Dora Smith has come to the Federally Qualified Health Center (FQHC) for several problems she is experiencing. Your group performed an interprofessional team evaluation with the results in the case below. Your team is now meeting to create a plan for Dora.
Dora Smith is a 52-year-old woman (DOB 6/1/68), that has been a patient at the Federally Qualified Health Center (FQHC) for the last 8 years. She attends her appointments sporadically. The last time she was seen was 1.5 years ago. Note: The FQHC has behavioral health, physical health, dental, and pharmacy services all in one building
- PMH:
- Chronic low back pain
- Opioid use disorder
- Gastroesophageal reflux disease
- Depression
- High blood pressure
- Peripheral neuropathy bilateral feet
- Type 2 diabetes mellitus
- Medications
- Oxycodone 5 mg every 3 hours PRN
- Rantidine 150 mg every 12 hours
- Metoprolol 50 mg every 12 hours
- Hydrochlorothiazide 25 mg daily
- Gabapentin 600 mg every 8 hours
- Clonidine 0.3 mg every 8 hours
- Social history: Patient is divorced. She lives in a second-floor apartment with her medium sized dog
- Reason for visit: Recent fall 1 month ago when walking her dog (tripped on the dog leash). She sustained a concussion and reports increased low back pain since the fall. Today, she reports severe pain in a tooth on bottom left side of her mouth that started about a week ago.
- Examination
- Vital Signs
- Temp: 99°F
- HR: 90 bpm
- BP: 159/85 mmHg
- RR: 12 bpm
- Height 5’2”, Weight 170 lbs
- Labs (from ED visit 1 month ago)
- Vital Signs
Laboratory Test
Result
Normal Range
Sodium
130
135-145 mEq/L
Potassium
5.5
3.5-5.0 mEq/L
Chloride
100
98-107 mEq/L
CO2
20
22-26 mEq/L
Glucose
150
90-108 mg/dL
BUN
20
5-25 mg/dL
Creatine
1.7
0.6-1.1 mg/dL
WBC
9,000
4,5000-11,000/mm3 %
Hgb
10
13-18 g/dL
Hct
32
36-49%
Platelets
150,000
145,000-450,000/mm3
- Dora was assessed in the dental clinic, prescribed antibiotics for an abscess and is to return in 12 days for a follow-up appointment. The next available appointment is one month from the dental clinin assessment visit.
Questions
- What are the issues?
- What is your desired outcome?
- What stakeholders will you need to work with to achieve your desired outcome?
- Describe in order, what major steps will need to happen to achieve your desired outcome?
- What unique strengths can each discipline bring to the team?
- How could your team include patients’ preferences into the plan?
- What strategies could you use if you encountered resistance from a colleague while working on a plan to achieve your desired outcome?
**Issues:**
- Lack of consistent healthcare utilization: Dora’s sporadic attendance at appointments may contribute to poor management of her chronic conditions and increase the risk of complications.
- Recent fall and increased low back pain: Dora’s fall and subsequent increase in low back pain require assessment and management to prevent further injury and optimize pain control.
- Severe tooth pain: Dora’s tooth pain may indicate an abscess or other dental problem requiring prompt treatment to prevent infection spread and alleviate discomfort.
**Desired Outcome:**
The desired outcome is to address Dora’s immediate health concerns, including managing her low back pain and dental issue effectively, while also promoting ongoing engagement in her healthcare to improve long-term management of her chronic conditions.
**Stakeholders:**
- Medical provider: Responsible for assessing and managing Dora’s overall health and coordinating care for her multiple chronic conditions.
- Dental provider: Responsible for evaluating and treating Dora’s tooth pain and any associated dental problems.
- Behavioral health provider: May address Dora’s depression and opioid use disorder, providing support and resources for mental health and substance use management.
- Pharmacy services: Involved in dispensing medications and providing education on proper medication use and adherence.
- Care coordinator/social worker: Assists with care coordination, connects Dora with community resources, and addresses any social determinants of health impacting her well-being.
**Major Steps:**
- Immediate pain management: Ensure prompt management of Dora’s tooth pain with antibiotics and pain medication.
- Dental follow-up: Schedule and facilitate Dora’s follow-up appointment with the dental provider to assess treatment effectiveness and address any ongoing dental issues.
- Chronic disease management: Develop a comprehensive care plan addressing Dora’s chronic conditions, including medication management, lifestyle modifications, and referrals to appropriate specialists for further evaluation and management.
- Behavioral health support: Engage Dora in behavioral health services to address depression and opioid use disorder, providing counseling, support groups, or medication-assisted treatment as needed.
- Patient education and empowerment: Provide Dora with education on her conditions, treatment options, and self-management strategies to empower her to take an active role in her healthcare.
**Unique Strengths of Each Discipline:**
– Medical provider: Expertise in managing chronic medical conditions and coordinating care for complex patients.
– Dental provider: Specialized knowledge and skills in diagnosing and treating dental problems, including abscesses and tooth pain.
– Behavioral health provider: Experience in addressing mental health and substance use issues, offering support and resources for holistic patient care.
– Pharmacy services: Expertise in medication management and education, ensuring safe and effective use of prescribed medications.
– Care coordinator/social worker: Skills in care coordination, advocacy, and connecting patients with community resources to address social determinants of health.
**Incorporating Patient Preferences:**
– Involve Dora in decision-making processes regarding her treatment plan, considering her preferences, values, and goals.
– Provide education and information in a manner that is accessible and understandable to Dora, allowing her to make informed choices about her care.
– Respect Dora’s autonomy and preferences, offering options and alternatives when appropriate to ensure her needs and priorities are addressed.
**Strategies for Resistance:**
– Foster open communication and collaboration within the team, emphasizing the shared goal of improving patient outcomes.
– Address any concerns or objections raised by colleagues respectfully and constructively, seeking to understand their perspective and find common ground.
– Utilize evidence-based practice guidelines and data to support proposed interventions and decisions, demonstrating the rationale behind the plan.
– Engage in shared decision-making processes, allowing all team members to contribute their expertise and perspectives to develop a consensus-based plan of care.
Dora Smith has come to the Federally Qualified Health Center (FQHC) for several problems
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