The Hospitalist Triage Role for Reducing Admission Delays: Impacts on Throughput, Quality, Interprofessional Practice, and Clinician Experience of Care

Attitudes toward Healthcare Teamwork between Osteopathic Medical Students in an Interprofessional or Intraprofessional Clinical Education Program

Framing the Future: Exploring Inter-Professional Education and Practice in an Undergraduate Course

Purpose: Discuss the challenges in delivering interprofessional education and clinical practice in community-based settings. Background: Implementing interprofessional education (IPE) and clinical practice (IPCP) programs remains challenging despite increased emphasis on IPE. Understanding the challenges in delivering IPE/IPCP community-based programs is important in developing a well-trained interprofessional workforce. Description of Program: IPE curricula was developed for two community-based IPCP experiences using a flexible framework for negotiating unforeseen challenges working with multiple health professions schools and community partners. Models utilized were a community of practice that allowed for shared interests, learning, and problem-solving, and Plan-Do-Study-Act that provides flexibility as challenges arise. Cohorts of 10-15 graduate students from nursing, pharmacy, dentistry, clinical psychology and social work attended 8-week IPE immersion experience with practicum using a humanities-informed curriculum. One project focused on improved interpersonal communication and the other on military culture and the unique behavioral health issues of veterans. Challenges include scheduling difficulties, apathy of faculty and students, and incompatible clinical practice experiences. Preliminary results: Students’ gained confidence as members of IPCP teams and are more reflective and able to anticipate and cope with adverse and challenging situations through learning to manage negative emotions and stress. The humanities-informed content has increased students’ ability to be more empathic and to communicate more effectively with patients and the interprofessional team. Recommendations: Despite well-intentioned plans, there are circumstances that require IPE faculty to discuss and negotiate solutions for overcoming challenges. Open communication among all parties is critical in community-based IPE/IPCP experiences. When faculty are adaptable and responsive to change, students adapt as well, and learn that flexibility is essential for development of an effective and productive health professional team. Measurable Objectives: Discuss methods for negotiating challenges in community-based interprofessional education programs. Discuss how humanities-informed curricula can assist with teaching the interprofessional core competencies.

In recent years, a number of historians of nursing and have asked whether our field might more appropriately and inclusively be renamed the history of health care.1 To outsiders, history of medicine appears to reinforce conceptual and professional silos that have historically privileged the role of physicians, Western medicine, and disease over more integrative accounts of caregiving, diverse epistemologies of healing, and health. Today, the mantra that interprofessional education and practice are the future of health care offers an explicit invitation to move beyond the disciplinary and professional silos often replicated in our approach to health-care history. While nurse-physician relationships have received considerable attention from historians, this section expands on that base to explore the history of the development of interprofessional education and practice more broadly.Five of the seven papers in this special section were presented at a lunch session on the history of interprofessional education and practice at the annual meeting of the American Association for the History of Medicine (AAHM) in 2014. As the authors document, the concepts of teamwork and interprofessionalism are not new, although, as Julie Fairman points out, the term interprofessional is of more recent coinage. The case studies here help establish the range of precedents and the varied contexts across the twentieth century for both informal learning and working together and more formal interprofessional teams that arose in response to the efficient organization of care, workforce issues, and demands for health-care delivery. This timeline departs from the tendency of practitioners to locate interprofessionalism primarily as a post-World War II movement best characterized by the development of advanced practice nursing, physician assistant programs, and specialized units and teams in hospitals.2 Taken together, and supplemented by the lively discussion at the AAHM session, these articles elucidate key themes emerging from the historical examples of interprofessional education and practice and suggest an agenda for further exploration.Inherent in the appeals for interprofessional education and practice, as Fairman notes, is the assumption that changes in education and practice will be a magic bullet producing new epistemologies and increasing quality of care. This must be disaggregated into more specific questions about what interdisciplinarity and interprofessionalism mean in practice. Are there problems that require a particular combination of knowledge and skill that cannot be solved any other way, such as the physiology and diet research questions posed by Ancel Key's Laboratory of Physiological Hygiene or the treatment decisions that benefit from bringing together pharmacists and clinicians at the bedside? To what extent must members of health-care teams master the knowledge base of the other professions represented, as exemplified by the clinical pharmacist curriculum and training for nurses in a range of medical skill sets as preparation for team practice? Can interprofessional teams function purely with the combination of individual professional expertise, on the model of rehabilitation? Where and why are new hybrid professions like nurse practitioners and physician assistants required? Is there a secondary implication that interprofessional practice will also be more holistic or ecological in its approach? Daniel Brauner's article on the cardiac arrest protocol suggests that interprofessional teamwork in the hospital can also produce greater biomedical reductionism, running against the trend toward holism fostered by interprofessional teams for family and community-based patient care.The articles also engage the reciprocal, shaping relationship between interprofessional practice and sites of care-the containers for health-care delivery. Beth Linker discusses the spread of rehabilitation units in hospitals, and Jennifer Gunn looks at the rise of community health centers, as an alternative to rural hospitals, designed to accommodate the need for a different interprofessional mix in the face of scarce physician labor. …

