CHIUS Interdisciplinary Clinic Case Examples The objectives of these two case examples are to: 1) Demonstrate the workflow of the CHIUS Interdisciplinary Clinic at Three Bridges 2) Demonstrate the interdisciplinary components using two case patients with type 2 diabetes and chronic pain Summary Flow Chart for CHIUS Clinic: Figure 1: Note for step 5, the client is seen by two students from the IPT (Interprofessional Team) and mentors. Subsequently, a collaborative care plan is formulated, and any intervention delivered as necessary. Depending on each patient, intervention may be required during the day of the first visit, and the patient may be scheduled for follow up for long term management. (Figure from Holmqvist et al., 2012)
Case 1: GK is a 55 year old male who has been recently diagnosed with type II diabetes. His current medical history is significant for hypertension, and hyperlipidemia. With the patient's consent, Dr S has decided to refer GK to the CHIUS Interdisciplinary Clinic for a complete assessment, with specific assistance from Physical Therapy and Dietetics. Please refer to Figure 1 (Flow Chart) as necessary. Initial Visit 1. Shift Supervisor presents case to Interprofessional Team (IPT), comprising 5 students from various disciplines. Two students are selected for the initial assessment e.g., 1 senior medical student and 1 junior dietetics student noting history/findings in the EMR. 2. After performing the initial assessment (using the Queensland Clinic Assessment Tool), the two students present client s history and findings back to the IPT (including students and preceptors). The patient may decide to stay for further intervention or book a follow up appointment. GK decides to stay (we provide a small meal for patients during their stay) 3. IPT case discussion. IPT recommends the following services based on patient's needs: Pharmacy medication review, insulin regimen assessment, provision of flu/pneumococcal vaccines Physical Therapy exercise regimen tailored to the patient's needs Dietetics counselling on improving diet (DASH diet) Social Work use of community services Occupational Therapy self management; how to incorporate diet & physical exercise recommendations in client s current lifestyle; medication management; adapt to any potential sensory loss due to diabetic neuropathy; psychosocial support. 4. The two students who originally assessed the patient will discuss our recommendations with GK. GK decides he wants to see the Dietetics and Social Work students for this visit, and follow up with Pharmacy and Physical Therapy on the next visit. 5. GK meets with Dietetics student and mentor and receives information on DASH diet. The team formulates a plan that will fit GK's needs 6. GK meets with Social Work student and mentor to receive information on use of community services. The team formulates a plan that will fit GK's needs Follow up 1) GK is re assessed according to the outcomes of the Dietetics and Social Work plan from the previous visit. 2) GK meets with Pharmacy student and mentor to conduct a medication review. The team
formulates a plan that will fit GK's needs 3) GK meets with Physical Therapy student and mentor to formulate an exercise regimen suitable to GK's needs. 4) GK meets with Occupational Therapy student to assess psychosocial aspects of new diagnosis, and help GK establish goals and routine to manage diabetes. Case 2: CH is a 34 year old male who has been experiencing chronic neck pain ever since a motor vehicle accident 3 years ago. He tried various NSAIDs and is currently on Tylenol #3 i ii q4 6h prn. However, he is still not finding relief. Asides from chronic pain, CH has a history of alcohol abuse but otherwise his medical history is insignificant. He mentions that he has to take on average one day off work every month because his neck pain would be so bad that it turns into a headache and [he] can t concentrate at work. With CH s consent, Dr. K refers CH to the CHIUS Interdiscplinary Clinic for a complete assessment. Initial Visit 1. Shift supervisor presents case to Interprofessional Team (IPT). IPT reviews client s chart and gathers relevant information. Two students (in either Medicine/Pharmacy/Social Work/Physical Therapy/Occupational Therapy) see CH and note history/findings into the EMR. 2. After performing the initial assessment (e.g., history taking, physical exam, conducting McGill Pain Questionnaire), the two students present the case back to the IPT (includes students and mentors), and the IPT discusses the case. The patient may decide to stay for further treatment/intervention, or book a follow up appointment. CH decides to stay (and we provide a small meal for clients during their stay). 3. IPT case discussion. IPT recommends the following services based on client s needs and professional scopes of practice: Medicine obtain history of alcohol and any substance/drug abuse; screen for depression and psychosocial issues; perform musculoskeletal/neurological physical exam for head/neck/shoulder Pharmacy medication review and analgesic recommendations; provide education on analgesic use
Social Work counselling and psychotherapy; assist CH to promote job security, minimize missed work days and reduce disability; connect CH with community resources Physiotherapy assess muscle tone/joint movement/nerve function; provide stretching exercises, posture correction, and active range of motion exercises Occupational therapy pain management training; work modification Dietetics assess nutritional risks and needs; nutritional counselling; education on avoidance of triggers (alcohol, nicotine, food) 4. The two student who originally saw and assessed CH will discuss the IPT s recommendations with CH. CH decides if he wants to see Physical Therapy and Occupational Therapy on this visit, followed by Dietetics, Social Work and/or Pharmacy on the next follow up appointment. 5. CH meets with a Physical Therapy student and mentor to formulate a home exercise regime suitable to CH s needs and lifestyle. 6. CH meets an Occupational Student to review pain management and modification of work environment. Follow up: 1. CH is re assessed according to the outcomes of treatment approach by Physical Therapy and Occupational Therapy from the previous visit. 2. CH meets with a Dietetics student and mentor to discuss nutritional assessment and counselling, as well as education on trigger avoidance. The team formulates a plan that meets CH s needs. 3. CH meets with a Social Work student and mentor to discuss missed work days and use of community resources (e.g., support groups). 4. CH meets with Pharmacy student and mentor, and receives a medication review and prescription on appropriate analgesics. The team formulates a prescription that fits CH s needs.
References: 1. Holmqvist M, Courtney C, Meili R, Dick A. Student Run Clinics: Opportunities for Interprofessional Education and Increasing Social Accountability. J Res Interprof Prac Educ. 2012 Aug; 2(3):264 267.