UNE Forms a Pipeline to Western Maine to Address Healthcare Shortages

November 10th, 2017 by healthinnovation
A group of ten UNE healthcare students recently participated in a rural health immersion to western Maine, in Oxford County, as part of a pipeline program to alleviate healthcare workforce shortages in rural communities.

A group of ten UNE healthcare students recently participated in a rural health immersion to western Maine, in Oxford County, as part of a pipeline program to alleviate healthcare workforce shortages in rural communities.

Ten healthcare students from UNE’s College of Osteopathic Medicine, College of Pharmacy, College of Dental Medicine, and Westbrook College of Health Professions Physican Assistant and Bachelor of Science in Nursing (BSN) programs recently attended a long weekend rural health immersion in Oxford County of Western Maine and Carroll County of Northern New Hampshire. The experience, which is coordinated and funded by UNE’s Center for Excellence in Health Innovation and the Maine Area Health Education Center (AHEC), is a pipeline activity created to reduce healthcare provider shortages in rural Maine and to strengthen UNE’s relationships with healthcare centers around Maine. The October immersion experience was the fourth time that a rural health immersion has been offered to UNE students but the first time that a group had gone to Oxford County; last May a weeklong immersion was held in Maine’s midcoast region of Knox and Waldo Counties; last March a weeklong immersion was held in Franklin County; and in May of 2016 the first weeklong immersion was held in Maine’s northern most county, Aroostook County.

“So far, we’ve had over 50 students participate in the immersion experience, and the data that we’ve collected from them suggests that these students are more interested in practicing in a rural or medically underserved area after participating in the immersion” says Karen O’Rourke, Director of the Maine AHEC, located within UNE’s Center for Excellence in Health Innovation. “This corresponds to the literature which shows that early and often exposure to rural health is the most effective strategy to increasing rural provider retention. This is is precisely why we’ve created the rural health immersion, to provide opportunities for our students to get exposed to Maine’s more rural communities, so that they are more likely to become a rural healthcare provider after graduating.”

The students discuss population health initiatives with Sue Ruka, RN, PhD, at Memorial Hopsital, a Critical Access Hospital in Conway, NH.

The students discuss population health initiatives with Sue Ruka, RN, PhD, at Memorial Hopsital, a Critical Access Hospital in Conway, NH.

Attracting healthcare professionals to rural and underserved communities has been a national priority for several years and a particular issue for Maine partly due to the fact that, according to the 2010 Census Data, Maine was the most rural state in the United States. Rural terrain can lead to long commutes for patients seeking basic healthcare services and can exacerbate provider shortages, leading to poorer health outcomes. This is a particular problem in Maine where nearly 1/3 of all of Maine’s providers work in Cumberland County, leaving many of Maine’s larger and more rural communities underserved. In order to help alleviate healthcare workforce shortages in Maine’s more rural counties, the Maine AHEC has strategically located three AHEC centers around Maine in Aroostook, Franklin, and Penobscot counties. “Oxford County is one of the Maine’s counties with the fewest healthcare providers in the State, with only about 2% of the providers living in that area. We were able to utilize our western Maine AHEC center, which covers Oxford County, to help connect with area hospitals for this immersion.”, says O’Rourke.

Sue leads the students through one of the Gemba boards at Memorial Hospital.

Sue leads the students through one of the Gemba boards at Memorial Hospital.

Maine and New Hampshire provide a contrasting picture of health and well being, despite neighboring one another. According to the United Health Foundation, New Hampshire ranked 6th in overall health rankings, whereas Maine did not fair as well, ranking 22nd. “These health disparities became apparent to the students rather quickly” said Ian Imbert, MPH, the project coordinator of a prestigious four year Josiah Macy Jr. Foundation grant in UNE’s Center for Excellence in Health Innovation, which aims to enhance team-based care and improve patient outcomes. “The immersion experience provided them an opportunity to see first-hand the effects of healthcare access and funding for prevention programs. In Maine, the decision not to expand Medicaid has created access barriers that have effected the health of our communities, whereas the expansion of Medicaid in New Hampshire has created additional funding to provide much needed services to its underserved populations.” Indeed, the Robert Wood Johnson Foundation’s 2016 county health rankings, for example, show that Carroll County in New Hampshire ranked 4 out of 10 in health outcomes, while Oxford County in Maine did not fair as well, finishing close to the bottom, 14th out of 16.

The first stop of the day was at Saccopee Valley Health Center in Porter, ME, where the students met with Dr. Jeff Ray, DO, Medical Director, and Dr. Israel Adeloye, DMD.

The first stop of the day was at Saccopee Valley Health Center in Porter, ME, where the students met with Dr. Jeff Ray, DO, Medical Director, and Dr. Israel Adeloye, DMD.

It’s predicted that some of the health challenges that Maine’s more disparate Counties face would be improved if there were more providers who lived and worked in those areas. According to the Robert Graham Center and the Nursing Workforce Forecast, Maine will need an additional 120 primary care physicians and 3,200 nurses in the next decade in order to maintain current rates of healthcare utilization. Moreover, the Maine Department of Labor projects a shortage of 170 dentists. Research shows that students are more likely to practice rural medicine if they have a personal connection to a rural area, so, the rural health immersions aim to provide opportunities for students to connect to rural Maine and hopefully alleviate healthcare provider shortages.

The students who participated in the Western Maine rural health immersion came from a broad array of backgrounds, some growing up throughout the country in areas like Maryland and Pennsylvania while about a third of the students had grown up in New England or had spent time previously in rural Maine, either through extended family or while vacationing. Most students had some experience working with underserved populations in the past but for a few it was their first opportunity to experience rural underserved healthcare. One student from UNE’s College of Dental Medicine, Nicole Caron, from Massachusetts, reflected after the final day of the immersion, “This trip introduced me to a bunch of different rural communities that all had one thing in common, extraordinary healthcare providers who work every day to improve the health of their patients and their communities, despite the obstacles they may face in rural areas. I have been inspired and I hope that I am able to practice dentistry just like the professionals that we interacted with this weekend.”

The students pose for a photo outside of Conway Oral Health with Dr. Eric Heirschfield, DMD.

