Interprofessional Diabetes Clinic Offers Care, Experience

It’s the defining story of the Pacific University Interprofessional Diabetes Clinic:

A woman visits the clinic for a morning of appointments with the interprofessional team.

In the optometry part of the visit, she is given eye drops to treat her glaucoma.

Later in the day, the physical therapy team realizes she also suffers severe arthritis — so severe that she would be unable to squeeze the eye-drop bottle.

As a result, practitioners and students work together to find another way for the woman to manage her eye condition.

What could easily have been an impediment to her health instead is overcome thanks to the cooperation of healthcare providers in a patient-centered environment.

Founded in 2010, the Pacific University Interprofessional Diabetes Clinic, or IDC as it’s often called, is a collaboration between programs in the university’s colleges of Optometry and Health Professions, along with some external partners. The mission of the clinic is to provide whole-person care to help low-income and underserved patients effectively manage their diabetes and live healthier lives.

Whole-Person Care

One Saturday each month, faculty healthcare providers and students from a number of programs gather at Pacific’s Hillsboro Campus to serve patients.

The numbers seem small at first glance: About 12 appointments are scheduled in each month’s clinic, and an average of about 10 show up, said Carole Timpone, associate dean of clinical programs in the College of Optometry.

In reality, though, the number of patient visits is several times that, as each patient will attend two months’ clinics, seeing three to four providers a day.

“It’s a high demand of time way to practice,” Timpone said. But it’s also a service that’s critical to patients.

Appointments at the clinic are by referral only. Some come from Virginia Garcia Memorial Health Clinics or other safety net clinics in the region. Others come from the visits that Pacific faculty and students pay to local vineyards and nurseries to provide healthcare screenings to migrant workers.

About 90 percent of the patients are Spanish-speaking immigrants, and almost all are without insurance. Rarely do they have access to basic, let alone specialized healthcare: Most have never had a teeth cleaning or eye exam, Timpone said.

At the IDC, they get it all. They see optometrists, dental hygienists, occupational therapists, physical therapists, physician assistants, pharmacists and psychologists, all of whom assess not only their diabetes but also the myriad companion conditions that can arise in relation to the chronic condition and the many factors that can impede successfully managing it.

Nor do they see these practitioners in isolation. A student follows each patient through their entire experience and presents on their experience in a case conference at the end of the day. That way, every practitioner learns the patient’s full background and they can develop a personalized care plan together.

“They all hear the full story of the patient,” Timpone said. “Suddenly you understand why the patient doesn’t take his meds: He’s just out of a job.

“Maybe he doesn’t tell the first person he sees, but he might tell the third. He has to choose to pay for meds or food for his kids. It’s so powerful when it comes out.”

The clinic has helped patients who, perhaps, need to keep insulin cool while working in a hot field all day. Or those working two jobs and trying to fit in scheduled balanced meals. People who need exercise to control their diabetes, but whose foot pain makes walking almost unbearable.

“We’re giving them the tools to work with for a healthy lifestyle,” Timpone said. “Helping them get to health management, not crisis management.”

Student Preparation

Coordinated care is a growing trend in American healthcare. But, she said, it’s not always practical to implement at the private practice level.

Still, students who spend time in the IDC — or anywhere in Pacific’s inteprofessionally-focused healthcare programs — are better prepared to serve their patients needs.

“When they’re practitioners, they will know how to communicate with a PT or an OT or an MD. They’re comfortable, because they’ve done that,” she said.

“They learn the scope of everyone’s practice. Students are always surprised. Even faculty sometimes say, ‘Oh, you can do that?’”

That allows them to better refer patients for issues that they can’t treat or solve.

Timpone envisions a private practitioner reaching out to other professionals in his or her community: “I’m new in town. I want to find out who the people are in town so we can talk to each other. If we refer to each other, we will all benefit.”

And, students learn to watch for signs of patient issues outside their own areas of expertise. For example, Timpone said, optometrists who have heard the eye-drop story now are more likely to ask patients if they are able to squeeze a bottle before prescribing drops.

“You want people to be focused on their profession, but you want that awareness, too,” Timpone said.

“For students, it builds up your suitcase.”