An Interprofessional Student-Led Approach to Home-Based Primary Care & Telehealth for Underserved Older Adults and People with Disabilities

Proposal:

Background: Social factors are known to have a huge impact on health outcomes. Yet, for many patients these factors remain unidentified and unaddressed, especially for patients with significant barriers to attending outpatient appointments. In-home care illuminates these factors and addressing these can improve health outcomes and equity for underserved older adults and people with disabilities. Recognizing the gap in training for health professional students in home-based care and telehealth, our student-led initiative aims to bridge this gap through interprofessional and experiential learning.

This collaborative project involves partnership between a local, federally qualified health center and experienced primary care practitioners in an academic center’s division of community health. In our model, student teams, consisting of a third-year medical student and graduate nurse practitioner student, accompany a primary care practitioner on patient home visits every other month. On alternate months, an office-based primary-care provider guides students, who are onsite in the patient’s home, via real-time video telehealth. This approach enables students to routinely assess history, physical exam findings, adherence to medication, and provide education in the patients’ home environment, shedding light on social and environmental factors not typically apparent in the clinic setting.

Methods: During an 8-month program cycle, student teams participate in home visits; the current cycle consists of 5 student teams serving 10 patients. Teams also meet for monthly debriefing sessions, where they share reflections related to home visits. Our longitudinal curriculum includes an interactive series covering home safety, goals of care, physical activity, nutrition, wound care, and proper use of medical devices. Learning outcomes are evaluated through mixed methods surveys completed pre- and post-program, focusing on four domains of learning: social drivers of health, interprofessional education, in-home care, and primary care perspectives.

Results: Data collection and analysis from the current iteration is ongoing. However, preliminary data from our pilot project show promising results. Eight medical students completed 20 visits between November 2022 and April 2023, with 100% of patients finding the program 'completely/very useful', being 'completely/very satisfied' and 'interested in continuing'. Student survey results highlight the initiative’s meaningful educational experience in understanding social determinants of health, practicing in-home care, and advancing clinical skills.

Conclusion: Our innovative program presents a unique opportunity for interprofessional collaboration between medical and graduate nursing students, with an experiential focus on social drivers of health. Most importantly, the program reflects a patient-centered and equity-minded response to the needs of an underserved segment of our community.