Collaborative Working Relationships Research Articles

Evaluation for learning and improvement at the right time: an example from the field.

Evaluation expertise to assist with identifying improvements, sourcing relevant literature and facilitating learning from project implementation is not routinely available or accessible to not-for-profit organisations. The right information, at the right time and in an appropriate format, is not routinely available to program managers. Program management team members who were implementing The Fred Hollows Foundation's Indigenous Australia Program's Trachoma Elimination Program required information about what was working well and what required improvement. This article describes a way of working where the program management team and an external evaluation consultancy collaboratively designed and implemented an utilisation-focused evaluation, informed by a developmental evaluation approach. Additionally, principles of knowledge translation were embedded in this process, thereby supporting the evaluation to translate knowledge into practice. The lessons learned were that combining external information and practice-based knowledge with local knowledge and experience is invaluable; it is useful to incorporate evaluative information from inception and for the duration of a program; a collaborative working relationship can result in higher quality information being produced and it is important to communicate findings to different audiences in different formats.

NOT JUST HOW MANY BUT WHO IS ON SHIFT: THE IMPACT OF WORKPLACE INCIVILITY AND BULLYING AMONG RCAS ON RESIDENT CARE

Much of the literature examining the link between care quality and staffing in long-term residential care focuses on staffing ratios and staffing mix; that is, how many staff are on shift. Far less attention has been devoted to exploring the impact of staff members’ workplace relationships, or who is on shift, on care quality. Of increasing concern is the potential for peer incivility and bullying to disrupt the respectful, collaborative and effective working relationships considered key to residential care aides’ (RCAs) care provision. This paper draws on data collected from a critical ethnography examining workplace incivility and bullying in a rural, not-for-profit care home. To date, more than 50 hours of participant observation, and 20 in-depth interviews with RCAs, licensed practical nurses, support staff, management and residents have been conducted. Thematic analyses identified three key themes: impact on resident safety; cutting corners; and impact on resident agitation and anxiety. Impact on resident safety highlights how incivility and bullying can result in non-adherence to two-person lift policies and procedures. Cutting corners outlines how RCAs’ relationships with their co-workers dictates to what extent they provide the requisite care to a resident for whom another RCA is responsible. Impact on resident agitation and anxiety focuses on residents’ reactions to the tensions that emerge between RCAs as a result of incivility and bullying. Findings highlight how peer incivility and bullying may indirectly influence certain quality indicators (e.g., pressure sores, psychotropic medication use) thereby offering additional insight into the staffing-care quality link.

Professional development beyond foundation training: a study of pharmacists working in Scotland.

In Scotland, post-registration hospital pharmacists typically undertake a vocationalfoundation training programme. Beyond this, there are no mandatory structures for ongoing professional training. To support progression to a more advanced level, competency frameworks are increasingly being used. This study aimed to measure the self-reported competence of pharmacists against a relevant framework and to determine what support was required to enable further professional development. An online survey was completed by pharmacists working across six acute hospital sites within NHS Greater Glasgow and Clyde who had completed foundation training between Jan 2013 and Jan 2018. Participants self-reported competency against the Royal Pharmaceutical Society's Advanced Practice Framework Advanced Stage 1 competencies and gave qualitative feedback through free-text questions. Twenty out of twenty-eight eligible pharmacists (71.4%) responded to the survey and three core areas requiring further support were identified: leadership, management and research. Participants reported that a strategic plan for professional development, more opportunities and managerial support were needed to help them develop these areas. Mentorship programmes and postgraduate qualifications were suggested as formats to support development. Pharmacists working towards advanced practice reported high levels of competence in expert professional practice, collaborative working relationships and education, training and development. While these results are promising, additional support is likely to be needed to cultivate leadership, management and research skills. Future training strategies need to consider this imbalance if we are to achieve national and international workforce goals for the professional development of pharmacists.

