Goals of the program

• Train students from multiple disciplines to practice collaboratively in the care of their older patients
• Increase trainees' knowledge of clinical geriatrics
• Foster an appreciation of the patients' communities, familes, and homes as contexts for care decisions

Funding sources and sponsors

William N. Hubbard, MD, and his children established the Elizabeth T. and William N. Hubbard, Jr. Memorial Fund to support collaborative clinical practice opportunities for health professionals. Dr. Hubbard recognized that each health profession utilizes a characterizing pattern of knowledge, skills, experience, relative values, legal definition and cultural history that can be joined to greatly enhance the well-being of the patient. Dr. Hubbard cited the elderly as one group likely to have measurable benefit from collaborative practice and suggested that the primary care environment is best suited for a teamwork approach to care. Since January 1997, The Elizabeth T. and William N. Hubbard, Jr. Memorial Fund has supported the UNC-CH Center for Aging and Health's Hubbard Program: Collaborative Clinical Practice in Geriatrics.

Description and activities

Who?
The team is comprised of advanced trainees in family medicine, physical therapy, pharmacy, occupational therapy, social work, and nursing. Each trainee is identified with a discipline specific preceptor. Faculty from the departments of physical therapy and social work are on-site preceptors.

How?
Patients selected for Hubbard team evaluation are medically and socially complex and often are in crises or transition. Patients are referred by the health care team at the geriatric evaluation clinic, from the Department on Aging, or their primary care physicians. The team travels to the patient's home and students from each discipline interview and evaluate the patient in the presence of all team members. There is a patient chart review and identification of the concerns to be addressed.The team then formulates a set of prioritized recommendations that is implemented by the primary care providers.

What?
Consultative team assessment.

Where?
In the patients' homes. Family members are encouraged to participate in the evaluation

When?

How much?
Trainees are offered a stipend each semester of their participation

Examples of patients seen by the Hubbard team include:

...an 88-year-old man who experienced a devastating stroke. The physical therapist was unsuccessful in her attempts to help him until the doctor recognized the patient's depression and prescribed appropriate medication.

...a 92-year-old woman with moderate dementia and renal failure was being cared for by her much younger husband. The husband died suddenly and the family was in conflict about how to care for their mother. The doctor recommended institutionalization for the patient until the nurse practitioner suggested a local program designed to support frail elders in their homes.

...an 86-year-old woman who believed her anti-psychotic medication caused her muscle weakness and hip pain. This belief was dismissed as folk logic until the pharmacist confirmed that the weakness could be a side-effect of the medication.

Evaluation

Program Evaluation is accomplished through preceptor feedback, monthly advisory meetings with the senior administrator, and quarterly reports. Each week, patient visits are summarized by the teams and case-based learning points are generated by trainees.

Trainee Evaluation is accomplished through mid-term and final meetings between Hubbard preceptors, individual trainees, and their discipline specific faculty liasons.

What trainees say about the Hubbard Program:

• "I have an increased understanding of PT/Social Work/Nursing and how vital they are to geriatric practice."
• "The program has helped me highlight the uniqueness within my profession, as well as what I share with other professions."
• "I gained an appreciation for the many skills of both nurse practitioners and physical therapists."
• "The program emphasized my need to consult with other professionals to provide optimal care to geriatric patients."

For more information, contact:

Cherie Rosemond, MS PT GCS, Team Leader, Core Clinician in the Center for Aging and Health and Faculty member in the Division of Physical Therapy, (843-8696, crosemon@med.unc.edu).

Last updated 7/12/2007.