Mapping Collective Sensemaking in Communication: The Interprofessional Patient Case Review in Acute Care Rounds

Interprofessional Education (IPE) and Interprofessional Collaborative Practice (IPCP) have become essential educational approaches to improve the collaboration system and quality of health services. This study aims to provide an overview of the IPE/IPCP implementation strategy focusing on achieving core competencies and their outcomes. The narrative literature review study preferred the PRISMA model approach. The articles were analyzed from three electronic databases, ScienceDirect, Scopus, and PubMed. The search keywords used “Healthcare professional” AND “Interprofessional practice” OR “interprofessional education” AND “Nursing education” AND “Improved competencies” with the study criteria involved students or health professionals, last ten years, English version, and used experimental or observational, mixed methods design. A total of 14 articles met the criteria and were summarised. As a result, the IPE/IPCP implementation strategies with simulation, curriculum, and training focused on the main competencies produced essential outcomes, including increasing knowledge, skills, positive attitudes, and perceptions of students and health professionals and improving the quality of patient care. IPE/IPCP strategies such as an integrated curriculum, simulation, and training program were recommended for implementation in the institution or clinical setting. Sustainable IPE/IPCP strategies and outcomes are essential in promoting collaborative practice and quality healthcare. Keywords: Healthcare professionals; collaboration; nursing curriculum; higher education; quality of care

Interprofessional education and practice in an Indian setting

To assess the impact of an intervention consisting of a computer-assisted clinical decision support system and performance-based incentives, aiming at improving quality of antenatal and childbirth care. Intervention study in rural primary healthcare (PHC) facilities in Burkina Faso, Ghana and Tanzania. In each country, six intervention and six non-intervention PHC facilities, located in one intervention and one non-intervention rural districts, were selected. Quality was assessed in each facility by health facility surveys, direct observation of antenatal and childbirth care, exit interviews, and reviews of patient records and maternal and child health registers. Findings of pre- and post-intervention and of intervention and non-intervention health facility quality assessments were analysed and assessed for significant (P < 0.05) quality of care differences. Post-intervention quality scores do not show a clear difference to pre-intervention scores and scores at non-intervention facilities. Only a few variables had a statistically significant better post-intervention quality score and when this is the case this is mostly observed in only one study-arm, being pre-/post-intervention or intervention/non-intervention. Post-intervention care shows similar deficiencies in quality of antenatal and childbirth care and in detection, prevention, and management of obstetric complications as at baseline and non-intervention study facilities. Our intervention study did not show a significant improvement in quality of care during the study period. However, the use of new technology seems acceptable and feasible in rural PHC facilities in resource-constrained settings, creating the opportunity to use this technology to improve quality of care.

