Qualitative analysis of clinical exposure obtained providing Home Based medical care to Alaska Native/American Indian population by Physician Assistant students in Northern Utah

LCDR Tim McCreary MS, PA-C1, Olivia Walton Ziegler, M.S., PA-C2, Jennifer Coombs, PhD, PA-C2, Darin Ryujin, M.S., MPA, PA-C2

USPHS, Indian Health Service Skull Valley Goshute Diabetes and Clinical Program1, University of Utah Division of Physician Assistant Studies2

Purpose: The purpose of this study is to report on a unique Indian Health Service (IHS) home health experience for Physician Assistant Students (PA-S) at the University of Utah.  The IHS and the University of Utah PA program (UPAP) collaborated to offer a brief home health experience that allows students to participate in home health visits to members of American Indian and Alaskan Native community in Northern Utah.  Our goal is to orient students to home health visit objectives, cultural competencies, and Type-2 Diabetes management. We present here our model and data collected during the initial 2 years of our collaborative program.

Methods: The Home Health Experience Orientation and Objectives were created by the UPAP in collaboration with the IHS preceptor in 2011.  Students were asked to participate in the clinical rotation based on interest.  Data was collected to include a special evaluation, patient demographics, reason for visit, ICD-9/CPT codes and prescriptions written.

Results: In UPAP’s two most recent graduating classes (2011, 2012) there was an average of 38 students.  Twelve students volunteered to participate in the first year and 14 in the second year (n=26).  In both years, students rated the experience as Excellent on an analog scale.  Comments on the evaluations show themes that align with our objectives: 1) To orient students to the possible goals of a home health visit:  Students identify the value of seeing patients in their homes and seeing “the challenges patients face in their homes.”  2) Cultural competency/health disparities:  Students identify the importance of learning “adaptability” working within the cultural structure of patients, and students gained a greater appreciation for the “barriers to health care access.” 3) Medical Knowledge/Diabetes in the Native American Population:  Students felt this was a great opportunity to learn more about diabetes, diabetes education, and long term DM sequela.   Lastly, a fourth theme emerged which was not expected but is an exciting outcome.  4) Students gained an “insight” to the IHS and appreciated the opportunity to talk with their preceptor, LCDR Tim McCreary, PA-C, about his professional experience with the service.

While the qualitative data is the most interesting data, we also collected quantitative data.  Students had an average caseload of 2/day.  The majority of the patients were over age 18: 18-49 (41.9%), 50-64 (38.7%).  67.7% were female.  Top 5 ICD-9 codes were Diabetes, Essential Hypertension, Disorders of Lipoid Metabolism, Overweight and Obesity, and Affective Psychoses.

Conclusion: Students gained valuable perspective into the culture and lifestyles of individuals in our home health program. 1 Enriching cultural experiences like these, however brief, have a powerful impact on students.  When asked to consider if this type of experience is of value and should be available to other health care learners one of our students made this comment:

“It is only one day in the scheme of 27 months. I think it is a great use of time, a horizon broadening experience. It is these sorts of unique opportunities that are likely to make an impact, be remembered, and inspire someone to serve.”

Author contact: tim.mccreary@ihs.gov