Impact of Hospitalist Comanagement on Outcomes in the Vascular Surgery Inpatient Population

Surgical comanagement with hospital medicine reduces mortality, increases patient satisfaction, and saves cost. Physicians can focus on their area of expertise, improving physician engagement. Comanagement is more prevalent in surgical specialties treating medically complex patients. The impact of comanagement has not been investigated thoroughly in vascular surgery. We sought to evaluate the impact of a strategic plan for comanagement of vascular surgery inpatients. The database at an academic medical center was queried for all admissions to vascular surgery between January 1, 2007 and December 31, 2017. In 2014, a hospitalist comanagement agreement was established to reduce surgical trainee workload, to improve outcomes, and to reduce cost. We collected data on demographics, comorbidities, length of stay, 30-day mortality, readmission, myocardial infarction (MI), and infection. Data were assessed to gauge impact on outcomes. There were 1438 admissions that met criteria for inclusion. Prevalence of comorbidities was 18.2% diabetes, 63.8% hypertension, 28.0% chronic kidney disease, and 46.7% coronary artery disease; mean age was 66.1 years, and 57.2% were male (similar in both groups). Mean length of stay was 8.2 days overall and 8.6 days before and 7.6 days after comanagement agreement (P = .0022), although logistic regression analysis revealed no significant difference. The 30-day mortality was 2.5%, similar in both groups. MI prevalence was 4.7%, significantly reduced with comanagement (2.6% vs 6.0%; P = .0028). Logistic regression modeling controlling for diabetes, hypertension, hyperlipidemia, coronary artery disease, chronic kidney disease, and peripheral artery disease demonstrated a 56% reduction in odds of MI in patients who were comanaged (P = .008). Given the health care industry's focus on quality of care, surgical outcomes, cost containment, and physician engagement, surgical comanagement paradigms should be considered a strategy to accomplish these goals. Comanagement has resulted here in a significant reduction in adverse cardiac events. The population of vascular surgery patients, with its advanced age and often multiple comorbidities, is well suited to benefit from a collaborative working relationship between vascular surgeons and their hospital medicine colleagues. Further assessment of benefits of comanagement is warranted.

Exploring physicians, nurses and ward-based pharmacists working relationships in a Swedish inpatient setting: a mixed methods study

Background In Sweden there has been limited work investigating the integration and nature of collaborative relationships between pharmacists and other healthcare practitioners. Objective To explore the working relationships of physicians, nurses and ward-based pharmacists in a rural hospital after the introduction of a clinical pharmacy service. Setting General medical ward in a rural hospital in northern Sweden. Method Mixed methods involving face-to-face semi-structured interviews with nurses, physicians and pharmacists, and a physician survey using the Physician-Pharmacist Collaboration Index to measure the extent of physician-reported collaborative working relationships. Main outcome measure Perceptions about collaborative working relationships between physician, nurses and pharmacists. Results All physicians (n = 9) who interacted with the clinical pharmacists completed the survey. The mean total score was 78.6 ± 4.7, total 92 (higher scores represent a more advanced relationship). Mean domain scores were highest for relationship initiation (13.0 ± 1.3, total 15), and trustworthiness (38.9 ± 3.4, total 42), followed by role specification (26.3 ± 2.6, total 30). The interviews (with nurses and physicians), showed how communication, collaboration and joint knowledge-exchange in the intervention changed and developed over time. Conclusion This study provides new insights into collaborative working relationships from the perspectives of physicians and nurses. The Physician-Pharmacist Collaboration Index scores suggest that physicians felt that clinical pharmacists were active in providing patient care; could be trusted to follow up on recommendations; and were credible. The interviews suggest that the team-based intervention provided good conditions for creating new ways to work to achieve commitment to professional working relationships.

Managing care for people with diabetes undergoing dialysis.

Caring for patients with diabetes undergoing dialysis often proves challenging for staff working in haemodialysis units as they are not experts in diabetes and unfamiliar with insulin dosing regimens and the impact dialysis can have on blood sugar levels and lifestyle adjustment. There is a need to improve the knowledge base of renal healthcare professionals to better understand the physiology of diabetes, its relationship with end stage kidney disease, and potential changes that can take place when commencing dialysis. The aim of this paper is to improve the understanding of the epidemiology of diabetes, associated risk factors, and complications associated with combined kidney disease & diabetes. In addition, readers will learn about the impact of dialysis on this complex patient group; adjustments which need to be made to accommodate haemodialysis schedules e.g. timing of meals and insulin requirements; treatment time including travel; the monitoring of blood glucose levels: increased risk of hypoglycaemia; review of oral glycaemic medication and the need to maintain regular health checks and contact with diabetes teams. Specialist evidence based guidelines for the management of patients with diabetes receiving haemodialysis are readily available and can be used to support clinical practice. One of the key components to improving the patient experience is to maintain collaborative working relationship between renal and diabetes teams. After reading this paper the reader will be able to Understand the risk factors and complications of diabetes and relate to patients in their care Critically review the management of patients undergoing dialysis with diabetes Gain knowledge and understanding of changes in the dosing of insulin needed for patients receiving dialysis Understand how clinical guidelines can be applied in practice.

