Students learn about interprofessional practice and social determinants of health

Knowledge of how to practice with different health care providers is essential for future practitioners, but so, too, is an understanding of the impact social factors can have on health.

For that reason, a co-enrolled course for University of Alabama medical and nursing students, Introduction to Interprofessional Health Care Teams and Critical Care Procedures, now incorporates information about social determinants of health.

The course was created by Dr. Louanne Friend, assistant professor in the College’s Department of Community Medicine and Population Health, and Dr. Richard Friend, professor of family medicine and interim dean of CCHS, and a family medicine physician.

The course, an elective that began in spring semester 2015, introduces students to interprofessional practice – when practitioners from different health professions collaboratively learn about, from and with each other to improve patients’ health outcomes. The course focuses on roles and responsibilities, communication, teamwork, and values and ethics for interprofessional practice.

To date, 59 medical and 108 nursing students have completed the course, and outcomes have shown increased student camaraderie, confidence to practice collaboratively and knowledge of healthy work environments.

Louanne Friend said while faculty are excited about the number of students taking and completing the course and the positive feedback, they agreed that a key component to health outcomes – prevention and primary care – was needed within the course content.

To introduce students to the impact that social factors, such as poverty, lack of access to health care and inadequate education, can have on health, Dr. Allyson Gold, a professor at the UA School of Law, recently delivered a guest lecture titled “Rx for Justice: Using the Medical-Legal Partnership to Improve Patient Health Outcomes.”

Gold identified the relationship between legal issues and negative health outcomes, and how the Medical Legal Partnership Model of Health can improve patient health. Under this model, lawyers are integrated into health-care settings to assist patients with unmet social needs, including lack of health insurance, public benefits, housing and utilities and income support.

Future plans for the course including opening the class to students from Social Work and Clinical Psychology and creating opportunities for students to participate in clinic and inpatient services.

Friend said the ultimate goal is to train students from different disciplines to collaborate to address health disparities among low-income populations.

New Faculty

Andrea Wright, MLIS, joined the College as associate professor and clinical/technical services librarian in the Health Sciences Library. Wright is responsible for supporting evidence-based practice in the clinical environment, providing access to the latest research to support patient care. She also collaborates in research and publishing efforts at the College, provides instructional support in research and evidence-based medicine and manages online access to library resources. Wright earned her master’s degree in Library and Information Studies from The University of Alabama and a bachelor’s degree in History from the University of North Alabama. She spent nine years offering research support and evidence-based medicine education as a technology and information services librarian at the University of South Alabama Biomedical Library before serving for a year as a digital projects librarian at The University of Alabama. In 2014, Wright received a Georgia/National Library of Medicine Biomedical Informatics Fellowship. Her interests include research and data management, technology and informatics services in libraries, reducing health disparities and evidence-based health care.

Dr. Elizabeth Western joined the College as a part-time adjunct faculty member in the Department of Family, Internal, and Rural Medicine. She is primarily responsible for teaching and curriculum development for the College’s Rural Medical Scholars Program, which is exclusively for rural Alabama students who want to become physicians and practice in rural communities. The program includes a year of study, after students receive their undergraduate degree, that leads to a master’s degree in Rural Community Health and early admission to the University of Alabama School of Medicine. Western received a bachelor’s degree in Chemistry from Middle Tennessee State University, and a master’s degree and PhD in Organic Chemistry from The University of Alabama. She received her MD from the University of Alabama School of Medicine and completed her residency training at the UA Family Medicine Residency, which is operated by the College. She was in private practice in Tuscaloosa for the past six years and currently is a hospitalist for the Tuscaloosa Veteran’s Affairs Medical Center.

Dr. Michelle Pike joined the College as a part-time adjunct faculty member in the Department of Family, Internal, and Rural Medicine. In that role, Pike will assist with The University of Alabama-Pickens County Partnership, led by the College and which works to place UA students in medicine, nursing, social work, nutrition, psychology and health education – and potentially others – in Pickens County for internships and learning experiences. Through the partnership, the rural, underserved county is provided with additional health care resources, and UA students receive real world training in their respective areas of study. Pike is also Emergency Services Medical Director at Pickens County Medical Center. She completed her undergraduate degree at Truman State University in Missouri, during which she also earned a paramedic license. She worked on an Advanced Life Support Unit as a paramedic on critical care and emergency patient transports before entering medical school. Pike completed medical school at the American University of the Caribbean, St. Maarten, Netherlands Antilies, and her residency training at the UA Family Medicine Residency, which is operated by the College. She completed an Emergency Medicine Fellowship at the College, which is provided in conjunction with Rush Foundation Hospital in Meridian, Mississippi.

