‘Huddling’ together for student learning and patient health

So much of the time patients are navigating the health care system on their own, without their physician talking to their pharmacist or their psychologist, for example. This can be difficult even for the most health literate to manage, often leading to fragmented care.

To both fix this problem for some of the most vulnerable patients and provide a model and learning opportunity to its students, Texas A&M University Health Science Center has recently instituted “provider huddles” at the nonprofit free health care clinic Health For All. The huddle involves the nurse practitioner and executive director of Health For All, along with pharmacists, physicians and psychologists—and students in each of those disciplines—all talking about the best treatment plan for an individual patient. “Every discipline can find ways to work together,” said Carly McCord, PhD, a licensed psychologist with the Center for Community Health Development at the Texas A&M School of Public Health who participates in the huddles and who is also the director of clinical services at the Telehealth Counseling Clinic. Health For All treats about 1,500 patients each year, helping to improve access to care in the Brazos Valley.

The Telehealth Counseling Clinic was already using Health For All as one of their remote sites, where Brazos Valley residents could go to be connected with a counselor in College Station via videoconference technology. McCord said that the collaboration with the medical and pharmacy professions only improves the services they are able to provide. “Physical health and mental health are very intertwined, with bidirectional influences,” she said. “For example, we know that exercise can improve certain mental health conditions, but how much can we push a patient to exercise, given their physical condition? That’s where a physician’s perspective on that patient can be extremely helpful.” At the same time, a psychologist’s input on a patient’s ability to carry out a proposed treatment plan can help the physician and pharmacist make better decisions.

“In addition to helping patients, the huddles have been a wonderful avenue for discussion and learning about different health professions,” said Bree Watzak, PharmD, assistant professor at the Texas A&M Irma Lerma Rangel College of Pharmacy. “When we get together, we can flesh out where medications can help or where medications—or interactions between medications—may actually be the cause of the problem.” Although interacting with physicians is fairly common for pharmacy students, Watzak said, it is far rarer for them to collaborate with mental health care providers. “The pharmacy students have learned so much about the options and care plans patients can receive from the Telehealth Counseling Clinic,” she added. “There have been patients where traditionally medications would be recommended, but the psychologists were able to provide counseling first to see if medications were really necessary.”

Because many of the patients seen at Health For All have multiple chronic conditions, it’s an ideal setting to try out this new model of collaboration. “Student education improves when they are able to get this kind of interprofessional, real world experience,” McCord said. “At the same time, patient care improves, so it’s a win-win.” Furthermore, the single location where multiple health needs can be me helps eliminate some of the barriers for patients who may lack easy access to transportation and sufficient time to visit multiple providers.

“Although it’s still new and on a relatively small scale, our hope is to continue to grow the program,” McCord said. “We would love to integrate practitioners and students in the other health disciplines to expand the educational opportunities and the services we can offer.”

In fact, the health science center is expanding beyond the single site and working to pilot interprofessional opportunities at clinics in the southern part of the state as part of the Texas A&M’s Healthy South Texas program. “We have a vision for expanded interprofessional experiences for all health science center students,” said Christine Kaunas, MPH, head of the Division of Interprofessional Education & Research in the health science center Office of Academic Affairs.

At each of the proposed sites, existing providers will identify patients who would benefit from a treatment plan re-evaluation from an interprofessional team of trainees and preceptors. During the initial re-evaluation visit, all student trainees will observe the patient interactions of other disciplines and participate in provider huddles, which will result in integrated care plans. “Not only does this provide our students the interprofessional experience they need,” Kaunas added, “it provides more holistic care for underserved patients in South Texas.”