Management of prenatal nursing care at a Health Center in Angola.

To understand how care management in prenatal care in a Care Center in Angola happens. A qualitative study, which used the Constructivist Grounded Theory (GT) as a methodological framework. The theoretical sample consisted of 22 participants, including nursing professionals, pregnant women and nursing students from Huambo, Angola. The data were collected by interviews and analyzed according to initial and focused coding. Five categories arose: Embracing the pregnant woman for prenatal care; Performing the prenatal consultation; Creating a bond and dialogical relationship with pregnant women; Establishing collaborative working relationships; and Inserting the pregnant woman's family into prenatal care. The management of nursing care in the study setting is effective through complementary and interdependent steps, based on collaborative relationships among professionals and in the effort to establish bonds with pregnant women and their families.

Psychology internship as partnership: Four perspectives

Internships for psychologists are intended to provide grounding and training for practice in the field. We posit that this, though certainly bringing focused attention to content and competencies, is best completed within collaborative working relationships intentionally nurtured between educational and practice settings on behalf of the intern to greater degrees than are normally present in most internships. This article brings views from four perspectives: Those of the University Programme Co-ordinator in overview, the Intern Psychologist, the Psychologist Site Supervisor, and the Psychologist University Supervisor. Using a mountaineering metaphor, we present a chronicle of the experience, useful learnings, and practical recommendations. The four authors worked together through the internship year, with the intern working in an on-campus student health centre. Internship detail of this setting is provided to anchor the narrative, but the learnings generalise across internship settings.

Effective capacity-building for spatial analyses: Risk mapping for emerging infectious diseases in Indonesia

Event Abstract Back to Event Effective capacity-building for spatial analyses: Risk mapping for emerging infectious diseases in Indonesia Caitlin N. Pfeiffer1*, Mark A. Stevenson1, Farida Zenal2 and Luuk Schoonman2 1 Asia Pacific Centre for Animal Health, Faculty of Veterinary Science, University of Melbourne, Australia 2 Food and Agriculture Organization of the United Nations (Indonesia), Indonesia Emerging infectious diseases are an important threat to human and animal health worldwide, and many of these diseases are zoonoses. To understand the likelihood of disease emergence, spatial analyses are extremely valuable to facilitate targeting surveillance and risk mitigation activities to high-risk geographic areas. However, collecting and collating relevant existing data to facilitate spatial analyses can be challenging. Furthermore, relevant expertise in the spatial analytical methods may not be present in the countries at greatest risk for infectious disease emergence. Indonesia is known to be at increased risk for emerging vector-borne diseases and spill-over of diseases from wildlife into human populations1. The aim of this analytical and capacity-building project was to better understand the spatial variation in emerging infectious disease risk across the country, through upskilling of in-country staff to identify, gain access to, manage and analyse relevant existing data. Relevant spatial risk data included human demographic and health information, animal population distribution and health status, historical disease outbreak locations, and known disease drivers such as environmental data including temperature, rainfall, elevation, land use change over time and greenness indices. The project will produce risk maps that can be used to effectively communicate disease emergence risk with decision-makers, to facilitate policy decisions that can safeguard human, animal and environmental health. To facilitate the in-country analysis and interpretation of the data, a series of capacity building training activities were conducted in 2019. Five workshops were delivered in Indonesia to a team of trainees comprised of Government of Indonesia employees, academics from Indonesian universities and FAO Indonesia staff. The training courses focussed on the development of technical skills, providing practical exposure to analysis of spatial data, use of advanced software including R and WinBUGS, and the principles of risk mapping. Crucially, the delivery of this material as a series of workshops staggered over a three-month period allowed participants to build their skills and confidence in the relevant techniques over time. An important feature of this capacity-building activity was engagement of staff from multiple ministries of the Government of Indonesia (a One Health approach). This provided several important benefits, including insights about the nature and quality of existing data and knowledge of local factors that could potentially influence the spread of emerging infectious diseases. Additionally, the continued attendance of the same group of trainees facilitated the development of collaborative working relationships between staff from different Government of Indonesia ministries, providing a rich foundation for future collaborative and One Health work. Relevant local examples were used throughout the training activities which enhanced the trainees’ engagement with the technically challenging content. Evaluation at the end of each workshop indicated progressive skill development and increasing theoretical understanding throughout the series of courses. This series of workshops serves as a model for empowering more countries to deliver technically advanced analyses, to better protect human and animal health. The One Health approach was very beneficial for these spatial analyses. Expertise from a variety of disciplines contributed to a thorough understanding of each dataset and facilitated the selection of appropriate techniques. As sophisticated spatial analyses become increasingly feasible (through the collection and availability of data and increasing availability of software), it is important to consider how capacity to perform these analyses can be fostered in countries with previously limited technical expertise. Expert input is needed to determine which analytical techniques might provide answers to important research and policy questions. Expertise in training and adult education is also needed, to support technical staff in developing the knowledge and skills needed to competently perform the analyses. Substantial focus on the policy relevance, effective visualisation and communication of analyses, rather than just their technical features, will be required. The delivery of effective capacity-building activities, such as the example described in this work, will help ensure spatial analyses can be meaningfully implemented in the parts of our world where they are most needed. Acknowledgements This project is part of the Emerging Pandemic Threats Phase 2 (EPT-2) programme, funded by the U.S. Agency for International Development (USAID). We thank FAO Indonesia for their support of the program and all of the participating trainees for their dedication to the workshop material.