The students pose for a photo outside of Conway Oral Health with Dr. Eric Heirschfield, DMD.

During the immersion, the students experienced a variety of activities in underserved areas in Oxford and Carroll Counties, such as meeting with providers of Memorial Hospital in Conway, NH, and Bridgton Hospital in Bridgton, ME, for a tour of the hospital facilities; a tour and discussion with providers at Sacopee Valley Health Center, a Federally Qualified Health Center in Porter, ME and at White Mountain Community Health Center, a rural community health center in Conway, NH; a trip to Conway Oral Health in Conway, NH to talk about dentition in rural communities; and a tour of Hannafords pharmacy in Bridgton, ME. “This was the first time that an immersion cradled two states”, said Imbert “which allowed the students to think about health policy, and the effect it can have on populations..”

A pharmacy and an osteopathic medicine student work together to collect a blood pressure from a community member at the Fryeburg Fair.

A pharmacy and an osteopathic medicine student work together to collect a blood pressure from a community member at the Fryeburg Fair.

The students attended the Fryeburg Fair, Maine’s largest agricultural festival, where they helped staff the first aid centers. The students created care kits, consisiting of basic, yet essential health care products, like toothpaste, toothbrush, soap, band aids, and more, to hand out to people at the fair. They also worked along paramedics to take blood pressures and provide basic health education on oral health, exercise, and nutrition. “This event gave me the opportunity to meet and talk with people who live in rural communities in Maine”, said Minh Tam Hua, a second year pharmacy student. “I feel that we as health professional students should create more health screenings in rural areas to educate the community about many of the diseases that we saw. If we all stand together and contribute our part, we will be able to help reduce the number of chronic diseases that are taking place in these rural areas.”

Students conducted a Worksite Health ScoreCard at the fair to assess it's performance in several categories like Animal areas, Nutrition, Tobacco, and more.

Students conducted a Worksite Health ScoreCard at the fair to assess it’s performance in several categories like Animal areas, Nutrition, Tobacco, and more.

Jen Van Deusen, MEd, Director of Curriculum in UNE’s College of Osteopathic Medicine, has participated in all four immersions and once again helped to lead the western Maine immersion. “It’s amazing to see the students perceptions of rural health change throughout the trip. And when they return to the classroom I see how excited they are to share what they’ve learned with their peers, creating a ripple effect.”

The full team of students who attended the Midcoast Maine immersion included two medical students from UNE’s College of Ostepathic Medicine Taylor Ouellette and Rodger Carter; two pharmacy students from UNE’s College of Pharmacy Kelly Banks and Minh Tam Hua; two students from UNE’s Nursing Department Katherine Clark and Lesley Lafland; three students from UNE’s College of Dental Medicine Nicole Caron, Brittany Malia, and Kimberlee Sell; and one student from UNE’s Physician Assistant Department Rachel Moore. You can read more on each students experience here.

The group roasts marshmallows on their last night together in Oxford County.

The group roasts marshmallows on their last night together in Oxford County.

The trip was graciously supported by Maine’s Area Health Education Center (AHEC), the Josiah Macy Jr. Foundation, and UNE’s Center for Excellence in Health Innovation. The Maine AHEC has continued to prioritize experiential learning in rural communities for graduate healthcare students and their commitment to the rural health immersion proved to be invaluable for the success of the trip. The Josiah Macy Jr. Foundation grant that also helped fund the experience is a four-year grant awarded to UNE in 2015 from the Josiah Macy Jr. Foundation and aims to improve health care and education in rural areas. Dora Anne Mills, MD, MPH, FAAP, Director of UNE’s Center for Excellence in Health Innovation, helped create the immersion experience.

 

FMI: Contact Ian Imbert, MPH, (207-221-4625 or iimbert@une.edu)

 

University of New England Works with State and Community Partners for Public Health Emergency Preparedness Exercises

November 8th, 2017 by healthinnovation
UNE osteopathic medicine student adminsters a flu vaccine at the October 20th Alternate Care Site emergency preparedness exercise located at UNE's Biddeford campus center gymnasium.

UNE osteopathic medicine student Justin Doroshenko adminsters a flu vaccine at the October 20th Alternate Care Site (ACS) emergency preparedness exercise located at UNE’s Biddeford campus center gymnasium.  This was the first time that an ACS exercise had been conducted in Maine.

The University of New England recently hosted two public health emergency preparedness training exercises in collaboration with state and community partners, offering free influenza vaccinations to the UNE community and public as part of the events. This is the second year in a row that UNE has partnered with local and state public health agencies to conduct a public health emergency preparedness exercise in order to be better prepared in the event of a real public health emergency. “For several years UNE has registered to be part of a volunteer network of Points of Distribution, or PODs, that will serve as centers for administering medicines, vaccines, and/or necessary supplies for the public in the event of a large-scale emergency”, explained Dora Anne Mills, M.D., M.P.H., FAAP, vice president for Clinical Affairs and director of UNE’s Center for Health Innovation. “To fully prepare for such an event, UNE faculty, staff, and students work in collaboration with state and community partners to simulate such an event, and offer free influenza vaccines to the public as part of the exercise.”

On October 20th, 2017, the UNE Biddeford Campus Center gymnasium was converted into an Alternate Care Site (ACS), a temporary medical system that is established to provide low-acuity care during a public health emergency. UNE students from four of UNE’s six colleges participated in the exercise to learn some of the principles of emergency preparedness planning from State officials.  A large turnout of people looking to receive their flu vaccine allowed medical and pharmacy students to administer vaccines to more than 225 UNE students, faculty, and staff.  Jessica Rehrig, a second year osteopathic medical student in UNE’s College of Osteopathic Medicine said “It is reassuring, both as a student physician and a member of the community, to know that adequate policies and procedures are in place to accommodate patients in the event of a medical surge or state-wide emergency.”

ACS exercise overview smaller copy

The UNE campus center gymnasium was converted into a temporary medical system to provide flu vaccines to the public. Several local and state public health agencies participated in the exercise, including the Maine DOT who delivered the durable medical supplies shown here to Biddeford from a warehouse in Augusta.