Interprofessional Collaboration Between Audiologists, SLPs

Key Points A competent, collaborative, interprofessional team centered on the patient is necessary for quality pain care; however, interprofessional collaborative practice is not yet an integral part of all health professions education programs. Interprofessional education involves 2 or more professions learning "with, from, and about" to enable effective collaborative practice and improve health outcomes. Core competencies and curricular resources are available for interprofessional education and pain and can be adapted for use at all levels of health professions education. 1. Introduction Pain is a complex experience that impacts health, productivity, and well-being. It requires a collaborative team approach with a common language and clear understanding of roles and responsibilities. With few exceptions, a minimum amount of pain content has been documented in health sciences curricula, and much of that has been fragmented by profession and delivered within a crowded agenda of conventional course topics such as anatomy and physiology.21 Most health professionals learn pain management on the job and are often ill-prepared to function as a team member in the real world. Despite documentation of the need for improved education on pain of all types, consistent professional training in pain is not widespread and innovation is warranted. The 2018 IASP Global Year for Excellence in Pain Education is a call to action on multiple levels. The purpose of this report is to describe opportunities for mutual learning through interprofessional (IP) pain education. Interprofessional education (IPE) is a growing trend across health professions and has been defined (Table 1) as when 2 or more professions learn with, from, and about each other to improve collaboration and the quality of care.16 For IP learning to occur, all 3 "with, from, and about" must be present.11Table 1: Operational definitions.2. With others–learning together to facilitate interprofessional collaborative practice The complexity of health care across the globe, technological advances, and modern models of care delivery has created demand for a practice-ready workforce and effective teamwork.31 Medical errors often result from poor communication within and across teams; high functioning teams improve outcomes of care.18 Professional education has not kept pace with increasing demands for collaboration-ready health workers in part because of disjointed, outdated, and static curricula; furthermore, a glaring mismatch of competencies to patient and population needs persists.12 We educate students most often in uniprofessional settings (silos) with little opportunity to learn and practice together. Although learning experiences in the clinic or on a ward offer more opportunities to learn with, from, and about other health care professionals, there may be few role model IP teams in the real environment. Uniprofessional education is inadequate to prepare health care trainees to work in teams and can spur competition rather than cooperation between the professions. Recognizing this struggle, the World Health Organization (WHO) issued a Framework for Action on Interprofessional Education and Collaborative Practice in 2010.34 The report contextualizes existing health systems, commits to implementing principles of IPE and collaborative practice, and champions the benefits of IP collaborations with regional partners, educators, and health workers. Contemporaneously, the Lancet Commissions issued a foundational report12 developed by 20 health profession leaders from diverse countries advancing a common strategy for educational reform in medicine, nursing, and public health. The Lancet Commission calls for education reform that is guided by the desired outcomes of transformative learning and interdependence in education. Transformative learning involves fundamental shifts from fact memorization to synthesis of information for decision making; from seeking professional credentials to achieving core competencies for effective teamwork in health systems; and adaptation of global resources to address local priorities.12 Interdependence stresses the system approach that offers insights into the dynamic and nonlinear nature of a complex system that cannot be gained by studying components of the environment in isolation. This report also underscores the pace, scale, and intensity of globalization impacting interactions of health systems and education. In several countries, collaboration of national associations of health profession regulatory bodies has given rise to recommendations for core competencies for IP collaborative practice designed to guide curriculum development in interactive learning. For example, competencies16 developed by the Interprofessional Education Collaborative (IPEC) in the United States have become part of the global conversation (Table 2). The Global Forum on Innovation in Health Professional Education has hosted a series of meetings engaging stakeholders and policymakers through linked projects and networks in Uganda, South Africa, India, and Europe.8 Updated in 2016, the IPEC competencies integrate explicit population health outcomes with individual care competencies to form an expanded model that targets desirable health system goals. Interprofessional collaboration, in this framework, is the central domain under which the original competencies are arranged. Similarly, the Canadian IP Health Collaborative developed the National Interprofessional Competency Framework in 2010, which has been used in various countries and academic settings.5Table 2: Interprofessional collaborative competency domains.Interprofessional collaboration occurs when learners/practitioners, patients/clients/families, and communities develop and maintain working relationships that enable optimal health outcomes.5 Interprofessional collaborative practice occurs when multiple health workers from different professional backgrounds work together with patients, families, and communities to deliver the highest quality of care. Interprofessional core competencies build on modern educational theory and practice to bring together all health professions with shared language, vision, and goals (Table 3). These competencies are important for positive outcomes, including those we aim for in quality pain care.Table 3: Characteristics of health-focused interprofessional core competencies.10,163. From others—learning from different professions to facilitate collaboration and communication Collaborative approaches are invaluable when pain management is complex, requiring the knowledge and skills of more than one profession. It is logical then, that to work together, future health care workers would benefit from learning together to understand each other's roles and responsibilities and how to communicate using common language. The provision of opportunities for student interaction