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?