The October 20th ACS exercise represents a milestone as the first deployment of a multi agency scenario for the newly established York County Medical Reserve Corps (MRC), a partnership between the greater York County community and UNE.  It was also the first time Maine had implemented a test of the ACS system. “Maine CDC Public Health Emergency Preparedness Program (PHEP) purchased these modules as a way to provide emergency medical assistance in the event of a real response situation. These modules are designed to assist in the immediate response effort, as in help until help arrives, when Federal Medical Systems cache can be deployed”, says Patrick Furey, Maine CDC Public Health Emergency Preparedness Exercise and Training Coordinator. “It was great working with UNE faculty, staff, and students, area Walgreens Pharmacy staff and management, as well as Maine’s Medical Reserve Corps (MRC) volunteers at this exercise.”

One week later, on October 27th, 2017, the newly renovated Innovation Hall at UNE’s Portland Campus was converted to a Point of Dispensing (POD) site where influenza vaccine was once again administered to community members.  Medical, pharmacy, nursing, and public health students helped staff the exercise.  Valerie Bedard, a senior nursing student in UNE’s Westbrook College of Health Professions said “As a student here, it is wonderful to see that UNE is proactively thinking about how it will take care of the community in the event of an emergency. I really enjoyed learning from, with, and about my medical and pharmacy student peers as well as from the local and state public health community.”

A Point of Dispensing (POD) exercise was conducted on October 27th in UNE's newly renovated Innovation Hall.

A Point of Dispensing (POD) exercise was conducted on October 27th 2017 in UNE’s newly renovated Innovation Hall.

Caity Hager, from Maine’s Cities Readiness Initiative based out of the City of Portland, helped coordinate last years POD exercise on the UNE Biddeford campus and was able to use some of the lessons learned from last year to improve upon this years exercise. “Partnering with UNE to conduct similar exercises two years in a row allows the Maine Cities Readiness Initiative to improve and strengthen our plans to respond to this type of emergency”, said Hager. “We have been improving and refining procedures based on feedback from last year’s exercise and it is important for our program to have the opportunity to exercise the changes and evaluate the improvements to our plans.”

Caity Hager from Maine's Cities Readiness Initiative provides a "Just-in-time" orienation training for the staff members who volunteered to operate the exercise.

Caity Hager from Maine’s Cities Readiness Initiative provides a “Just-in-time” orientation training for the staff members who volunteered to help operate the exercise.

In total, more than 350 people receive an influenza vaccine at these exercises. A partnership with Walgreens and UNE’s Health Services ensured that there was enough vaccine supply to dispense to the public at the exercises. Several employees from Walgreens, including seven licensed pharmacists, donated there time to help staff crucial clinical and non-clinical roles at both exercises.  Heather Stewart, an alumnus of UNE’s College of Pharmacy Class of 2014, and current Walgreens pharmacist, says that her time at UNE as a student helped instill the importance of influenza surveillance as a tool to keep the public healthy.  “Influenza is a vaccine preventable virus that has significant public health consequences including decreased productivity, and increased morbidity, mortality, and healthcare expenditures.  Events such as the ACS and POD exercises not only prepare our First Responders for a large scale emergency but they also increase ease of access by creating another public health environment for patients to obtain their influenza immunization.”, said Stewart.

Heather Stewart, PharmD, provides a workshop on proper flu vaccine administration techniques to UNE healthcare students.

Heather Stewart, PharmD, provides a workshop on proper flu vaccine administration techniques to UNE healthcare students.

These exercises are done in collaboration with a number of partners, including: Maine CDC, York and Cumberland District Public Health Councils, Emergency Management Agencys, the City of Portland’s Maine Cities Readiness Initiative, area Walgreens pharmacists and management, and Maine Responds (Maine’s emergency health volunteer system). “As part of this initiative, UNE’s Center for Health Innovation works collaboratively with our health professions programs as well as state and community partners to provide learning experiences for our students. A number of medical, public health, nursing, pharmacy, and other students attend sessions run by emergency preparedness experts and assist in administering vaccines,” said Mills. “As a result, southern Maine will be better prepared for an emergency today, and tomorrow’s health professionals will also be better prepared.”

To learn more about the Center for Excellence in Health Innovation, visit: www.une.edu/academics/centers-institutes/center-excellence-health-innovation

UNE Holds Workshop on Opioid Use Disorder and Medication Assisted Treatment

November 8th, 2017 by healthinnovation
Expert speakers discuss opioid use disorder and medication assisted treatment at the October 28th workshop located on UNE's Portland campus.

Expert speakers discuss opioid use disorder and medication assisted treatment at the October 28th workshop located on UNE’s Portland campus.

On Saturday, October 28, 2017, the University of New England Center for Excellence in Health Innovation hosted an opioid use disorder (OUD) and medication assisted treatment (MAT) Workshop at UNE’s newly renovated Innovation Hall.

More than 150 people registered, and attendees included UNE students from the College of Osteopathic Medicine, College of Pharmacy, Westbrook College of Health Professions and College of Dental Medicine, as well as UNE faculty and clinicians from the community. Experts led presentations and discussions on MAT; screening, brief intervention, and referral to treatment (SBIRT); prescribing laws; public health impact; and stigma.

“As we face a deadly epidemic of opioid addiction, workshops like this are critical to assuring the clinicians of tomorrow as well as today are able to work together with clinicians from other professions and patients to successfully screen people for addiction, help people get into treatment, and keep them in recovery,” said Dora Anne Mills, M.D., M.P.H., director of the Center for Excellence in Health Innovation.

In 2016, 313 Mainers died of an opioid-related overdose, which represents 83 percent of all drug-related deaths in the State. Currently, the demand for MAT in the state still outpaces the supply, especially among those who lack health insurance or live in health professional shortage areas. To address the critical need for health professions education around OUD and MAT, the Center for Excellence in Health Innovation received $80,000 in supplemental funding from its federal Health Resources Services Administration (HRSA) Primary Care Training and Enhancement (PCTE) grant to further increase education around MAT in primary care. The Center for Excellence in Health Innovation plans to hold lunch and learn programs and future events for faculty and students who are looking to learn more about OUD and specifically MAT.

