Interprofessional Team Care for Uninsured Patient with New Diagnosis of Diabetes
Background: Patient presented to clinic with complaints of not feeling well mentally and physically, including lethargy, moodiness, polyuria, polydipsia, along with weight gain, extreme fatigue, and muscle aches. Initial in-office glucometer reading was greater than 600, A1C was greater than 14, and urine dipstick showed significant glucose. Decision was made to treat him in the clinic with close follow up, since he was very reluctant to go to the Emergency Room and was stable. The patient was able to understand instructions for his care, and he was amenable to this plan.
Methods/Interventions: During this visit the patient was initially seen by student volunteers from Nursing, Social Work, and MAC team members in a group setting. It was determined that the patient was undergoing a significant amount of physiological and psychological distress. During this first visit, he was given information about his new diagnosis, how to use a glucometer, and how to give himself insulin. Social work was able to set up a schedule for regular check-in sessions, and an appointment was made for a consult with students from public health/nutrition who work remotely.
Results: Through intense follow up from all members of the IPE team, within 3 months the patient’s A1C level was under 7, and his glucose was under 150.
Lessons Learned: The biggest takeaway from this case is that when all the members of the IPE teams work together during the initial encounter, a smoother transition of care can take place, and members are more likely to understand the goals of care. The IPE teams can also learn from each other with questioning techniques and responses to patient statements. This combined assessment technique can decrease the amount of time a patient is in the clinic, and increase the likelihood that all IPE teams are working toward the same goals of care.
Future Application and Next Steps: We will continue to do initial assessments as a team to better identify physiological and psychological issues and solutions. Through a combined assessment technique, the IPE teams can learn by observing each team's questioning techniques and hearing how each team responds to patient statements. This technique can also decrease the amount of time the patient needs to be at the clinic and ensure the IPE teams are collaborating with the patient to meet the goal of improved health, while addressing challenges such as lack of insurance, food insecurity and depression.