is fundamental to the learning experience to develop an understanding of the perspective of various professions and to foster a climate of mutual respect and relationship-building values. Interprofessional education requires active learner participation and case-based content that is authentic and foundational to many health professionals.6,26 Although most IPE is focused on prelicensure students, literature is emerging in post graduate clinical education. Themes in the context of back pain in a primary care setting included the context, value of involving the patient, listening, time and learning together.7 The intent is to impact practice and improve quality of health care. 4. About others–attaining competence to use knowledge of one's own role and those of other professions to address pain care needs Pain experience is multidimensional; therefore, pain education draws on not only mechanisms but also a variety of theories such as relational, professionalism, and social constructivism and is grounded in adult learning theory.31,33 The concept of communities of practice and situated learning is also important as students move from learning about their own profession to other professions and members of a team.31 These concepts reinforce a model of multiprofessional team management of pain championed long ago by John Bonica. Learners need to become self-directed, critical thinkers and reflective practitioners, able to function as members of teams, and be good communicators, adaptable to change and continuing to learn through professional experiences.3,22 Interprofessional education is not a replacement for education specific to each profession, a reason to lose individual professional identity, the only innovation needed in the health system, and an end in itself. We do not do IPE for its own sake; we do it to help understand each other's roles and contributions to work together in a real-world practice setting. 5. Barriers to overcome A number of significant barriers must be overcome to successfully implement and sustain a culture of IPE.22,32 Leadership at the highest level is needed for a culture change to be successful. For example, licensure and accreditation requirements do not currently reinforce preparation for collaborative practice in most countries. A survey of 41 countries from WHO's 6 regions representing various income economies reported IPE was often voluntary.27 Moreover, the lack of compulsory IPE and pain competencies for entry-to-practice graduates has implications for advancing skillful and ethical practice; it can limit the capacity of health care professionals to alleviate suffering, foster autonomy, and use resources justly.32 As well, many faculty are trained and familiar with the didactic teacher role rather than how to be an effective IPE facilitator and are not comfortable teaching pain content4; faculty education and development are needed. Faculty and clinician composition in the development and implementation of IPE activities may influence the outcomes of the learning activities.25,33 Evidence is scarce in developing countries, but challenges may be similar including curriculum structure and complexity. It has been suggested that barriers be taken as opportunities to transform approaches to core health problems in developing countries.30 Modifications in physical classroom space, competition for curriculum hours, and coordination of schedules can be challenging. Ideally, students should be introduced to IPE early with learning activities that build on competencies. Curriculum design is an iterative process necessitating modifications of complexity in patient cases and also the challenges of integrating clinical content to meet the needs of all levels of learners.33 Perceived differences in hierarchy, power status, and unequal participation rates among certain health professions have also been described as challenges.24 However, IPE can provide an opportunity to transform the way we socialize students by improving the understanding and respect of each other's unique roles and responsibilities within the team. Of course, the ultimate challenge is to harmonize learning experiences with well-functioning IP teams in clinical practice. Involvement of clinicians in curriculum development and implementation can help to insure real-world pain care and patient-centered modeling.33 6. Defining components of interprofessional education–competencies (learning outcomes), curriculum (learning plans), and content (learning objectives) Competency is the desired outcome of education. Distinct from learning objectives that emphasize gains in factual knowledge, attitudes, and skills, competency places emphasis on students' capacity to act effectively in relevant clinical situations.10 Competency generally includes observable phenomena such as being able to demonstrate the ability to explain a treatment or educate a patient about relevant treatment adverse effects. It also includes appropriate attitudinal and affective qualities to the extent that such are observable, eg, being able to maintain perceptibly compassionate communication while examining a painful part, potentially gauged through the use of interpersonal skills checklists. Core competencies in pain management for health professional education have been established.10 These pain competencies address the fundamental concepts and complexity of pain; how pain is observed and assessed; collaborative approaches to treatment options; and application of competencies across the life span in the context of various settings, populations, and care team models (Fig. 1). A set of values and guiding principles is embedded within each domain. These competencies can serve as a foundation for developing, defining, and revising curricula and as a resource for the creation of IP learning activities across health professions designed to advance care that effectively responds to pain.Figure 1.: Core competencies for pain management. These core competencies pain assessment and management were developed through an interprofessional consensus process10 to address prelicensure pain management education in all major health care professions that are consistent with the IASP pain curricula outlines. Graphic created by Ian Koebner, PhD. Used with permission University of California Regents or Graphic courtesy of University of California Regents.Pain curricula outlines provide the template that helps to structure learning. Curricula include considerations of sequencing material, developmental appropriateness, and coordination of different health professions' learning activities, so that students from different health profession programs will learn about for IPE at the same time. The IASP Pain Curriculum Outlines15 provide recommended curricula for pharmacy, psychology, physical therapy, occupational therapy, nursing, medicine, dentistry, social work, and IPE. Each is arranged to address 4 main domains and related