Pharmacy student and pharmacist perceptions of professional socialism and communication in a real-life clinical setting.

To determine the impact of authentic clinical tasks on student confidence in interprofessional communication and assess the perceptions of pharmacists and pharmacy undergraduate students on how their degree prepares them to communicate and integrate with other healthcare professionals. Pharmacists completed a questionnaire regarding how their degree prepared them to communicate with other healthcare professionals. Third- and fourth-year pharmacy undergraduate students completed a modified questionnaire with questions relating to interprofessional learning and their experiences of reflective interprofessional communication tasks whilst on hospital placement. The questionnaires produced a combination of qualitative and quantitative data. Pharmacists (n = 36) and pharmacy students (n = 186) were in agreement that interprofessional training is important for undergraduate pharmacy students. Over 80% of student respondents viewed the interprofessional communication skills task as a useful method to develop communication skills with an increase in confidence following completion of the task. A variety of methods ranging from classroom- to practical-based sessions may be used to develop communication skills and professional socialism. Interprofessional learning has an important role for all working within the multidisciplinary healthcare team and contributes to the development of collaborative working relationships. It should be introduced and reinforced throughout undergraduate studies and continued in the workplace.

'Interaction structures' between depressed adolescents and their therapists in short-term psychoanalytic psychotherapy and cognitive behavioural therapy.

Identify the core 'interaction structures' between therapists and depressed adolescents within and across two common forms of psychotherapy. A total of 70 audio-recorded psychotherapy sessions representing short-term psychoanalytic psychotherapy (STPP) and cognitive behavioural therapy (CBT) with youth aged 12-18 years old were coded with the Adolescent Psychotherapy Q-set (APQ), a newly developed instrument. Data included different therapist-patient dyads and stages in treatment and were analysed with cluster analysis. Three distinct interaction structures between therapists and depressed adolescents: two influenced by the therapists' techniques and one more influenced by the young people's attitude to therapy. When there is a collaborative working relationship between therapists and depressed young people, the therapy process is influenced by the therapists' techniques; while when there is a poor working relationship, the techniques used by therapists of different theoretical orientation become more similar with the aim of engaging the young person in the process.

A Multisystemic Approach to the Prevention and Treatment of Child Abuse and Neglect.

