Interprofessional Management Research Articles

Interprofessional Management of (Risk of) Malnutrition and Sarcopenia: A Grounded Theory Study from the Perspective of Professionals.

As our global population ages, malnutrition and sarcopenia are increasingly prevalent. Given the multifactorial nature of these conditions, effective management of (risk of) malnutrition and sarcopenia necessitates interprofessional collaboration (IPC). This study aimed to understand primary and social care professionals' barriers, facilitators, preferences, and needs regarding interprofessional management of (risk of) malnutrition and sarcopenia in community-dwelling older adults. We conducted a qualitative, Straussian, grounded theory study. We collected data using online semi-structured focus group interviews. A grounded theory data analysis was performed using open, axial, and selective coding, followed by developing a conceptual model. We conducted five online focus groups with 28 professionals from the primary and social care setting. We identified five selective codes: 1) Information exchange between professionals must be smooth, 2) Regular consultation on the tasks, responsibilities, and extent of IPC is needed; 3) Thorough involvement of older adults in IPC is preferred; 4) Coordination of interprofessional care around the older adult is needed; and 5) IPC must move beyond healthcare systems. Our conceptual model illustrates three interconnected dimensions in interprofessional collaboration: professionals, infrastructure, and older adults. Based on insights from professionals, interprofessional collaboration requires synergy between professionals, infrastructure, and older adults. Professionals need both infrastructure elements and the engagement of older adults for successful interprofessional collaboration.

Improving Nurse Practitioner Students' Knowledge and Confidence in the Identification and Management of Human Trafficking Victims.

Human trafficking is a global public health problem affecting millions of people worldwide. In the United States, many trafficking victims seek medical care for physical, sexual, and mental health concerns. Unfortunately, many of these individuals go unrecognized by health care providers as being victims of human trafficking and return to their trafficker without interventions for their safety and protection. To provide effective quality care for this patient population, health care providers must be knowledgeable regarding the identification of signs of trafficking, trauma-informed interventions to ensure the safety and protection of the victim(s), and methods to collaborate with interprofessional partners for the provision of appropriate medical and socioeconomic care following the exit from their trafficking situation. The purpose of this pilot study was to evaluate best practices in teaching Family Nurse Practitioner (FNP) students to identify and implement appropriate interventions for victims of human trafficking. The study was conducted in two phases using a mixed-method research design with repeated measures. In the first phase, education was provided through the validated HOPE Training modules produced by the Safe House Project using a pretest, posttest design. In the second phase, the students observed an interprofessional simulation followed by focus groups using a phenomenological approach to explore students' perceptions. Knowledge and confidence increased significantly following the implementation of this study. The results provide essential information regarding incorporating human trafficking education into FNP curricula. This study also contributes to the body of knowledge regarding the vital role that nurse practitioners play in the interprofessional management of human trafficking victims.

Interprofessional Management of Chronic Orofacial Pain: A Topic Review, Steps to Improve Collaborative Care, and a Case Example

Interprofessional Management of Chronic Orofacial Pain: A Topic Review, Steps to Improve Collaborative Care, and a Case Example

Unusual Location: Omental Ectopic Pregnancy Killing Me Slowly

Objective: Omentum pregnancy is an ectopic pregnancy in the abdominal cavity. The event has high morbidity and mortality. The purpose of this case is to present a rare case of abdominal ectopic pregnancy that occurred in a young woman.
 Methods: Case report.
 Results: A 22-year-old woman at 16 weeks gestation presented with abdominal pain and clinical shock. Examination results revealed pregnancy outside the womb, with an estimated fetal weight of 193 grams and positive heart activity. The patient underwent laparotomy surgery, revealing that the pregnancy had occurred in the omentum organ with placental attachment.
 Conclusion: In this case, emergency management began with the patient's reception in the emergency department, followed by laparotomy exploration. After a meticulous surgery, the pregnancy's location was identified in the omentum, and the evacuation of pregnancy products was performed. The patient received treatment for several days until being discharged home. Early diagnosis and interprofessional management are crucial if similar conditions are suspected in the future to prevent morbidity.
 Keywords: abdominal cavity, ectopic pregnancy, omental pregnancy

The role of psychosocial factors in the interprofessional management of women with chronic pelvic pain: A systematic review.