core competencies including (1) the multidimensional nature of pain, (2) pain assessment and measurement, (3) the management of pain, and (4) pain in specific clinical conditions. The outlines are helpful for establishing courses that provide an integrated foundation in pain at both the undergraduate and graduate levels. With this foundation, students are prepared to understand and approach patients with many forms of pain, as well as provide support to families and caregivers. All IASP curricula outlines including IPE were updated in 2017 for the Global Year for Excellence in Pain Education. Content is the description of what is being taught at the most granular level, eg, what are the learning objectives. Content serves as an important common language necessary to effectively communicate with each other about the specific elements of our uniprofessional and IP learning plans. Three teaching modules that address a number of IASP topics and are adaptable for IPE are available on the Portal of Geriatric Online Education (POGOe.org).20 In the United States, the National Institutes of Health has created a freely accessible portal of pain education online learning modules. Based on a variety of local models of IP collaboration, these modules demonstrate that IPE can take various forms depending on the specific professions engaged and the goals for learning.23 A unique and perhaps most comprehensive program is the 20-hour University of Toronto's Pain IP Curriculum involving students from 7 professional programs. The program's design and implementation components are described in the Pain IP Curriculum Model as (1) dynamic, (2) competency-based, (3) interrelated, and (4) collaborative with the patient focus at the center.33 Experience with the program has informed the creation of an eLearning Pain Education Interprofessional Resource that is internet accessible and available on request.19 As a blended eLearning program, Pain Education Interprofessional Resource has been designed as a self-learning resource to be coupled with facilitated small group, IP, collaborative discussion. 7. Outcomes of interprofessional education Measuring outcomes of IPE can be quite challenging. Large gaps regarding methods, theory, and context remain, and most studies focus on short-term results. The heterogeneity of contexts, variety of interventions, and methodological limitations makes it difficult to draw generalizable inferences about key elements and effectiveness of IPE.17,26 Evaluation should ideally link to clinical practice, but there is a paucity of contextually and synthesized literature regarding outcomes, particularly for pain management.24 University-based IPE using patient scenarios and group work in small teams, as contrasted to didactic lectures, has been shown to be feasible and has led to improved attitudes toward IP interaction and teamwork and improved understanding of health professional roles.24 Studies of IPE have found differences between professions, with students in professions deemed psychosocial were more positive about IPE than students in biomedical career tracks.13 Similarly, Erickson et al.9 found that IP mentorship and group participation improved first year medical students' pain management skills but did not have the same effect on fourth year nursing student performance. Differences were attributed in part to experience in clinical settings but also suggested that combining different levels of students is acceptable if they are of similar age and life experience. A significant positive shift in the pain knowledge and attitudes toward collaboration has been demonstrated through IPE.14,28 Simko et al.29 reported an increased knowledge and understanding of the importance of other profession's role in pain management in an IPE course for nursing and pharmacy students. Other studies have reported high student satisfaction and significant improvement in self-efficacy1 as well as respect for each other's roles and responsibilities.2 Positive changes have also been reported in pain assessment and documentation behaviors from IPE.17 8. Summary The delivery of effective pain management can be complex, requiring collaborative, team approaches that exceed the expertise of any one profession. Interprofessional collaboration is increasingly recognized as a core skill for all clinicians and is beginning to be required by some accrediting bodies for medical, nursing, pharmacy, physician assistant, and social work programs. However, IP collaborative practice is not yet an integral part of all health professions education programs. Recommendations of the WHO34 and other leading organizations recognize IP collaborative practice and education as a central component of transformative improvements in health care. Based on work in a number of global settings, recommendations for educational change to incorporate IP collaboration into practice are available and undergoing further development. Creating IPE learning opportunities is important. The intent of IPE is to produce a collaborative practice-ready workforce to improve the quality of health care. Students should be introduced to IPE early and have developmentally appropriate opportunities throughout a curriculum program. Students can change agents in the real world to continuously improve the way health professionals work together, mentor students and improve the quality of pain care. The quality and rigor of IPE research is inadequate, and research needs to move beyond feasibility and attitudes toward long-term improvements in clinical care. When focused on pain, IPE is likely to provide substantive benefits in the real-world practice setting, but barriers to IPE adoption, including slow adoption of pain-focused competencies and cultural habits, limit uptake. When able to overcome these obstacles, IPE has the capacity to harmonize learning experiences and promote patient-centered socialization of health profession trainees at all levels. Importantly, communicating and assessing innovation in IPE relies on understanding the conceptual education framework built on key elements of competencies (learning outcomes), curriculum (learning plans), and content (learning objectives). Although more work is needed to identify the most effective approaches, and even fundamentally to define meaningful approaches to outcomes assessment, models of education such as IP workshop training and online education exist with positive impact. We leave readers with a brief table of actions they can take to advance and transform health professions' education (Table 4).Table 4: Suggested actions individuals can take to promote IPE.Disclosures The authors have no conflict of interest to declare. D.B. Gordon and B. Hogans hold positions of leadership in their University's NIH Pain Consortium designated Centers of Excellence in Pain Education (CoEPEs). J.Watt-Watson is a principal leader in the University of Toronto's IP curriculum program.