Families experiencing physical abuse and/or neglect are at risk of continued difficulties that may involve long-term monitoring by Child Protective Services (CPS) and perhaps even removal of the child. Interventions needed to help the family remain intact safely and reduce both the clinical challenges they are experiencing and risk of further maltreatment will need to meet the multiple needs of all family members and involve a positive, collaborative working relationship with CPS. If services that are typically provided at outpatient clinics are used, the CPS case worker may be tasked with linking the family to many providers. When the family cannot make all the appointments, they are at further risk of removal of their child. In this article we present Multisystemic Therapy for Child Abuse and Neglect (MST-CAN), an ecologically based treatment for families experiencing physical abuse and/or neglect in which research-supported mental health services are delivered in the home by one clinical team to families who have serious clinical needs. To date, MST-CAN has been implemented with families experiencing the most serious levels of risk, but application is feasible for families with lower risk levels. Among high-risk families, MST-CAN has been shown effective for reducing out-of-home placement, abusive or neglectful parent behavior, and parent and child mental health difficulties and for increasing natural social supports. Two specialty population programs based on MST-CAN are also presented. These are MST - Building Stronger Families, a specialty program for parents who are experiencing abuse or neglect co-occurring with substance abuse, and MST for Intimate Partner Violence for families experiencing abuse or neglect and intimate partner violence. All models are based on the core Standard MST model. We trace the history of model development to dissemination.

Pharmacy and nursing students\u2019 attitudes toward nurse-pharmacist collaboration at a Chinese university

BackgroundThe collaborative working relationship of nurses with pharmacists has increasingly captured considerable attention. This study measured pharmacy and nursing students’ attitudes toward nurse-pharmacist collaboration at a university in China.MethodsThis cross-sectional study was conducted to assess the attitudes toward nurse-pharmacist collaboration using a self-developed scale delivered to a sample involving 202 nursing students and 258 pharmacy students enrolled in Wuhan University of Science and Technology.ResultsCompleted instruments were returned by 192 nursing students (95.0% effective response rate) and 249 pharmacy students (96.5% effective response rate). The average students’ score of attitudes toward nurse-pharmacist collaboration was 78.85 out of a total of 100. No significance was found for the attitudes toward nurse-pharmacist collaboration between two professions or between gender. The college freshmen (first-year) students had the maximum scores suggesting the most positive attitude toward nurse-pharmacist collaboration, followed by second- and third-year students, while final-year (fourth-year) students had the least.ConclusionThe students had somewhat positive attitudes toward nurse-pharmacist collaboration, but there is still room for improvement.

Improving Research in Radiation Oncology through Interdisciplinary Collaboration.

The contribution of radiation oncology to the future of cancer treatment depends significantly on our continued clinical progress and future research advancements. Such progress relies on multidisciplinary collaboration among radiation oncologists, medical physicists and radiobiologists. Cultivating collaborative educational and research opportunities among these three disciplines and further investing in the infrastructure used to train both clinicians and researchers will therefore help us improve the future of cancer care. This article evaluates the success of a short-term educational environment to foster multidisciplinary collaboration. The NIH-funded educational course developed at Wayne State University, called "Integration of Biology and Physics into Radiation Oncology" (IBPRO), was designed to facilitate the engagement of radiation oncologists, medical physicists and radiobiologists in activities that enhance collaborative investigation. Having now been delivered to nearly 200 participants over the past four years, the relative success of IBPRO in fostering productive interdisciplinary collaboration and producing tangible research outcomes can be evaluated. The 140 IBPRO participants from the first three years were surveyed to quantify the effectiveness of the course. In total, 62 respondents reported developing 23 institutional protocols, submitting more than 25 research grants (nine of which have been funded thus far), and publishing more than 30 research manuscripts attributable to participation in IBPRO. Nearly one-half (45%) of respondents reported generating at least one of these research metrics attributable to participation in IBPRO and these participants reported an average of over four such quantitative research metrics per respondent. This represents a very substantial contribution to radiation oncology research by a relatively small number of researchers within a relatively short time. Nearly one-half of respondents reported ongoing collaborative working relationships generated by IBPRO. In addition, approximately one-half of respondents stated that specific information presented at IBPRO changed the way they practice, and over 80% of respondents practicing in a clinical setting stated that, since participation in IBPRO, they have approached clinical dilemmas more collaboratively. We believe that educational opportunities such as IBPRO can have a significant impact on interdisciplinary collaborative research. In addition, such interventions have the ability to effect significant clinical change. Both of these should have a positive impact on future advancements in radiation oncology and affect the future contribution of radiation oncology to the treatment of cancer.

