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질문 내용 : Interdisciplinary
Research: An Eye-Opening Experience

By Gino R. Garza, RDH with Carol Nguyen, RDH, MS, Faculty Mentor
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Introduction

In the summer of 2009, as a result of a community collaboration among the University of Texas Health Science Center San Antonio (UTHSCSA), School of Health Professions, School of Medicine, College of Pharmacy, AHEC, and Reaching Maximum Independence, Inc., I had the opportunity to participate in an Area Health Education Center (AHEC) interdisciplinary research fellowship at UTHSCSA. Not only was I excited to branch out into the field of research, but I was also looking forward to the unique opportunity the fellowship offers to work in a collaborative team of students from different programs and backgrounds.

Our diverse group included Vanessa Agado from respiratory care, Katherine Perez and Megan Cunningham who were pharmacy students, Chun Yu Yeung from the physical therapy department, and me from the department of dental hygiene. When we met for the first time, we shared what we expected to learn during the fellowship. We all expected to learn quite a bit about the research process, as none of us had any previous research experience, and we also expected to gain insight into each other’s specialties through discussions.

The fellowship involves a three-year pilot study on health care services for young adults with developmental disabilities (DD) as they make the transition to adulthood. Last summer (2009) was the first of three during which research fellows will administer a 45-minute interview to research participants about topics like the quality of care they receive and their insurance needs.

We spent the first six weeks of the fellowship learning everything about the research process—from the need for the Institutional Review Board, to analyzing data and developing poster presentations to present the data we collected. Through the agreement with AHEC, who provided the funding for our fellowship, we were to develop three different posters to present at the UTHSCSA Research Day in the fall semester.
After working in pairs to interview all of the participants and analyzing the data with the help of the incredibly helpful faculty at UTHSCSA, the entire group decided on three poster topics:

• Patient-Centered Care: Essential for People with DD in San Antonio, Texas
• Health Care Transitions
• Gaps in Health Professionals’ Education: Caring for Patients with DD

After choosing the topics, we again split into pairs. Megan Cunningham and I chose to pursue the poster topic, “Gaps in Health Professionals’ Education: Caring for Patients with Developmental Disabilities.”

Background

The Americans with Disabilities Act of 1990 defined a developmental disability (DD) as “a physical or mental impairment that substantially limits one or more of the major life activities that manifests before age 22 and is likely to continue… .” Of the more than 300,000,000 people living in the U.S. (2007 U.S. Bureau of the Census), 20 percent are adult, non-institutionalized persons with disabilities.[1] Many adults with DD face challenges in receiving adequate health care because the professionals who provide their medical and dental care lack the required training. This can lead to poor health outcomes, limit social interactions and increase health care costs.

Evidence suggests that parents of children with disabilities view health professionals as adequate supporters when the professional makes every effort to improve the child’s well-being. Parents are more satisfied with their child’s care when health professionals demonstrate trust in the family’s capacity to care for their child and take interest in the child as a person as well as a patient.[2] To date, limited research exists regarding gaps in health care services for young adults with DD as they transition to adult life. This pilot study identified areas where improvement in medical and dental services for these patients is needed, based on factors including patient satisfaction.

Study Design and Population

This pilot study focused on the experience of young adults with DD transitioning to adulthood and their family members. Its purpose was to gain new insights into the medical and dental needs of this population. An exploratory research design was used to identify a convenience sample of 15 individuals, in which descriptive, quantitative and qualitative data were gathered in a structured interview format. Demographic results demonstrated that 67 percent (10) of our population was male and 33 percent (5) was female, with a mean age of 22. Under race/ethnicity, we found that 53.3 percent were white, 33.3 percent were Hispanic, 6.7 percent were Black/African American and 6.7 percent were Asian.

This pilot study was approved by the Institutional Review Board, May 6, 2009, approval number HSC2009033H. All research assistants were CITI trained in the biomedical affiliate course on the topic of human research and to ensure patient privacy. Participants in the study were young adults enrolled in a transition program. Transition programs help high school students with disabilities attain the skills needed to move toward independence and self-sufficiency. We worked with Reaching Maximum Independence, Inc., a non-profit organization administered by Executive Director Pamela Kelly through Northside and Northeast Independent School Districts in San Antonio, Texas. These programs teach daily living skills like money management, transportation arrangements and setting appointments as well as providing vocational training, fostering employment skills, and assisting in the transition to being an active participant in the community.

The study subjects and/or their legally consenting adult participated in a 45-minute face-to-face interview. Upon completion of data collection, data were entered into the UTHSCSA server.

Results

13 percent of patients were very dissatisfied with the quality of dental care they had received
(Figure 1).
26.7 percent of patients felt that their general dentist was not prepared to treat patients with DD (Figure 2).
13 percent of patients were very dissatisfied with the quality of medical care they had received (Figure 3).
33.3 percent of patients felt that their general physician was not prepared to treat patients with DD (Figure 4).
Patients felt providers do not listen while communicating.
Providers often have an inaccurate perception that successful communication occurred when it has not.
Families often feel segregated during appointments and treatment planning.
Patients feel that providers should be caring and sensitive, and when communicating, take their time, make sentences shorter, give explanations, listen and answer questions.
Patient-centered care should keep families in the loop.

Conclusions

Upon review of our limited interviews, the following conclusions can be made about the current state and needs of the health professionals’ knowledge for participants in this study:

Health professionals of these participants lack training specific to interacting with young adults with DD.
Patients with DD in this study are dissatisfied with their medical and dental carntal care.
Patients with DD and their families in this study would like health professionals to empathize more with their situation
Training of new health professionals should focus on patient- and family-centered care.[3]
Health care students should have hands-on training treating patients with DD to improve health literacy and communication.
Health professionals should know to make special accommodations when treating patients with DD to improve patient compliance and treatment outcomes.
Theories of learning models and case studies should be implemented in professional schools to help prepare health care professions in patient management, which will ultimately improve patient treatment outcomes.
This fellowship was one of the most rewarding educational experiences of my life. As fellows worked together for the duration of the fellowship, we learned so much about the field of research and the challenges faced by people with DD. We also got to know each other well and learned what other specialties thought about different information and situations. When we were presented with the same information, we were able to share input from our respective backgrounds. Interdisciplinary cooperation and collaboration are key in the future of health care education.

References

U.S. Census Bureau, 2007. American Fact Finder. Available at: http://factfinder.census.gov/home/saff/main.html?_lang=en. Accessed January 15, 2008.
Lindblad BM, Rasmussen BH, Sandman PO. Being in tune with oneself, children, and parents: meanings of being a supporter to families with children who have developmental disabilities as narrated by parent-selected professionals. J Pediatr Nurs. 2005;20(3):214-23.
Johnson BH, Abraham MR, Shelton TL. Patient- and family-centered care: partnerships for quality and safety. North Carolina Med J 2009; 70(2): 125-30.
Gino R. Garza, RDH, is a 2008 graduate of Coastal Bend College in Beeville, Texas. He currently works in both private practice and public health while he attends the bachelor’s completion program at the University of Texas Health Science Center San Antonio.

Carol Nguyen, MS, RDH, is a dental hygiene educator and assistant professor at UTHSCSA, Department of Dental Hygiene on tenure track. She focuses on treating medically compromised populations in institutional and non-institutional settings. She enjoys sharing her knowledge through education and the reflective process of service learning in community settings. Her research focus is dedicated to patients affected with disabilities.