There’s No Place Like Home

“The experience was eye-opening and inspiring. Our elderly patient had suffered from aspiration pneumonia while eating and was hospitalized. He went from walking and having minimal dementia to rapidly declining cognitive function and not being able to walk after his hospital visit. We saw the toll on the body from being bedridden for so long and how difficult it would be to get him on his feet again. We learned that the health goals for the elderly, especially during such an ordeal, are completely different when you are visiting them at home. Activities of daily living, or ADLs, such as being able to walk, dress and eat on your own, are just as important as controlling one’s blood pressure or blood sugar. When we see patients in the hospital, they seem to be just another number, but when we were invited into the home of this family, we were surrounded by family pictures and the reality of the situation. It was definitely an amazing experience that I will never forget.”

These are the words of Lydia Matar Solis, a University of Houston (UH) doctoral student in the College of Pharmacy, describing her experiences during one of her field visits as an intern in the “No Place Like Home” program, which is one of several Longitudinal Ambulatory Clinical Experience (LACE) course tracks. This initiative pairs UH pharmacy students with medical students from Baylor College of Medicine (BCM), under the supervision of physicians and nurse practitioners, to deliver in-home ambulatory care services to Houston-area geriatric patients who are predominantly homebound due to mobility limitations typically resulting in multiple chronic conditions.

By interacting with a patient in their home environment, the interprofessional team is able to observe aspects of a patient’s normal routine and make adjustments to the care plan or suggest changes in behavioral practices that might not otherwise be apparent from just a visit to a clinic or pharmacy. Bringing all aspects of the patient — life, home, family — in to view allows these future physicians and pharmacists to see the entire picture of a patient firsthand, which is invaluable to making appropriate evaluations for a care plan. It gives students the opportunity to look behind the curtain to see the real aspects of patient life outside of a clinical setting.

Solis joins a new generation of students who are learning under the Interprofessional Education (IPE) model of instruction. This relatively new way of teaching up-and-coming medical professionals focuses on better integrating and coordinating the education of nurses, physicians, dentists, pharmacists, public health professionals and other members of the patient health care team to provide more collaborative, team-based and patient-centered care. These shared learning experiences among students across a variety of health disciplines have been shown to improve health outcomes. Leading agencies, such as the World Health Organization, have recognized IPE as an effective way to enhance the preparation of the health care workforce and improve care delivery.

Following the pilot stage of the “No Place Like Home” LACE initiative, UH and BCM expanded the program to more than 40 pharmacy and medical students from each institution. Eventually, the program partners plan to offer the experience to all third-year BCM medical and UH pharmacy students, as well as incorporating pharmacy faculty.

“The goal is not only to improve communication between patients and medical professionals, but also to give students from different health care professions an opportunity to gain an appreciation of the knowledge, skills and contributions brought by other members of the team,” said Catherine Hatfield, the director of Interprofessional Education at the UH College of Pharmacy. “It’s becoming increasingly important in the early stages of clinical education to demonstrate that an entire team helps treat and keep patients safe. With economic, psychological, medical, functional, spiritual and social issues all affecting patient health, the expertise of several people is necessary to take good care of patients. It’s the reality of how we practice medicine.”

No One is Forgotten

Another IPE for which students can volunteer is through the Healthcare for the Homeless — Houston’s HOMES clinic, which is entirely student-managed with oversight by attending physicians and licensed pharmacists. A collaboration among three institutions, HOMES (Houston Outreach Medicine, Education, and Social Services) has been successfully run for more than a decade by students from the UH College of Pharmacy, Baylor College of Medicine and The University of Texas Health Science Center Schools of Medicine and Public Health.

Managers from the University of Houston College of Pharmacy, Baylor College of Medicine and The University of Texas Health Science Center help care for a patient at the HOMES clinic.

Faizan Sattar is one of the UH pharmacy doctoral students who has spent many hours volunteering at the clinic and speaks passionately about his experiences.

“The health care system now is all about working together with different professions as a group effort, resulting in an interdisciplinary experience. The opportunity to work with medical students not only helps us in approaching things with a different perspective, but also allows us to gain an appreciation of what we do and how we can contribute from the pharmacological standpoint,” Sattar said. “I like to volunteer and have always volunteered. What I enjoy most is making a difference, because everybody deserves to be taken care of, and nobody deserves to be forgotten. The patients have been through different life experiences that I’ve never been through in my life, facing different challenges that I can’t even fathom. It’s taught me to be patient with people and, most importantly, to listen to what patients have to say, because we don’t know everything and need patient input for it to work.”

He goes on to say, “Working in the clinic gives us hands-on patient experience that we can’t learn in school, so it’s a great opportunity to actually practice what you learn. It’s helped me build my clinical knowledge, learn how to treat patients and how to improve patient care. It’s also helped with my personal growth, since the homeless population is one most people don’t think about. Most of us think of going into hospitals or the community setting, so this experience is eye opening.”

UH pharmacy students are required to do 10 hours of volunteering or community service, called pharmacy experience hours, in their first year and 20 hours each in their second and third years, for a total of 50 hours. Sattar says that’s the minimum and, as the 2014 UH Volunteer of the Year at HOMES, he has put in many more hours than that.

The HOMES clinic is open every Sunday to ensure access to needed services on a day when most other health care providers are closed, while also reducing the use of hospital emergency rooms for non-emergent conditions. More than 3,000 patients have been served through the clinic since its launch in 2000. The pharmacy students also have worked with Walgreens to offer free seasonal flu immunizations to clinic patients.

While the doctors on site usually change from week to week, chances are that the pharmacist will be UH College of Pharmacy clinical associate professor David A. Wallace, who has been a fixture at the HOMES clinic almost every Sunday since it opened, serving as faculty advisor, preceptor and clinical pharmacist.

“It’s very rewarding to see the students grow not only in their technical and clinical knowledge and skills, but also in their empathy and awareness of the complex medical, mental health and social needs within this patient population,” Wallace said. “Getting a chance to see students apply what they’re learning in class, doing the patient care and experiencing ‘aha’ moments for the first time is very fulfilling. What I find most gratifying is watching the students take off in their profession. I look at it as training my colleagues and enjoy watching the students get that chance to interact and become part of a health care team.”