Pharmacist-Physician Collaboration at a Family Medicine Residency Program: A Focus Group Study

Background: In response to transforming healthcare and pursuit of the Triple Aim, many health systems have added team members to expand the capabilities and effectiveness of the team to facilitate these aims. The objective of this study was to explore knowledge and perceptions of pharmacist-physician collaboration among family medicine residents (FMR), family medicine faculty (FMF), and pharmacist faculty and residents in a practice where clinical pharmacy services were relatively new. Understanding the nuances of pharmacist-physician interactions will provide insight into how to improve FMR education to prepare learners for patient-centered, team-based practice.
 Methods: An exploratory descriptive qualitative study design was used to articulate perceptions of professional roles and team-based care in an interprofessional family medicine community-based clinical practice. Five, 60-minute focus groups were conducted in a clinical training setting that focuses on preparing family medicine physicians for collaborative rural primary care practice.
 Results: Twenty-one FMRs, eight FMF, and six clinical pharmacists participated. Three themes emerged from the focus groups and were consistent across the groups: 1) roles of pharmacists recognized by physicians in different settings, 2) benefits to collaboration, and 3) keys to successful pharmacist-physician collaboration which include a) developing the relationship, b) optimizing communication, c) creating beneficial clinical workflow, d) clarifying roles and responsibilities, and e) increasing opportunities for meaningful interactions.
 Conclusion: This study demonstrated that by co-locating physicians and pharmacists in the same environment, and providing a basic structure for collaboration, a collaborative working relationship can be initiated. Practices looking to have more effective collaborative working relationships should strive to increase the frequency of interactions of the professions, help the physicians understand the abilities of pharmacists, and help the pharmacists articulate to the physicians the value of what they provide to patients. The five keys identified in this study are building blocks to advance a successful collaborative working relationship that positively benefits patient care and achieves the Quadruple Aim.
 Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties
 Treatment of Human Subjects: IRB exemption granted
 
 Type: Original Research

Building a chiropractic academy of educators: A needs assessment of selected faculty educators.

Professional demands have led to health-care educator specialization in research or patient care. The academy movement is an avenue that attempts to return prestige and importance to improved instruction. The authors performed a needs analysis of selected faculty at 3 chiropractic colleges to assess the need for, and willingness to participate in, an academy of educators program. An expert-developed, pretested survey was deployed using SurveyMonkey. Analysis of variance and regression analysis were used to address 3 research questions related to the academy of educators program. The study achieved a 53% response rate and reflected that an overwhelming majority of chiropractic faulty members (89%) reported the need for an academy of educators. The study found no significant differences between faculty ranks, years of experience, and participation willingness. A structured approach, such as an academy, to foster professional teaching development may create positive outcomes for an institution. Faculty educators were willing to engage in an efficient program that may improve teaching methods and create opportunities for collaborative working relationships, which signals the potential for wide acceptance of the program.

Doctors\u2019 and nurses\u2019 perceptions of a ward-based pharmacist in rural northern Sweden

Background This project is part of the prospective quasi experimental proof-of-concept investigation of clinical pharmacist intervention study to reduce drug-related problems among people admitted to a ward in a rural hospital in northern Sweden. Objective To explore doctors’ and nurses’ perceptions and expectations of having a ward-based pharmacist providing clinical pharmacy services. Setting Medical ward in a rural hospital in northern Sweden. Method Eighteen face-to-face semi-structured interviews were conducted with a purposive sample of doctors and nurses working on the ward where the clinical pharmacy service was due to be implemented. Semi-structured interviews were digitally recorded, transcribed and analysed using thematic analysis. Main outcome measure Perceptions and expectations of nurses and doctors. Results Doctors and nurses had limited experience of working with pharmacists. Most had a vague idea of what pharmacists can contribute within a ward setting. Participants, mainly nurses, suggested inventory and drug distribution roles, but few were aware of the pharmacists’ skills and clinical competence. Different views were expressed on whether the new clinical pharmacy service would have an impact on workload. However, most participants took a positive view of having a ward-based pharmacist. Conclusion This study provided an opportunity to explore doctors’ and nurses’ expectations of the role of clinical pharmacists before a clinical pharmacy service was implemented. To successfully implement a clinical pharmacy service, roles, clinical competence and responsibilities should be clearly described. Furthermore, it is important to focus on collaborative working relationships between doctors, nurses and pharmacists.