FMI contact Melanie Caldwell, mcaldwell4@une.edu or visit http://www.une.edu/academics/centers-institutes/center-excellence-health-innovation/grants-initiatives/primary-care-training-and-enhancement-grant

UNE Faculty and Staff Present at Collaborating Across Borders VI Conference in Banff, Canada

November 8th, 2017 by healthinnovation
UNE faculty from the Westbrook College of Health Professions present in Banff Alberta at the Collaborating Across Border (CAB) conference (From L-R, Nancy Jo Ross, Sally McCormack Tutt, Kelli Fox, Elizabeth Crampsey, and Kris Hall)

UNE faculty from the Westbrook College of Health Professions present in Banff Alberta at the international Collaborating Across Border (CAB) conference (From L-R, Nancy Jo Ross, Sally McCormack Tutt, Kelli Fox, Elizabeth Crampsey, and Kris Hall)

The University of New England was well represented at the Collaborating Across Borders VI conference in Banff, Canada. Ruth Dufresne, S.M., research associate and evaluator in the Center for Excellence in Health Innovation, gave a presentation focused on evaluation of the Josiah Macy Jr. Foundation and the Health Resource Services Administration (HRSA) funded Primary Care Training an Enhancement (PCTE) Project. She presented on behalf of the PCTE Team which includes Dora Mills, M.D., M.P.H., F.A.A.P., Jennifer Gunderman, M.P.H., Melanie Caldwell, M.S., Ian Imbert, M.P.H., and Toho Soma, M.P.H., as well as clinical partners at Penobscot Community Health Care (PCHC).

Elizabeth Crampsey M.S., OTR/L, BCPR, Kelli S. Fox LCSW, CCS, LADC, Kris Hall M.F.A., Sally McCormack Tutt PT, D.P.T., M.P.H., and Nancy Jo Ross Ph.D., RN, gave an interactive presentation titled, “Parallel Processes in Interprofessional Education (IPE): From Campus to Community.” They described an interprofessional educational (IPE) experience the team has been teaching for the past three summers in collaboration with clinicians from Maine Medical Center. They led participants through activities that simulated student activities in the course. Other UNE faculty contributors include Jan Froehlich M.S., OTR/L, Valerie Jones LMSW, Kira Rodriguez, M.H.S., and Heather McNeil.

Faculty worked to parallel/align the on-campus curriculum with professionals in the field to illustrate the real-world challenges faced by interprofessional teams in clinical practice. The course consisted of two classroom sessions and an assignment for the student groups to work on during the week between the classroom sessions. Students were assigned to interprofessional groups and were guided through activities that provided them the opportunity to learn about two key interprofessional core competencies: teamwork and professional communication. The classroom sessions were evaluated by faculty student feedback. The student feedback was analyzed to determine changes in their comfort level with IPE upon completion of the entire series of activities. The results of this analysis were also presented at the conference.

FMI: Contact Kris Hall of UNE’s IPEC at ipec@une.edu or at (207) 221-4491

UNE Students Share Experiences on their Second Day of the Fall Long Weekend Western Maine Rural Health Immersion

October 11th, 2017 by healthinnovation
Minh Tam Hua, second year pharmacy student, and Rodger Carter, first year osteopathic medicine student provide a blood pressure screening to a volunteer at the Fryeburg Fair on Saturday, October 7th.

Minh Tam Hua, second year pharmacy student, and Rodger Carter, first year osteopathic medicine student provide a blood pressure screening to a volunteer at the Fryeburg Fair on Saturday, October 7th.

Ten UNE health professions students recently participated in a long weekend rural health immersion to Oxford County in western Maine and to Carroll County in northern New Hampshire.  The immersion experience is a part of a pipeline program with Maine’s Area Health Education Center (AHEC) program and UNE’s Center for Excellence in Health Innovation (CEHI) to address healthcare provider shortages in rural Maine.  This is the fourth immersion experience that the Maine AHEC and CEHI have provided for UNE students but the first time that a group has traveled to Oxford County.  Last May a group of 13 medical, pharmacy, dental, and nursing students traveled to Maine’s midcoast region of Knox and Waldo Counties for a weeklong immersion; last March medical and nursing students participated in a weeklong immersion in Franklin County; and in May of 2016 a group of 15 medical, pharmacy, and dental students participated in a weeklong immersion in Aroostook County.  Of the four immersions that have been held so far, this was the most diverse group of students, five different health professions were represented from UNE from the College of Osteopathic Medicine, College of Pharmacy, College of Dental Medicine, and Westbrook College of Health Professions Physician Assistant and Bachelor of Science in Nursing (BSN) programs.  Throughout the trip the students were split into interprofessional teams so that they could learn about the roles of the other professions and how to communicate effectively across disciplines in order to provide team-based care and improve patient outcomes, a primary learning outcome of the four year Josiah Macy Jr. Foundation grant that helps fund the immersion experiences.   The students experienced a variety of clinical, community, and population health activities in underserved areas in western Maine and northern New Hampshire.  Below are reflections from one team after the second day on Saturday, October 7th, 2017.

Brittany Malia, second year dental medicine student

The rural health immersion trip has been an amazing experience! Today was our second day and in the morning we volunteered at the Fryeburg Fair to help staff the First Aid centers. At the fair, we handed out care kits and provided blood pressure screenings. I enjoyed interacting with members of the community at the fair and talking to them about the communities that they live in.

After the fair, we toured a local community Pharmacy at a Hannafords supermarket. The pharmacist showed the entire group how a prescription is filled from start to finish, which I thought was enlightening since I will be prescribing once I become a dentist. This was just one of the many places that we have been able to see throughout the weekend; yesterday we also toured two critical access hospitals, two community health centers, and an oral health clinic. The rural health immersion trip has been a wonderful opportunity to learn about the roles of other health professions, and how we can successfully work together as a team in order to provide the highest quality care to our patients.

Later in the evening we returned back to our house on the water to play board games and have s’mores in front of an open fire. During this trip, I have met many wonderful students from other health professions that I otherwise wouldn’t have had the opportunity to meet. I highly recommend this trip to anyone considering attending!