Chronic pelvic pain (CPP) is a common pain disorder in women associated with negative biopsychosocial consequences. The multifactorial etiology and maintaining aspects of CPP logically require an interprofessional treatment approach. However, the effects of interprofessional treatment strategies on psychosocial factors remain unclear. The study aims to investigate how interprofessional therapy helps to treat psychosocial factors in women with CPP. The systematic review summarizes the current evidence of interprofessional treatment in women with CPP. A systematic literature review was performed in six databases (Medline, Web of Science, Cochrane Library, PEDro, CINAHL, and PsycINFO) until February 2023. Studies were selected in a two-step approach applying as inclusion criteria the search combinations of Chronic Pelvic Pain and CPP, synonyms for interprofessional therapies, and for female patients. Studies were excluded if they were not quantitative primary research published in English, if CPP was not defined appropriately, if the study population was not female adult patients, if the interprofessional intervention was not operationalized appropriately, if they were single case studies, and if outcomes did not include at least one of the psychosocial factors pain, depressive symptoms, pain catastrophizing, fear, or anxiety. Risk of bias of the included studies was rated with the McMaster Critical Review Form. Studies were summarized narratively. The review is registered in PROSPERO (CRD42023391008). Five studies with a total sample size of n = 186 women were included, three of them were uncontrolled retrospective before-after chart review. Only one study used a randomized controlled design, the other study used a non-randomized controlled group. The studies' methodological quality is adequate with perspective of study design. The multiprofessional treatment approaches used in the studies differed with regard to professions involved, therapy methods, and modalities. Psychosocial outcome measures were pain (five studies), depressive symptoms (three studies), and anxiety symptoms (four studies). Although interprofessional treatment strategies for women with CPP are recommended in existing guidelines, available evidence is scarce and does not allow for identification of the best interprofessional treatment approach. The effect on psychosocial factors remains unclear. More research is needed determining the best practice interprofessional treatment option for women with CPP.

Welcome to the HALM Journal from the American Association for Physician Leadership

The American Association for Physician Leadership (AAPL) is proud to now offer an information resource and journal entirely focused upon the evolving needs of physician and non-physician managers and leaders addressing the multitude of topics and issues related to healthcare administration, leadership, and management—the new Healthcare Administration Leadership and Management Journal (HALM Journal). Every other month, the HALM Journal will deliver indispensable and reliable results-oriented guidance for a healthcare industry moving toward inter-professional management and leadership that positively impacts patient care outcomes and population health.

Update bone infections

Bone and joint infections are becoming of great concern in an elderly population with growing numbers of prosthetic joints and comorbidities. This paper summarizes recently published literature on periprosthetic joint infections, vertebral osteomyelitis and diabetic foot infections. According to a new study, in the presence of a hematogenous periprosthetic infection and other inserted joint prostheses that are unremarkable on clinical examination, further invasive or imaging diagnostics may not be necessary. Periprosthetic infections that occur late (> 3 months after joint installation) have a worse outcome. New studies tried to identify factors when prosthesis preservation might still be an option. A new randomized landmark trial from France failed to show non-inferiority for 6 versus 12 weeks of therapy length. Thus, it can be assumed that this will currently become the standard therapy length for all surgical modalities (retention or replacement). Vertebral osteomyelitis is a rather rare bone infection, but the incidence has continued to rise sharply in recent years. A retrospective study from Korea provides information on the distribution of pathogens in different age groups and with selected comorbidities; this could help in the selection of an empiric therapy when pathogen identification is not successful before starting the treatment. The guidelines by the "International Working Group on the Diabetic Foot (IWGDF)" have been updated with a slightly different classification. New practice recommendations of the German society of diabetology emphasize an early interdisciplinary interprofessional management. Empirical therapy continues to be based on the severity of the infection and other risk factors (such as previous therapies or ischemia). Microbiological diagnosis from tissue samples is described as superior to smears. According to a randomized pilot study, 3 weeks therapy length for osteomyelitis after debridement appears to be noninferior to 6 weeks.