Medical student selected for AMA leadership institute

Allison Montgomery, a University of Alabama School of Medicine student completing her clinical education years at the College, was selected as one of 10 students nationwide for the inaugural class of the AMA Leadership Development Institute.

Montgomery is a fourth-year medical student and a Rural Medical Scholar at the College, which also functions as the School of Medicine’s Tuscaloosa Regional Campus. The Rural Medical Scholars Program, operated by the College, is exclusively for rural Alabama students who want to become physicians and practice in rural communities and includes a year of study, after students receive their undergraduate degree, that leads to a master’s degree and early admission to the School of Medicine.

The AMA Leadership Development Institute offers medical students in their final year of school an opportunity to gain individualized insight into the skills needed to foster their careers and the future of medicine. Through quarterly group web conferences and a retreat at AMA offices, participants interact with professionals who are leaders in their fields and who offer advice on topics beyond the classroom and clinic, such as communications techniques and networking strategies.

Throughout the year-long program, participants are paired with a nearby mentor in their field, who is an experience and practicing physician and leader. Through monthly meetings and conversations, participants receive career consultation and guidance while expanding their professional networks.

Montgomery is pursuing a career in obstetrics and gynecology and has an interest in rural and international health care initiatives and gynecologic oncology research.

As a medical student, she serves as president of her class, and as a student representative on the Group on Regional Medical Campuses Steering Committee.

“I hope that this program will give me concrete advice on how to seek out valuable opportunities and how to be successful in creating change as a physician leader throughout my career,” Montgomery said.

Interprofessional Research Breakfast – October 18

Several College faculty members presented their research during an Interprofessional Research Breakfast for University of Alabama faculty and staff hosted October 18 by the College’s Institute for Rural Health Research.

Among the work highlighted was the ACTION Program and the All of Us Research Project.

ACTION: Short for Appropriate Care and Treatment in Our Neighborhoods, the program seeks to reduce unnecessary use of ambulances and hospital emergency departments for routine medical needs by providing onsite care for non-emergency 911 calls.

Dr. Abbey Gregg, assistant professor in the College’s Department of Community Medicine and Population Health, is researching savings to the health care system and patients who use ACTION, and if patients are satisfied with care received through the program. “We’re interested in how much money can be saved, and how people feel about their care,” she said.

ACTION is a partnership of the College and Tuscaloosa Fire and Rescue Services. The program places a nurse practitioner and mental health professionals on low-emergency 911 calls. Onsite care is provided to patients who don’t require ambulance transport to an emergency room, and patients with unmet social needs that impact health also receive follow-up service.

Gregg said ACTION has assisted with 911 calls received by people suffering from depression, anxiety, high blood pressure and general aches and pains. Now in its second year, she said data shows the program saves $2,603.77 per patient in avoided treatment charges.

Going forward, Gregg said ACTION will seek to be proactive by reducing hospital readmissions, providing case management services for frequent 911 callers and establishing a “social work hub” in the community.

All of Us: Precision medicine is an emerging approach for disease treatment and prevention that considers individual differences in lifestyle, socioeconomic status and biology – with the potential to show how each of us can receive the best possible care based on our unique makeup.

“It’s like prescription eyeglasses, insulin pumps and hearing aids, which are developed based on an individual’s specific needs,” said Dr. John C. Higginbotham, the College’s associate dean for Research. Higginbotham also serves as chair of the College’s Department of Community and Rural Medicine and director of IRHR and is also serving as UA’s interim vice president for Research.

Health care is often targeted to the average patient, not the individual, so, the National Institutes of Health launched the All of Us Project to advance research into precision medicine. The project seeks to enroll one million individuals living in the US and gather their health information and other data over time.

The College, through its University Medical Center, is part of the Southern All of Us Network and is working with partners in Alabama, Mississippi and Louisiana to recruit participants; Higginbotham is a co-principle investigator. Together, the Southern All of Us is working to recruit 100,000 participants from the three states over the next five years. The College’s goal is to recruit  7,500 patients during that time.

All of Us is making a concerted effort to produce a research cohort that is diverse – demographically, geographically, medically and those traditionally underrepresented in biomedical research. Higginbotham said traditionally, there hasn’t been enough research to draw on for clinical evidence, especially in diverse populations.






Spotlight Shines on College’s Geriatrician

Dr. Anne Halli-Tierney, assistant professor in the College’s Department of Family, Internal, and Rural Medicine and practicing geriatrician at University Medical Center, was featured by the American Geriatric Society in its October Educator Spotlight.

In the article that appears in the society’s online publication, Halli-Tierney, who also directs the College’s Geriatrics Fellowship, talked about her role with the College and the impact of her work with learners and patients.