 

 

UNE students pose for a photo in front of one of the first aid stations at the Fryeburg Fair, where the students helped hand out free Care Kits and provided health screenings to anyone interested.

UNE students pose for a photo in front of one of the first aid stations at the Fryeburg Fair, where the students helped hand out free Care Kits and provided health screenings to anyone interested.

Minh Tam Hua, second year pharmacy student

Today during the Fall Long Weekend Rural Health Immersion, I got the opportunity to volunteer taking blood pressure and passing out Care Kits to the people at the Fryeburg Fair, which is known to be the largest agricultural fair in Maine. We were divided into groups, where each groups consisted of a medical student, a nursing student, a dental student, and a pharmacy student. This was my first time working with other students from other health professionals so I got the chance to learn more about their profession and what their roles were.

This event gave me the opportunity to meet and talk with people from the rural communities in Maine. My group and I took blood pressure of total 12 people and only one person turned out to have a “normal” blood pressure reading. The other 11 people’s blood pressures ranked in the hypertensive range. From class I know that the normal blood pressure reading in a healthy individual is around 120/80 and anything higher than that will be a risk factor for developing certain diseases. I was shocked that it was that many people who were at risk of getting Hypertension. As future health care providers, my group and I would recommend that the people whose blood pressures were in the hypertensive range be referred to the paramedics on staff. To our surprise, most of them weren’t concerned that their blood pressures were high. I feel that most of the people that we met during this fair didn’t want to hear about many of the health risk factors, such as unhealthy diet, lack of exercise, smoking and high blood pressure readings and how they can all lead to serious health issues in the future.

Based on this personal experience, I feel that we as health professionals should create more events in Rural communities where we provide free screenings and educate the community about the danger of the chronic diseases, such as Hypertension, Diabetes, Hyperlipidemia, Stroke, and Heart diseases. I think that, as students, we can make an impact on the health of these people. From a health professional point of view, and from what we’ve learned during this immersion so far, I believe that it’s important and better to prevent a disease early on than treating it later on. I feel that if we all stand together and contribute our part, we will be able to help reduce the number of chronic diseases that are taking place not only in these rural areas but also throughout the US.

Students conducted a Worksite Health ScoreCard at the fair to assess it's performance in several categories like Animal areas, Nutrition, Tobacco, and more.

Students conducted a Worksite Health ScoreCard assessment at the fair to assess it’s performance in several categories like Animal areas, Nutrition, Tobacco, and more.

 

Kimberlee Sell, second year dental student

On the second day of the immersion we attended the Fryeburg Fair which can attract between 30,000-40,000 people in a single day. We split into three teams, two teams worked at the first aid stations and one team would check the “Health Score” of the fair using an altered health assessment tool created by the CDC. While at the first aid stations we offered free blood pressure screenings and we gave out Care Kits consisting of things like toothpaste, soap, and band-aids. While the care kits seemed insignificant to me, it felt good to see how excited people were to get some basic health supplies for free, especially the toothpaste.

My first two shifts at the fair were spent giving blood pressure screenings. There was a good number of people who were very excited to see what their blood pressure was. I did notice a lot of people had a blood pressure that read into the hypertensive range. We would talk to them about visiting their primary care provider and hand them off to the NP or paramedic on staff with us. The people I talked to didn’t seem eager to visit their provider when we talked with them about it, perhaps because they had to travel long distances or couldn’t afford the co-pays at their doctors office.

The third station was checking the health of the Fair regarding Tobacco and Nutrition policies. The only ‘no smoking’ signs were located by the first aid stations. We noticed many people smoking in the middle of crowds of people. We thought the fair could improve it’s tobacco policy in order to make it a more healthy environment for guests; one recommendation would be to have designated smoking areas away from crowds of people. We also noticed that the healthy food choices were few and far between. We did see a steak salad and a smoothie bar. Overall, it was a fried paradise- anything you could think of was fried, oreos, ice-cream, dough, and more. Because of this we also thought the fair could improve its nutrition score by providing more healthy food options.

 

DSC_1071 smaller photo fire

Later in the evening the students returned to the house to enjoy s’mores over an open fire and reflect on the days activities.

UNE’s Fall Long Weekend Rural Health Immersion Kicks off

October 10th, 2017 by healthinnovation
DSC_1077 smaller file group pic

Ten UNE healthcare students recently participated in a long weekend rural health immersion to western Maine and northern New Hampshire. (From L – R Row 1 Taylor Ouellette OMS I, Brittany Malia CDM II, Kimberlee Sell CDM II, Minh Tam Hua CoP II, Kelly Banks CoP II, Katie Clark BSN IV, Nicole Caron CDM II; Row 2 Ian Imbert MPH, Rodger Carter OMS I, Lesley Lafland BSN IV, Rachel Moore PA I)

Ten UNE health professions students recently participated in a long weekend rural health immersion to Oxford County in western Maine and to Carroll County in northern New Hampshire.  The immersion experience is a part of a pipeline program with Maine’s Area Health Education Center (AHEC) program and UNE’s Center for Excellence in Health Innovation (CEHI) to address healthcare provider shortages in rural Maine.  This is the fourth immersion experience that the Maine AHEC and CEHI have provided for UNE students but the first time that a group has traveled to Oxford County.  Last May a group of 13 medical, pharmacy, dental, and nursing students traveled to Maine’s midcoast region of Knox and Waldo Counties for a weeklong immersion; last March medical and nursing students participated in a weeklong immersion in Franklin County; and in May of 2016 a group of 15 medical, pharmacy, and dental students participated in a weeklong immersion in Aroostook County.  Of the four immersions that have been held so far, this was the most diverse group of students, five different health professions were represented from UNE from the College of Osteopathic Medicine, College of Pharmacy, College of Dental Medicine, and Westbrook College of Health Professions Physician Assistant and Bachelor of Science in Nursing (BSN) programs.  Throughout the trip the students were split into interprofessional teams so that they could learn about the roles of the other professions and how to communicate effectively across disciplines in order to provide team-based care and improve patient outcomes, a primary learning outcome of the four year Josiah Macy Jr. Foundation grant that helps fund the immersion experiences.   The students experienced a variety of clinical, community, and population health activities in underserved areas in western Maine and northern New Hampshire.  Below are reflections from one team after the first day on Friday, October 6th, 2017.