Assessment of Stuttering Priapism in Individuals with Sickle Cell Disease

Stuttering priapism is a rare and underinvestigated urologic condition reported in individuals with sickle cell disease (SCD). SCD is the most common cause of stuttering priapism. Stuttering priapism, also known as recurrent or intermittent priapism, manifests as transient, repetitive, painful episodes of prolonged erections with intermittent periods of detumescence without sexual stimulation. The tumescence or erection can result in ischemic damage to the corporal tissues. A detailed history and physical examination are paramount for interprofessional management. The nurse practitioner is in a key position to assist individuals with SCD in identification, prevention, and management of stuttering priapism.

Leader-member exchanges with leaders who have worked for 25 years in health institutions.

The aim is to investigate long-term leader experiences with leader- member exchanges (LMX) over 25 years. Leader-member exchanges focus on relational power and communication exchanges between leaders and employees when they communicate with each other or perform an action. This qualitative study is characterized by a phenomenological hermeneutical design and is based on the informants' interpretation and construction of meaning. A qualitative study with eight interviews with supreme nurse leaders from the Norwegian and Finnish health care services. The data analysis and interpretation show that relationships are built through trust, dialogue and confirmation and are affected by other contextual aspects such as the organizational size or workload and human factors such as safety, angst, and self-esteem. The informants fight for their subordinates. Interprofessional management and obtaining good relations with the doctors was challenging. No Patient or Public Contribution.

The impact of instrumented gait analysis on decision-making in the interprofessional management of cerebral palsy: A scoping review.

Management of gait-related problems in children and young people with Cerebral Palsy (CYPwCP) is complex and requires an interprofessional approach. Irrespective of underlying mechanisms, instrumented gait analysis (IGA) can provide quantification of gait to support clinical decision-making for CYPwCP when planning treatment interventions. This scoping review aimed to determine the impact of instrumented gait analysis (IGA) on treatment decision-making for CYPwCP, paying particular attention to interprofessional decision-making. PubMed, EMBASE, Web of Science and Scopus databases were searched from inception to October 2019 for studies including CYPwCP age<25 years. The PRISMA ScR protocol was followed, and Quality was assessed with the Downs and Black (D&B) scale. Influences on decision-making were coded according to the International Classification of Functioning, Disability and Health for Children and Youth framework (ICF-CY). Seventeen studies (1144 patients, 2.8-23 years) of varying quality (mean D&B=17.2, range=11-26) were included. Studies considered IGA influence at three decision-making stages 'Clinical Planning', 'Treatment Performed' and 'Follow up'. Child and Family, and Clinician and Service-centred factors had a high impact on engagement with IGA recommendations. IGA guided recommendations can differ from initial clinical plans, and often lead to modification of the treatment ultimately performed. The effect on individual patients' outcomes when treatment recommendations based on instrumented gait analysis are followed is not yet clear and warrants further research. The differences in clinicians' engagement with IGA recommendations occur due to an array of Child and Family, and Clinician and Service-centred factors. Overall, IGA leads to less surgical recommendations, and has the potential to influence conservative gait-related management in CYPwCP.

Integrating Mild Cognitive Impairment Screening Tools in Audiologic Care: A Review