Years in role: Seven years (assistant professor) and two years (fellowship director)

Best part of job: Getting to interact with learners from all levels of education and all disciplines (teaching undergraduate, medical school, residency, post residency students and community learners, as well as students from social work, pharmacy, psychology, nutrition and law).

Currently working on: Lots of things! Working on my first active fellowship year with two awesome fellows, actively researching resident and patient knowledge of advance directives in our clinic, developing a community-based longitudinal mental health database for older adults and working on development and deployment of interprofessional case series for geriatric/interprofessional education, among other things. I’m fairly hyper.

What I would like to collaborate on: Love to collaborate on novel interprofessional educational models mainly geared toward older adults/end of life care, or on anything that would increase geriatrics awareness in medical students and undergraduate populations.

One thing I have learned from my patients: (Well-timed) humor, candor and humility can be healing, both for the patient and for the practitioner.

One thing I have learned from my learners: You should never assume that you know everything about a topic, even if you think that you’re an expert on it. Someone will always be able to trip you up with a well thought out question (even if it is about jellyfish).

One thing you want your learners to know: That learning happens best with emotion and humanity attached to it. Clinical pearls stick much better if you can put a face or a name to the first time you saw a disease process and learned about the human side of the textbook pathology.

Favorite geriatric pearl of wisdom:  Occam’s razor doesn’t work.

Favorite geriatric syndrome:  Oh, that’s tough! Probably polypharmacy. Watching that be treated in my grandfather is what inspired me to become a geriatrician, and there is nothing more satisfying than ripping apart a 40-med list and having a patient thrive because of it. I’m a nerd.

What’s saving your life right now? Overly obsessive to-do lists, a husband with a great sense of patience and humor and mint chocolate chip ice cream.

Dr. Giggie part of expert panel on prescription opioid epidemic

Dr. Marissa Giggie, associate professor in the College’s Department of Psychiatry and Behavioral Medicine, participated in a community outreach panel October 18 about the causes and effects of, and solutions to, prescription opioid abuse in Alabama. The state has the highest rate of opioid prescribing in the nation.

The panel presentation and discussion, “Leading the Nation in Opioid Prescriptions: What are the consequences for Alabama?” was hosted by the Department of Criminal Justice at The University of Alabama.

In addition to Giggie, panelists included researchers, attorneys, members of law enforcement and policy experts.

Alabama leads the nation in opioid prescriptions, with an average of 1.2 prescriptions per person compared to the national average of 0.71 prescriptions per person, according to 2015 data from the US Centers for Disease Control and Prevention. That data also shows that there were 736 reported drug overdose deaths in Alabama in 2015, of which 38 percent were caused by opioids.

Center exhibition shows tobacco industry’s marketing to African Americans

A new exhibition showing the tobacco industry’s targeted marketing of mentholated cigarettes to African Americans, presented by The University of Alabama Center for the Study of Tobacco and Society, is probably the first in-depth exploration of its kind, according to the center’s director.

The exhibition, “Of Mice and Menthol: The Targeting of African Americans by the Tobacco Industry,” was finalized and uploaded in September to the center’s website. The vast majority of items in the exhibition come from the center’s collection.

Center Director Dr. Alan Blum, the College’s Gerald Leon Wallace, MD, Endowed Chair of Family Medicine, said by the 1960s, mentholated cigarettes “were especially popular among African-Americans, to whom they were heavily marketed.” Menthol is a colorless anesthetic, and in the 1920s it was accidentally discovered that menthol reduced the harshness of smoking, Blum said.

The exhibition includes magazine covers and advertising, some dating to the 1950s, featuring African-American models, performing artists and athletes, including former world heavyweight boxing champion Joe Louis and baseball greats Jackie Robinson and Hank Aaron. Blum said tobacco advertising was especially prevalent in Essence and Ebony magazines, which reached more than a third of the adult African-American population.

By 1985, the Task Force on Black and Minority Health of the US Department of Health and Human Services reported that there were 58,000 excess deaths annually among African Americans compared with the death rate for whites, Blum said. “Principal among the rising causes of death were cardiovascular disease and lung cancer – the two major consequences of cigarette smoking,” he said.

Blum said the exhibition was a large scholarly endeavor, taking three years to research and complete.

Mini Medical School Continues

The College of Community Health Sciences continues its Mini Medical School program this fall with eight faculty providing lectures.

Lectures for the fall semester began September 11 and continue each Tuesday, at noon, through October.

The Mini Medical School program, a lecture series for The University of Alabama’s OLLI program, has been put on by faculty and resident physicians at the College since 2016. The program provides an opportunity for adults and community learners to explore trends in medicine and health, and the lectures offer important information about issues and advances in medicine and research.