 

The first stop of the day was at Saccopee Valley Health Center in Porter, ME, where the students met with Dr. Jeff Ray, DO, Medical Director, and Dr. Israel Adeloye, DMD.

The first stop of the day was at Saccopee Valley Health Center in Porter, ME, where the students met with Dr. Jeff Ray, DO, Medical Director, and Dr. Israel Adeloye, DMD, to discuss providing care to underserved populations.

Rachel Moore, first year physician assistant student

Reflecting on the first day of the Rural Health immersion, it is hard to fully sum up everything I experienced and learned. From the very first stop at Saccopee Valley Health Center (SVHC), I was in awe of all the things I took for granted as a practitioner. We quickly learned that many patients in this community are severely limited by transportation, which limits their ability to go to Portland for referrals or any further care that SVHC was not able to offer. Not only that, but even basic oral hygiene did not really exist; and their dentist discussed how for a while 75% of his appointments were full mouth extractions because his patients teeth were beyond the point of repair. From one clinic to the next we witnessed the struggles everyone faced with opioid addictions and patients who are at or below the poverty line and unable to pay for their care. At Bridgton Hospital, we were informed that nearly half of the babies are born addicted to tobacco, alcohol, or other drugs. It would be understandable if someone were to look at the challenges their health practitioners are facing and feel they are insurmountable.

And yet, despite the seemingly insurmountable challenges, at each clinic we saw health care practitioners full of passion, creativity, and love for their community. Each of the people we met with were full of excitement to serve the rural populations and were willing to do whatever it took to do right by them. Throughout the day we say endless examples of this, including a dentist fresh out of school who built the entire dental program at SVHC from scratch and started outreach to the community to teach proper teeth dentition to children in schools; an NP who had achieved countless additional certifications, including one in Psych to help serve the specific needs of her community; the Bridgeton Hospital’s free shuttle for their patients so they can get the care they need; the cross competency trainings of nurses in all the departments so that they can change departments at a moment’s notice to serve where they are most needed.

There is a vast network of community in these health systems and everyone seems to know everyone and offer their support to help serve their patients. It’s true that the rural communities that we’ve visited so far have been underserved but nevertheless it is so clear that the providers that we’ve met give every ounce of their energy to improving the health of their communities.

 

 

The students discuss population health initiatives with Sue Ruka, RN, PhD, at Memorial Hopsital, a Critical Access Hospital in Conway, NH.

The students discuss population health initiatives with Sue Ruka, RN, PhD, at Memorial Hopsital, a Critical Access Hospital in Conway, NH.

 

Taylor Ouellette, first year osteopathic medicine student

What resonated with me most about today’s site visits was the passion of the providers that spoke to us about their practices. Providers of various backgrounds showed us around each site, and the different backgrounds of these providers added to our visits and served to show us the unique personality of each place. When these individuals showed us around the facility and interacted with other providers and staff at the site, we could tell by looking at their facial expression and listening to their presentation how excited and proud of their office, hospital or clinic they were even though these sites are not the may not have the most state of the art equipment to practice medicine and see patients. In fact, one provider at a small community health center communicated to us that although the practice was lacking in funding and resources, there was another similar sized health center in the state that was worse off than the site she worked at, as if to say “it could be worse”.

Hearing this providers optimism about her practice showed the positive and steadfast attitude these rural healthcare providers have about the work that they do every day. These providers that we are meeting with know how significant of an impact they are making on the local community and how vital they are to the wellbeing of the community as a whole. Yet, they were humble about this fact as they were talking to us. Listening to the providers tell stories about patients in the community they care for was very inspirational and uplifting despite the challenging circumstances of many of the people these providers treat. Their passion was contagious.

I was also very impressed by the fact that these providers develop the skills to think on their feet and get creative with the limited resources they have to treat patients who face many barriers to accessing quality healthcare. Furthermore, these providers are remarkable in the sense that their scope of practice is forced to become so broad as they have to become competent in a variety of topics due to the range of issues they deal with on a daily basis in a rural setting. I’m looking forward to what tomorrow has in store for us!

 

Sue leads the students through one of the Gemba boards at Memorial Hospital.

Sue leads the students through one of the Gemba boards at Memorial Hospital.

 

Kelly Banks, second year pharmacy student

The first stop of the day was at Sacopee Valley Health Center with Dr. Jeff Ray. Before arriving the perception of a rural area was the potential for lack of resources. What was fascinating about Dr. Ray and his facility was how much more ahead of the medical game than most facilities are in a non-rural area. When asked about E-prescribing and electronic records he indicated his facility has been working with that type of system long before it was mandatory. When asked about the opioid crisis he indicated they offer plenty of access for patients to speak with someone at the facility, hold meetings, and try their best to regulate the date at which the prescriptions can be filled. An issue he did bring up with the opioid crisis is that the pharmacy will sometimes fill prescriptions earlier than indicated which he was hopeful will eventually change.

The second stop was at Memorial Hospital in which the pharmacy students got the option to speak with the pharmacist. He had worked in community pharmacy for a number of years before working in the hospital setting. What I took away from the visit with him was the sense of community he has by working in a smaller hospital pharmacy. Two pharmacists will run the whole hospital while a larger hospital has one pharmacist per level. He explained that everyone seems like family, all of their families grow up together, and it gave him a better “quality of life”.

The third stop was White Mountain Community Center. What seemed to amaze everyone about this facility was that there was a food pantry in the middle of the practice that was run by volunteers in the community. They have a physician on site only a couple times a week so the NPs on staff run the show. Another important point to this stop was that the NPs would get extra certifications in order to serve the community needs better. This facility also had a teen clinic run by volunteers in the area where kids could get birth control, condoms, and someone to talk to if needed. There are not many teen clinics around so they are crucial to helping the area.

The last stop was Bridgton Hospital which was the most enthusiastic work setting of all. The atmosphere in the hospital was that the patient comes first while making use of their small facility. It was interesting how, in the case of a sudden patient surge, the different departments of the hospital can expand to become a part of other departments by just opening up a few doors. This helps with work flow depending on staffing and time of day.