Purpose: The main purpose of this clinical focus article is to highlight the potential role of audiologists in screening for mild cognitive impairment (MCI). The secondary purpose is to review public health implications of integrating MCI screening procedures in audiologic care for older adults experiencing the dual burden of age-related hearing loss (HL) and cognitive decline. The tertiary purpose is to provide current evidence-based literature regarding cognitive screening tools available for detection of MCI in audiologic practice. Method: This clinical focus article is broadly organized into three sections: (a) public health burden of MCI and the role of audiologists in screening for MCI among older adults seeking audiologic care, (b) potential cognitive screening tools amenable for integration into audiologic practice, and (c) recommendations grounded in a public health audiology framework of assessment, policy, and assurance aimed at improving the audiologic outcomes for older adults experiencing the dual effects of age-related HL and MCI and reducing the overall public health burden of MCI. Conclusions: MCI presents an important public health concern for audiologists, as cognitive decline and age-related HL often co-occur. Given the projected increase in the number of older adults in the next 40 years, audiologists will cater to an increasing number of older adults seeking hearing care, who might also have concomitant MCI. Considering cognitive screening procedures in audiologic practice is a key step toward addressing this challenge. It will also be important to integrate cognitive screening procedures and interprofessional management of MCI into the training of future audiologists.

Interprofessional Management of Orofacial Pain: Wearing Many Hats!

Orofacial pain is one the commonest chronic oral health disorder. Yet, its complete management is still a researchable matter as it is a disorder which is caused due to various factors. It is very rare is find a single etiology leading to orofacial pain. It often encompasses multiple etiological factors. Hence it is important to understand that not one but multiple healthcare professionals are needed for its successful outcome and thus forming an interprofessional management team becomes important.

Healthcare Provider Perspectives on Digital and Interprofessional Medication Management in Chronically Ill Older Adults of Turkish Descent in Germany: A Qualitative Structuring Content Analysis.

Medication management for chronically ill older adults with a history of migration can be associated with specific challenges, for instance language barriers. This study examined healthcare provider perspectives on interprofessional cooperation and digital medication management tools as approaches for increasing medication safety for chronically ill older adults of Turkish descent in Germany. Semi-structured interviews were conducted with 11 healthcare providers, including general practitioners, pharmacists, a geriatric consultant, a hospital social worker, and an expert on digitalization in nursing care. The interviews were analyzed by means of qualitative structuring content analysis. This article presents selected results of the analysis relating to medication management, barriers to optimal medication management, interprofessional cooperation, and digital tools. Compliance was perceived to be high among chronically ill older adults of Turkish descent and the involvement of family members in medication management was rated positively by respondents. Barriers to medication management were identified in relation to health literacy and language barriers, systemic problems such as short appointments and generic substitution, and racism on behalf of healthcare providers. Additionally, the respondents highlighted structural barriers to interprofessional communication in the German healthcare system. Furthermore, two technology acceptance models presented in this article to illustrate the respondents' perspectives on a) a digital application for medication management to be used by chronically ill older adults of Turkish descent and b) a digital tool for interprofessional communication. The discussion highlights the implications of the results for medication management within the German healthcare system.

For the interprofessional management of the discomfort of long-term care facility residents with dementia

ABSTRACT Educating interprofessional practitioners in long-term care facilities (LTCFs) is critical for managing discomfort of residents with dementia, which is often unnoticed and undertreated. A framework of education on discomfort management that is applicable in various environments in different facilities is necessary. We developed a preliminary framework to educate interprofessional practitioners on discomfort management of dementia residents in LTCFs. We conducted a three-step research process: a literature review using topic modeling, in-depth interviews, and Delphi surveys. We derived four categories for an interprofessional approach toward discomfort management education in LTCFs: identifying visual and nonvisual signs to communicate among professionals, close observation using comparison and contrast to share information for discomfort care, harmony in interprofessional roles, and applying common and specific professional knowledge for discomfort management. The findings provide the first outline for an educational framework for interprofessional discomfort management in LTCFs for residents with dementia. We recommend interventions across different cultures to verify the framework in future research.

Diabetes and Oral Health (DiabOH): The Perspectives of Primary Healthcare Providers in the Management of Diabetes and Periodontitis in China and Comparison with Those in Australia.