Interprofessional practice is increasingly cited as necessary in the delivery of high-quality nutrition and rehabilitation services. However, there is limited evidence available exploring the factors which influence interprofessional practice in subacute rehabilitation nutrition services. Our ethnographic study explored collaborative activities, influential factors and staff attitudes related to interprofessional practice in nutrition care. Fifty-eight hours of ethnographic field work were undertaken from September 2021—April 2022, across three subacute rehabilitation units, with a total of 165 patients, support persons and staff participating. Overall, 125 unique participants were observed and 77 were interviewed. We generated three themes through reflexive thematic analysis. First, the potential opportunities for interprofessional practice at mealtimes, as influenced by communication, role clarity and reciprocity. Second, hierarchy of nutrition roles and tasks impedes interprofessional practice, where the perceived lower importance of nutrition care to other clinical roles and physical therapies influences staff practice. Third, the mystery of nutrition care roles and systems in rehabilitation, which exposes gaps in the awareness of different team members regarding nutrition care roles and systems, hindering interprofessional practice. Our findings highlight the opportunity for embedded, innovative models of care and staff education to enhance interprofessional practice in nutrition and mealtimes.

BackgroundImproving the patient experience is one of the quadruple aims of healthcare. Therefore, understanding patient experiences and perceptions of healthcare interactions is paramount to quality improvement. This integrative review aimed to explore how patients with chronic conditions experience Interprofessional Collaborative Practice in primary care.MethodsAn integrative review was conducted to comprehensively synthesize primary studies that used qualitative, quantitative, and mixed methods. Databases searched were Medline, Embase, CINAHL and Web of Science on June 1st, 2021. Eligible studies were empirical full-text studies in primary care that reported experiences or perceptions of Interprofessional Collaborative Practice by adult patients with a chronic condition, in any language published in any year. Quality appraisal was conducted on included studies using the Mixed Method Appraisal Tool. Data on patients’ experiences and perceptions of Interprofessional Collaborative Practice in primary care were extracted, and findings were thematically analyzed through a meta-synthesis.ResultsForty-eight (n = 48) studies met the inclusion criteria with a total of n = 3803 participants. Study quality of individual studies was limited by study design, incomplete reporting, and the potential for positive publication bias. Three themes and their sub-themes were developed inductively: (1) Interacting with Healthcare Teams, subthemes: widening the network, connecting with professionals, looking beyond the condition, and overcoming chronic condition collectively; (2) Valuing Convenient Healthcare, subthemes: sharing space and time, care planning creates structure, coordinating care, valuing the general practitioner role, and affording healthcare; (3) Engaging Self-care, subthemes: engaging passively is circumstantial, and, engaging actively and leading care.ConclusionsPatients overwhelmingly had positive experiences of Interprofessional Collaborative Practice, signaling it is appropriate for chronic condition management in primary care. The patient role in managing their chronic condition was closely linked to their experience. Future studies should investigate how the patient role impacts the experience of patients, carers, and health professionals in this context.Systematic review registrationPROSPERO: CRD42020156536.