Understanding experiences of and preferences for service user and carer involvement in physical health care discussions within mental health care planning

BackgroundPeople with severe mental illness suffer more physical comorbidity than the general population, which can require a tailored approach to physical health care discussions within mental health care planning. Although evidence pertaining to service user and carer involvement in mental health care planning is accumulating, current understanding of how physical health is prioritised within this framework is limited. Understanding stakeholder experiences of physical health discussions within mental health care planning, and the key domains that underpin this phenomena is essential to improve quality of care. Our study aimed to explore service user, carer and professional experiences of and preferences for service user and carer involvement in physical health discussions within mental health care planning, and develop a conceptual framework of effective user-led involvement in this aspect of service provision.MethodsSix focus groups and four telephone interviews were carried out with twelve service users, nine carers, three service users with a dual service user and carer role, and ten mental health professionals recruited from one mental health Trust in the United Kingdom. Data was analysed utilising a thematic approach, analysed separately for each stakeholder group, and combined to aid comparisons.ResultsNo service users or carers recalled being explicitly involved in physical health discussions within mental health care planning. Six prerequisites for effective service user and carer involvement in physical care planning were identified. Three themes confirmed general mental health care planning requirements: tailoring a collaborative working relationship, maintaining a trusting relationship with a professional, and having access to and being able to edit a living document. Three themes were novel to feeling involved in physical health care planning discussions: valuing physical health equally with mental health; experiencing coordination of care between physical-mental health professionals, and having a physical health discussion that is personalised.ConclusionsHigh quality physical health care discussions within the care planning process demands action at multiple levels. A conceptual framework is presented which provides an evidence-based foundation for service level improvement. Further work is necessary to develop a new patient reported outcome measure to enable meaningful quantification of health care quality and patient experience.

Understanding the drivers of interprofessional collaborative practice among HIV primary care providers and case managers in HIV care programmes

ABSTRACTCare coordination programmes are an important aspect of HIV management whose success depends largely on HIV primary care provider (PCP) and case manager collaboration. Factors influencing collaboration among HIV PCPs and case managers remain to be studied. The study objective was to test an existing theoretical model of interprofessional collaborative practice and determine which factors play the most important role in facilitating collaboration. A self-administered, anonymous mail survey was sent to HIV PCPs and case managers in New York City. An adapted survey instrument elicited information on demographic, contextual, and perceived social exchange (trustworthiness, role specification, and relationship initiation) characteristics. The dependent variable, perceived interprofessional practice, was constructed from a validated scale. A sequential block wise regression model specifying variable entry order examined the relative importance of each group of factors and of individual variables. The analysis showed that social exchange factors were the dominant drivers of collaboration. Relationship initiation was the most important predictor of interprofessional collaboration. Additional influential factors included organisational leadership support of collaboration, practice settings, and frequency of interprofessional meetings. Addressing factors influencing collaboration among providers will help public health programmes optimally design their structural, hiring, and training strategies to foster effective social exchanges and promote collaborative working relationships.

A collaborative approach to psychotherapy termination.

Collaboration has been recognized as an important relationship variable in psychotherapy that is linked to client treatment outcomes. Although many therapists seek to build a collaborative working relationship with their clients when making treatment decisions, collaboration is also an important technique that can be used to help clients plan for a successful termination. Collaborative termination strategies can first be used in the initial session in order to address clients' termination expectations. Strategies can also be used throughout treatment to help clients focus on their treatment goals. Last, collaborative termination strategies should be used in the final session to help clients take ownership of their gains and to equalize the therapeutic relationship. In this article, we provide specific recommendations for collaborating with clients in preparing for psychotherapy termination. Case examples demonstrating these strategies are also provided. (PsycINFO Database Record