reassessed in fall 2013. Changes in HbA1c were calculated and compared using the Wilcoxon signed-rank test.OutcomesThe student-facilitated, interprofessional diabetes clinic has operated for 2 years, and changes are under way. More than 90% of participants reported being well satisfied with the clinic in the first year. Among the group with uncontrolled HbA1c (n = 18), mean HbA1c values declined from 9.3% to 7.6% (P = .004). Among the group with controlled HbA1c (n = 30), 83% were controlled at follow-up.InterpretationThe Penobscot diabetes clinic is evolving to meet the needs of community members, and pharmacy students have an interprofessional practice site well suited for experiential learning.

Effect of student-led health interventions on patient outcomes for those with cardiovascular disease or cardiovascular disease risk factors: a systematic review

“…Student-led interventions consisted of medication reviews [ 31 , 38 , 40 ], counselling through an interprofessional team of students [ 35 , 38 ], medical appointments [ 36 , 43 , 44 ], home visitations for medication and dietary review [ 45 ] or a program of medical care and group education classes [ 39 ] or an individual program of phone calls and group classes [ 37 ].…”

“…Student-led health interventions were primarily located in a clinic setting [31][32][33][34][35][36][37][38][39][40][41][42][43][44]. Of the student-led clinics, five studies described the service provided as a "free clinic" [33,36,41,42,44].…”

“…Two studies reported a mean reduction in HbA1c of − 0.5%, n = 8 [36] and − 1.1%, n = 18 [38] but did not report statistical significance represented as p-values. Kahkoska and colleagues [36] provided a student-run free clinic which included a triaged medical appointment by a physician assistant, nursing students, a pharmacy resident and medical student.…”

“…Medical appointments were shared amongst cohorts of four to 12 patients with diabetes where students led a discussion on diabetes self-management [36]. Martin and colleagues [38] provided multidisciplinary counselling (i.e. physician, pharmacist, nurse and dietitian) followed by student pharmacist review.…”

“…physician, pharmacist, nurse and dietitian) followed by student pharmacist review. The pharmacy student provided follow up the next day making recommendations and answering any patient questions [38].…”