The Rural Health Immersion allowed for us to get an idea of what health professionals deal with on a daily basis. Whether the facilities were teaching how to brush teeth through community outreach at the schools or helping the nearly 50% of babies born on drug dependence, the facilities adapt to serving their community as it needs it most. The first day showed me how much of a difference each health care professional can make on the rural community one day and one patient at a time, especially when they work well together as a team. This Rural Health Immersion has really opened my eyes to how difficult but rewarding working in a rural health community can be with the right attitude.

The students pose for a photo outside of Conway Oral Health with Dr. Eric Heirschfield, DMD.

Later in the day the students pose for a photo outside of Conway Oral Health with Dr. Eric Heirschfield, DDS.

Lesley Lafland, fourth year nursing student

I enjoyed the Rural Health Immersion to Oxford County, it was truly an eye opener as it provide a glimpse into rural health. My two favorite stops today were Saccopee Valley Health Center and Bridgton Hospital. I grew up in what I thought was a rural setting in Aroostook County but, looking back, I always had readily accessible health care.   After todays experiences, I realized that I actually had it a lot better than most people in rural settings. I had a hospital in my hometown and transportation to get to my appointments whereas the patients in the greater Porter community have to travel over an hour to get to the hospital or to specialists. I’m considering becoming an infusion nurse and noticed that they don’t have anyone doing infusions there, largely due to the fact that there is no way to monitor the patients and make sure they are communicating with their oncologist and following their treatment plan.

Bridgton Hospital was great to visit and learn that even though it’s in a rural area and is a critical access hospital they have an infusion room so that cancer patients don’t have to travel over an hour to Central Maine Medical Center to receive their treatments. Despite being a small hospital it’s great to see that that patients can get the care they need without having to travel a long distance, which is sometimes the difference between whether a patient completes their treatment plan or not.

 

UNE to Offer Opioid Use Disorder and Medication Assisted Treatment Workshop

September 26th, 2017 by healthinnovation

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In July 2017, UNE received $80,000 in supplemental funding from its HRSA Primary Care Training and Enhancement (PCTE) grant to further increase education around Medication Assisted Treatment (MAT) in primary care to address the opioid crisis. In 2016, 313 Mainers died of an opioid-related overdose, which represents 83% of all drug-related deaths in the State. Currently the demand for MAT in the state still outpaces the supply, especially among those who lack health insurance or live in health professional shortage areas.

To address the critical need for training, UNE’s Center for Excellence in Health Innovation will be hosting an Opioid Use Disorder and Medication Assisted Treatment Workshop on Saturday, October 28, 2017. The workshop will host experts discussing the current climate in Maine concerning the opioid epidemic and its impact on the state. Attendees will gain knowledge in areas including OUD diagnosis, prevention and treatment, and emphasizing MAT. Day of presenters will include:

  • Dora Anne Mills, MD, MPH– University of New England
  • Toho Soma, MPH- University of New England
  • Peter Michaud, JD, RN– Maine Medical Association
  • Matthew Braun- Young People in Recovery
  • Clay Graybeal, PhD, MSW – University of New England
  • Bethany Fortier, MPH – University of New England
  • Brianna Nalley, MPH– University of New England
  • Lisa Letourneau, MD, MPH– Keynote Speaker
  • Alane O’Connor, DNP– MaineGeneral Medical Center
  • Mary Beth Leone – Thomas, LCSW– Penobscot Community Health Care
  • Noah Nesin, MD– Penobscot Community Health Care

The workshop is free and open to all UNE health professions students, UNE faculty, and interested community members. Student attendees to this workshop can apply their attendance toward SBIRT Student Leader Certificate, IP Honors Distinction, or Care for the Underserved Pathway (CUP) scholar distinction. Contact hours will also be available for practicing clinicians.

For more information and to register please visit:  http://www.une.edu/calendar/2017/opioid-use-disorder-and-medication-assisted-treatment-workshop

UNE Receives Federal Grant to Support Health Workforce Development in Rural and Underserved Areas

September 26th, 2017 by healthinnovation

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The University of New England Center for Excellence in Health Innovation has received a federal grant to support the Maine Area Health Education Center (AHEC), which works to alleviate health workforce shortages in rural and underserved areas of the state.

This $309,000 grant from the Health Resources and Services Administration (HRSA), will enhance AHEC’s ability to achieve greater workforce diversity, distribution, and practice transformation as part of, and within the context of ongoing changes to the way health care is delivered.

Through this program, AHEC will increase the number of students trained in rural and underserved areas by adding a robust AHEC Scholars program. It will increase community-based training and interprofessional learning opportunities for health profession students, support new strategies to increase workforce diversity and strengthen pipeline activities to encourage youth to pursue health professions.

The funding will also address the training needs of health professions students and rural providers on emerging health issues and health disparities, and support partnerships with government and community-based organizations to enhance workforce-training needs around the challenges of practice transformation.

The AHEC program office at UNE contracts with three rural centers: Eastern Maine AHEC at the Penobscot Community Health Care, Northern Maine AHEC at Northern Maine Community College, and Eastern Maine AHEC at Franklin Memorial Hospital.

FMI: http://www.une.edu/ahec

UNE’s Clinical Interprofessional Team on the move nationally

September 26th, 2017 by healthinnovation
Dora Anne Mills, Toho Soma, and Melanie Caldwell provide consultation to a leader from A.T. Still University.

Dora Anne Mills, Toho Soma, and Melanie Caldwell provide consultation to a leader from A.T. Still University.

 

On Tuesday August 22, 2017, several people from the University of New England’s Clinical Interprofessional Team presented a one-and-a-half hour session at the National Summit for Interprofessional Practice and Education, hosted by the federally-funded National Center for Interprofessional Practice and Education at the University of Minnesota.

