Dora Smith has come to the Federally Qualified Health Center (FQHC) for several problems she is experiencing. Your group performed an interprofessional team evaluation with the results in the case below. Your team is now meeting to create a plan for Dora.
Dora Smith is a 52-year-old woman (DOB 6/1/68), that has been a patient at the Federally Qualified Health Center (FQHC) for the last 8 years. She attends her appointments sporadically. The last time she was seen was 1.5 years ago. Note: The FQHC has behavioral health, physical health, dental, and pharmacy services all in one building
PMH:
Chronic low back pain
Opioid use disorder
Gastroesophageal reflux disease
Depression
High blood pressure
Peripheral neuropathy bilateral feet
Type 2 diabetes mellitus
Medications
Oxycodone 5 mg every 3 hours PRN
Rantidine 150 mg every 12 hours
Metoprolol 50 mg every 12 hours
Hydrochlorothiazide 25 mg daily
Gabapentin 600 mg every 8 hours
Clonidine 0.3 mg every 8 hours
Social history: Patient is divorced. She lives in a second-floor apartment with her medium sized dog
Reason for visit: Recent fall 1 month ago when walking her dog (tripped on the dog leash). She sustained a concussion and reports increased low back pain since the fall. Today, she reports severe pain in a tooth on bottom left side of her mouth that started about a week ago.
Examination
Vital Signs
Temp: 99°F
HR: 90 bpm
BP: 159/85 mmHg
RR: 12 bpm
Height 5’2”, Weight 170 lbs
Labs (from ED visit 1 month ago)
Laboratory Test
Result
Normal Range
Sodium
130
135-145 mEq/L
Potassium
5.5
3.5-5.0 mEq/L
Chloride
100
98-107 mEq/L
CO2
20
22-26 mEq/L
Glucose
150
90-108 mg/dL
BUN
20
5-25 mg/dL
Creatine
1.7
0.6-1.1 mg/dL
WBC
9,000
4,5000-11,000/mm3 %
Hgb
10
13-18 g/dL
Hct
32
36-49%
Platelets
150,000
145,000-450,000/mm3
Dora was assessed in the dental clinic, prescribed antibiotics for an abscess and is to return in 12 days for a follow-up appointment. The next available appointment is one month from the dental clinin assessment visit.
Questions
What are the issues?
What is your desired outcome?
What stakeholders will you need to work with to achieve your desired outcome?
Describe in order, what major steps will need to happen to achieve your desired outcome?
What unique strengths can each discipline bring to the team?
How could your team include patients’ preferences into the plan?
What strategies could you use if you encountered resistance from a colleague while working on a plan to achieve your desired outcome?
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