OLLI, short for Osher Lifelong Learning Institute, is a member-led program catering to those aged 50 years and older and offers educational courses, as well as field trips, socials, special events and travel.

Dr. Catherine Ikard, assistant professor of neurology, gave the first lecture of the semester on Peripheral Neuropathy. On September 18 Dr. Raheem Paxton, associate professor of community medicine and population health presented on sedentary behavior and health outcomes. Dr. Jane Weida, associate professor of family medicine, provided a lecture on lung disease on September 25.

Upcoming lectures include immunizations, Crohn’s Disease, men’s health, dementia and delirium and diet and nutrition.


CCHS Service Learning – Health Screenings

Medical students assist with health screenings of Tuscaloosa school children as part of the pediatrics clinical rotation at The University of Alabama College of Community Health Sciences.

Each year through the pre-K Partnership, UA School of Medicine students completing their third and fourth years of medical education at CCHS assist in providing basic exams, blood tests and hearing screenings at Tuscaloosa City Schools from September through the first week of November.

All screenings are attended by Dr. Heather Taylor, associate professor of pediatrics for CCHS who directs the rotation, or a nurse practitioner from the UA Capstone College of Nursing. They check any abnormal health findings and make recommendations for follow-up care.

The Tuscaloosa City Schools District then sends letters to parents with information about their children’s health and referrals to physicians, dentists and social workers, as needed.

“This is a unique opportunity for us to collaborate with multiple different organizations in a project that hopefully improves the health of the children we serve,” said Taylor, who also cares for patients at University Medical Center.

CCHS, which operates UMC, also functions as the School of Medicine’s Tuscaloosa Regional Campus.

This year, screenings will be conducted at 11 schools and more than 500 pre-K children are expected to participate, Taylor said. Parents opt in to the different components of each screening, which offers physical exams, blood pressure checks, dental, vision and hearing screenings, as well as lab screenings for glucose, cholesterol and anemia.

The pre-K Partnership is a collaborative effort of CCHS, UA Office of Service Learning, Tuscaloosa City Schools System, Tuscaloosa’s Mayor’s Office, UA Capstone College of Nursing and Shelton State’s Nursing Program.




Scholarship Conference – Latinos and Cardiometabolic Disease

Dr. Bertha Hidalgo, an associate scientist at the UAB Nutrition Obesity Research Center and Faculty Scholar at the UAB Center for the Study of Community Health, provided the September 25 Scholarship Conference lecture hosted by the College of Community Health Sciences.

Her lecture focused on innovative research on Latinos and cardiometabolic diseases – obesity, cardiovascular disease and Type-2 diabetes ­– and implications for medical practice and was provided during The University of Alabama’s Hispanic/Latino Heritage Month.

Hidalgo, who is also an assistant professor of Epidemiology at the University of Alabama at Birmingham, discussed the differences between precision medicine and precision health along with genomics and epidemiology.

“When you think of genomics, you think of precision medicine— the right treatment, the right person, at the right time,” said Hidalgo. “Precision health is the right intervention for the right population at the right time. So we are thinking bigger scale.”

Hidalgo, the principal investigator of Epigenomics of Cardiometabolic Disease in Mexican Americans, is particularly interested in the heterogeneity of populations and the implications of that heterogeneity for genomic findings.

“There are a lot of nuances in Mexican Americans, Native Mexicans, that differ from the cultural, social and other nuances that say, Dominicans and Puerto Ricans and Central Americans and Chileans and so forth have,” said Hidalgo. “We differ in terms of our diet, we differ in terms of our social practices and all of that has implications for health outcomes.”

Hidalgo, herself Mexican American, found that genomic studies have increased diversity but are still leaving many populations, such as Hispanic/Latino, Native American and Middle Eastern, underrepresented.

Rare genetic variations, those that occur in less than five percent of the world’s population, but comprise the bulk of variants, tend to be population specific. If they do play a key part in disease, the lack of diversity in studies creates a skewed version of the entire health picture.

Type-2 diabetes research is an example of this skewed image. There are more than 100 gene variations that contribute to risk of Type-2 diabetes, however the majority of work today has been done only on populations of European ancestry. Hidalgo is focusing her research to better understand the genetic and environmental contributors to cardiometabolic diseases in a cohort of Mexican Americans.

Through her research, Hidalgo has found that shared genetic ancestry may play a role in increased risk for Type-2 diabetes, specifically in Mexican Americans. The correlation between Type-2 diabetes and genetics is still being explored and researched to further understand the role between genetics and medicine.

“Just having genetic information in and of itself is not important,” noted Hidalgo. “It’s what you do with that genetic information.”