Diabetes and periodontal disease are highly prevalent conditions around the world with a bilateral causative relationship. Research suggests that interprofessional collaboration can improve care delivery and treatment outcomes. However, there continues to be little interprofessional management of these diseases. DiabOH research aims to develop an interprofessional diabetes and oral health care model for primary health care that would be globally applicable. Community medical practitioners (CMPs), community health nurses (CNs), and dentists in Shanghai were recruited to participate in online quantitative surveys. Response data of 76 CMPs, CNs, and dentists was analysed for descriptive statistics and compared with Australian data. Health professionals in China reported that, while screening for diabetes and periodontitis, increasing patient referral and improving interprofessional collaboration would be feasible, these were not within their scope of practice. Oral health screening was rarely conducted by CMPs or CNs, while dentists were not comfortable discussing diabetes with patients. Most participants believed that better collaboration would benefit patients. Chinese professionals concurred that interprofessional collaboration is vital for the improved management of diabetes and periodontitis. These views were similar in Melbourne, except that Shanghai health professionals held increased confidence in managing patients with diabetes and were more welcoming to increased oral health training.

Interprofessional Collaboration and Diabetes Management in Primary Care: A Systematic Review and Meta-Analysis of Patient-Reported Outcomes.

The global spread of diabetes poses serious threats to public health requiring a patient-centered approach based both on interprofessional collaboration (IPC) given by the cooperation of several different health professionals, and patients’ perspective through the assessment of Patient-Reported Outcomes (PROs). The aim of the present study is to evaluate the impact of interprofessional collaboration interventions, for the management of type 2 diabetes in primary care settings, through PROs. A systematic review and meta-analysis was conducted querying the PubMed, Scopus and Embase databases. Out of the 1961 papers initially retrieved, 19 met the inclusion criteria. Interprofessional collaboration is significantly associated with an increase in both patient’s satisfaction (SMD 0.32 95% CI 0.05–0.59) and in the mental well-being component of the HRQoL (SMD 0.18; 95% CI 0.06–0.30), and there was also promising evidence supporting the association between an interprofessional approach and an increase in self-care and in generic and specific quality-of-life. No statistical differences were found, supporting the positive impact on IPC interventions on the physical component of the HRQoL, depression, emotional distress, and self-efficacy. In conclusion, the effect of IPC impacts positively on the few areas assessed by PROMs. Policymakers should promote the widespread adoption of a collaborative approach as well as to endorse an active engagement of patients across the whole process of care.

Interprofessional care of patients with type 2 diabetes mellitus in primary care: family physicians\u2019 perspectives

BackgroundThere is a lack of understanding of the team processes and factors that influence teamwork and medication management practices in the care of patients with type 2 diabetes mellitus (T2DM). The purpose of the study was to explore physicians’ perspectives of barriers and facilitators to interprofessional care of patients with T2DM within team-based family practice settings.MethodsThis was a qualitative, descriptive study. Participants included physicians affiliated with a primary care network providing care to patients with T2DM in an interprofessional team-based primary care setting in Edmonton, Alberta, Canada. Participants’ contact information was obtained from the publicly available College of Physicians and Surgeons of Alberta and respective primary care network websites. Interview questions addressed physicians’ perspectives on factors or processes that facilitated and hindered the care and medication management of adult patients with T2DM in primary care team-based clinical practice. Interviews were audio-recorded, transcribed, and analyzed using qualitative content analysis and a constant comparative approach.ResultsA total of 15 family physicians participated in individual interviews. Family physicians identified facilitators of interprofessional team-based care and medication management of patients with T2DM in three theme areas—access to team members and programs, knowledgeable and skilled health professionals, and provision of patient education by other health professionals. Two themes emerged as barriers to interprofessional care – lack of provider continuity and the loss of skills from delegation of tasks.ConclusionFamily physicians perceive both benefits and risks to interprofessional team-based care in caring for patients with T2DM. Successful functioning of team-based care in family practice will require overcoming traditional professional roles.

Key Factors and Modeling of Interprofessional Management of Clinical Deterioration in Hospital Units: A Scoping Review.