Dora Anne Mills, M.D., M.P.H., FAAP, Toho Soma, M.P.H., and Melanie Caldwell, M.S., presented a session called, “Lessons Learned from Scaling Clinical Interprofessional Sites from One to 12 Sites Across Maine.” They also provided consultations and shared resources at a kiosk. During the session they shared challenges, lessons learned and resources during their several years of developing clinical interprofessional clerkships that involve UNE osteopathic medical students working alongside other UNE health professions students across Maine, with a focus on rural health centers providing care for the underserved. The Clinical Interprofessional Team, based in UNE’s Center for Excellence in Health Innovation, works collaboratively with UNE colleges and clinical affiliates, with support from the Josiah Macy Jr. Foundation. This last academic year, 165 UNE health professions students, including 86 osteopathic medical students, participated in interprofessional clerkships of at least several weeks in 12 clinical sites across Maine. In 2017 and 2018, 15 clinical sites are expected to participate.

The presentation at the National Summit was one of several recent national presentations by the Center in Health Innovation’s Clinical Interprofessional Team on UNE’s successful efforts to scale up interprofessional education (IPE) and practice learning activities in clinical sites in order to assure UNE health professions students have these opportunities and graduate team-ready. For instance, over the last few weeks Mills delivered: a keynote presentation at the Interprofessional Education Collaborative (IPEC) Institute in Washington DC; a breakout session at the annual meeting of the American Association of Colleges of Osteopathic Medicine (AACOM) in Baltimore, Maryland; and a webinar sponsored by the Interprofessional Education Collaborative on UNE’s clinical IPE efforts.

Additionally, team members from UNE’s clinical IPE staff and faculty, including Toho Soma, Judith Metcalf, Ruth Dufresne, and Ian Imbert, along with Mills, attended the three-day IPEC Institute in D.C. with clinical leaders from Greater Portland Health, the area’s federally qualified health center, to plan an expansion of clinical interprofessional practice opportunities for UNE health professions students that include osteopathic medical students. Mills also gave an invited keynote on leadership in a changing health landscape to the Chief Medical Officer’s (CMOs) Leadership Academy convened by the American Association of Medical Colleges (AAMC) in Washington DC. This is a year-long academy for CMOs in major academic health centers.

To learn more about the Center for Excellence in Health Innovation, visit: http://www.une.edu/academics/centers-institutes/center-excellence-health-innovation

To apply, visit www.une.edu/admissions

UNE Interprofessional Community Health Rotations: Training medical students in team-based rural primary care

August 27th, 2017 by healthinnovation

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August 13-19, 2017 was recognized as National Health Center Week, celebrating the work of Federally Qualified Health Centers (FQHCs) in providing comprehensive, coordinated health care to rural and urban underserved communities throughout America. This event drew attention to Maine’s network of mostly rural FQHCs, some of which have begun to serve as training sites for UNE College of Osteopathic Medicine (COM) students as part of an Interprofessional Education Community Health Rotation (IPE CHR) experience.

While UNE COM’s four-week CHR has traditionally addressed not only patients’ clinical needs, but the socioeconomic and cultural factors that shape health outcomes, the IPE CHR was created in 2016 to help COM students apply their on-campus interprofessional training to team-based primary care practice. The IPE CHR includes four to eight hours per week of engagement with non-medical health professionals, providing a profound awareness for COM students of the value of collaborative care. According to Dora Anne Mills, MD, MPH, FAAP, Vice President for Clinical Affairs and Director of UNE’s Center for Excellence in Health Innovation (CEHI), “Maine’s FQHCs are ideal settings for introducing UNE COM students to interprofessional care, as the one-stop shop FQHC care model often includes behavioral health, dentistry, care coordination, and assistance with community resources, effectively meeting patients’ and families’ complex care needs.”

As a foundation for clinical IPE training in rural Maine, the UNE CEHI created the Clinical Interprofessional Curriculum (CIPC) in 2016, which introduces COM students to the national Patient Centered Medical Home (PCMH) model of care now in place at the majority of Maine’s FQHCs. The CIPC’s three-pronged emphasis on team-based care, care management, and population health now guides UNE students in practice-based IPE CHR activities including: student engagement with specialists (podiatrists, optometrists, psychiatrists, etc.) as well as engagement with pharmacists, clinical care managers, behavioral health providers, diabetes educators, case managers (addressing social service needs), dentists, and more. COM students have also worked within interprofessional teams addressing care planning, quality improvement, post-discharge care, and palliative care.


IPE CHR Spotlight: Nasson Health Care, Sanford, Maine

Samuel Wood, OMS-III, UNE College of Medicine

Samuel Wood, OMS-III, UNE College of Medicine

Sam Wood, a third-year COM student and Care for the Underserved Pathway (CUP) scholar with a specific intent to serve vulnerable populations, recently completed his IPE CHR at Nasson Health Care, an FQHC serving rural, low-income communities in southwestern Maine. Following a wide range of team-based care experiences at Nasson including a home visit to a patient with terminal kidney disease, participation in a Cooking Matters nutrition class for food stamp program enrollees, and an unscheduled intake for an opioid-dependent patient, Sam observed that “every link in the chain matters” in meeting patients’ complex needs. At the close of his IPE CHR, Sam reflected that his opioid-dependent patient had “walked in helpless, alone, and without any resources, but roughly one hour later, she emerged with confidence, a plan, and a team to help her implement it.” –Samuel Wood, OMS-III, UNE College of Medicine

Mary Jeralds, RN, Clinical Nurse Manager at Nasson Health Care, also noted at the close of Nasson’s first IPE CHR that her team “feels very fortunate to have had an opportunity to provide a medical student with a rural health rotation. [Sam Wood] was able to participate in providing comprehensive and integrated care in a Patient Centered model of care.”


To date, students have completed IPE CHRs at Nasson Health Care/Sanford, Penobscot Community Health Care/Bangor and Brewer, MDI Hospital/Hancock County* , Swift River Family Medicine/Rumford*, Greater Portland Health/Portland (serving a large refugee/immigrant population). Future IPE CHRs are also planned at Health Access Network/Lincoln, Sacopee Valley Health Center/Porter, Harrington Family Health Center/Harrington, Islands Community Medical Services/Vinalhaven, and DFD Russell Medical Center/Leeds and Monmouth.

* rural practice network; not FQHC

 

FMI: contact MaryFrances Smith, AHEC Clinical Coordinator, msmith4@une.edu or Ian Imbert, Clinical IPE Project Coordinator, iimbert@une.edu