"No Wrong Door" to Hypertension Control: Interprofessional Service-Learning in Dentistry
Background: Many patients at the University of North Carolina Adams School of Dentistry present with complex and often undiagnosed medical needs. Twenty-two percent report not visiting a primary care provider within 2 years and 55% have high blood pressure. Uncontrolled hypertension can create significant barriers to dental care, increasing the risk of poor oral-systemic health. To address this need, a student-led interprofessional health intervention in dentistry was created to provide at-home hypertension management for dental patients.
Methods: Patients diagnosed with hypertension or multiple recent elevated blood pressure readings were identified from new patient admissions and through referrals from an on-site social worker. Eligible participants were invited to enroll in an 8-week program including four virtual meetings and daily blood pressure tracking. Monitors were provided. Meetings were conducted via Zoom by an interprofessional team (one dental student, one medical student) and included a verbal 10-question survey assessing behaviors, perceived health status, and barriers to care, followed by hypertension education and lifestyle counseling. Community referrals were provided to those lacking medical care. Patients completed a follow-up survey 4 weeks after program completion.
Results: Twenty patients were enrolled: 13F/7M, age range 45-75 (mean: 62), located in 12 North Carolina counties. 74 virtual patient encounters were completed. Participants most frequently cited improved awareness of disease status, greater motivation to make healthier choices, and increased medication adherence as benefits from participation. 100% of participants who finished the program (n=17) report making one or more healthy lifestyle changes that they plan to sustain and 89% have continued monitoring their blood pressure one month after the program.
Conclusions: The dental setting offers a unique opportunity to identify at-risk patients and facilitate engagement with the healthcare system through interprofessional collaboration. Providing educational counseling with follow-up support is a strategy to improve patient-reported outcomes and self-efficacy. This presents a rich service-learning environment for interprofessional student education.
Reflection: Through the creation and administration of this program, students gained valuable experience with telemedicine and patient communication, in addition to fostering appreciation for the contributions of health professions other than their own. Conducting all programming virtually due to the COVID-19 pandemic allowed us to reach a wider geographic distribution of patients. Practicing these team-based skills outside of the classroom will prepare learners to succeed in an increasingly collaborative healthcare landscape, leading to improved patient outcomes.