13 - Interprofessional education: state and federal policy considerations in the tale of two professions

PurposeThe purpose of this review was to explore the literature for evidence of the impact of interprofessional practice models on health service inequity, particularly within community care settings for diverse ageing populations.Design/methodology/approachAn integrative systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework combined with the EndNote reference management system. Following the collection and comprehensive screening process completion, a thematic analysis of the included articles occurred utilising within NVivo 12 software.FindingsThe review found that there was a paucity of evidence related to the relationship between interprofessional practice models (IPM) and health service equity for ageing populations. There is a need to improve collaborative practices between social care, public health care and health service providers to more clearly define team member roles. Key aspirations included the need for future innovations in health service delivery to place health service equity as a goal for interprofessional practice. There is a need to find ways to measure and articulate the impact for vulnerable populations and communities.Research limitations/implicationsThe review offers insight into the need for health care delivery models to place health service equity at the centre of the model design. In practice settings, this includes setting interprofessional team goals around achieving equitable care outcomes for, and with, vulnerable populations. Implications for practice relate to improving how interprofessional teams work with communities to achieve health care equity.Originality/valueThere is a consensus across the literature that there continues to be health service inequity, yet IPE and interprofessional collaborative practice (IPC) have been growing in momentum for some time. Despite many statements that there is a link between interprofessional practice and improved health service equity and health outcomes, evidence for this is yet to be fully realised. This review highlights the urgent need to review the link between education and practice, and innovative health models of care that enable heath care professionals and social care providers to work together towards achieving health equity for ageing populations. It is clear that more evidence is required to establish evidence for best practice in interprofessional care that has the mitigation of health care inequity as a central objective.

PurposeThis study investigated the improvement of interprofessional practice in primary care by performing the first three steps of the implementation model described by Grol et al. This article describes the targets for improvement in a setting for children with complex care needs (step 1), the identification of barriers and facilitators influencing interprofessional practice (step 2), and the development of a tailored interprofessional process model (step 3).MethodsIn step 2, thirteen qualitative semistructured interviews were held with several stakeholders, including parents of children, an occupational therapist, a speech and language therapist, a physical therapist, the manager of the team, two general practitioners, a psychologist, and a primary school teacher. The data were analyzed using directed content analysis and using the domains of the Chronic Care Model as a framework. In step 3, a project group was formed to develop helpful strategies, including the development of an interprofessional process through process mapping.ResultsIn step 2, it was found that the most important barriers to implementing interprofessional practice related to the lack of structure in the care process. A process model for interprofessional primary care was developed for the target group.ConclusionThe lack of a shared view of what is involved in the process of interprofessional practice was the most important barrier to its successful implementation. It is suggested that the tailored process developed, supported with the appropriate tools, may provide both professional staff and their clients, in this setting but also in other areas of primary care, with insight to the care process and a clear representation of “who should do what, when, and how.”