Situations of clinical deterioration compromise patient safety, and their management can be a challenge for professionals. In this review, we synthesize the problematic factors for clinicians during the collective management of patient clinical deterioration in hospital units, and we provide a modeling of the action processes involved in patient safety. Electronic databases MEDLINE, CINAHL, EMBASE, and ERIC were systematically searched, and studies were critically appraised with MMAT. Seventeen articles were identified from 1222 for full-text screening. Data were deductively coded according to the Systems Analysis of Clinical Incidents model developed by Taylor-Adams and Vincent (2004), and results were consolidated using a narrative synthesis. Faced with these uncertain and rapidly changing situations, great adaptability is essential, and the quality of social interactions is a central issue for the effectiveness of teamwork. Interprofessional management of patients in clinical deterioration is complex due to multiple factors related to patients, professionals, tasks, environment, and teamwork. Caregivers' sense of worry about the patient's evolution is a key factor in early detection and therefore in the implementation of interventions. The model of four action processes proposed (Evaluation-Solicitation-Articulation-Composition) constitutes the points of attention for patient safety. It aims to guide the activities of the interprofessional collective involved.

Hospital and Geriatric Settings: A Comparison of Prevalence, Anatomical Locations, and Interventions

BACKGROUND: Skin conditions and dermatological diseases (eg, intertrigo) in older patients are common in clinical practice. In addition to the negative impact on the patient’s health, diseases such as intertrigo place a financial burden on the health care system. PURPOSE: The purpose of this secondary data analysis was to compare the prevalence, anatomical locations, and applied interventions of intertrigo in patients in hospitals and geriatric institutions. METHODS: The authors report the outcome of a secondary data analysis of data collected from 2012 to 2016 from the Nursing Quality Measurement 2.0. This is an annually conducted cross-sectional multicenter study. Descriptive statistics and statistical tests were used to analyze the data. RESULTS: Of patients in the hospital, 2.4% (n = 15,152) had intertrigo compared with 3.4% (n = 3743) of patients in geriatric institutions. In general, expert consultation was the least used intervention for the treatment of intertrigo in hospitals (6.1%, n = 359) and geriatric institutions (9.8%, n = 122). CONCLUSION: Independent of the setting, considering the worldwide climate change, the authors expect that the number of patients with intertrigo will be increasing. Therefore, they highly recommend implementing standardized skin assessments for moisture-associated skin damage to identify intertrigo as early as possible. Moreover, as the consultation of experts was seldom used in both settings, advances in the interdisciplinary and interprofessional management of moisture-associated skin damages are needed.

Management of rhino-orbital-cerebral mucormycosis: our experience

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Mucormycosis is a rapidly progressive, angio-invasive fungal infection caused by the fungus belonging to mucoraceae family that has predilection for the paranasal sinuses and adjacent mucosa. Of all the forms of mucormycosis, rhino orbital cerebral (ROCM) is the most commonand most aggressive. Our aim is to study the diagnosis, investigation, medical and surgical management of ROCM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective study of 273 patients was conducted at the department of ENT, government medical college and hospital, Nagpur between March 2021 to August 2021. Data was collected and analysed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Total 273 patients of mucormycosis were included in this study. There was total 197 (73%) males and 76 (27%) females, patient belonged to age group between 16 to 74 years. Diagnosis was made on the basis of clinical presentation and typical radiological and histopathological findings. On radiography, disease may be limited to a single sinus or involve multiple sinuses. In our study maxillary sinus was most commonly involved sinus 265 (97.06%) followed by ethmoid sinus 258 (94.50%), sphenoid sinus 209 (76.55%), frontal sinus 88 (32.23%). Extension to pterygomaxillary and infratemporal fossa was seen in 160 (58.60% patients), frontal bone involvement in 7 (2.56%), intra-orbital extension 67 (24.54%), intracranial extension 43 (15.75%), mandibular erosion 4 (1.46%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Rhino orbital cerebral mucormycosis is a life-threatening fungal infection, with very high mortality. Interprofessional management typically consists of intervention from an infectious disease specialist, otorhinolaryngologist, microbiologist, ophthalmologist, and paramedical staff, all working hand in hand for better achievement of results. Early diagnosis and intervention surely achieve better prognosis.&lt;/p&gt;