Interprofessional Care Models Research Articles

Changes in primary care physician’s management of low back pain in a model of interprofessional collaborative care: an uncontrolled before-after study

BackgroundTracking how clinicians treat patients provides an opportunity to explore how the clinical management of common musculoskeletal disorders evolves over time. We present an uncontrolled before-after study of a primary care physician’s management of low back pain and describe how his involvement in an interprofessional collaborative practice was associated with a change in the management of patients with low back pain.MethodData from the electronic medical record of one primary care physician who participated in a study of a model of chiropractic-medical collaboration were retrospectively collected. Records of a sample of consecutive patients prior to the start (i.e. pre-study, n = 51) and at the end of the collaborative study (i.e. study, n = 49) were collected.ResultsDemographics were similar in both groups but median number of physician visits (2.5 and 1.0), average prescriptions per patients (1.24 and 0.47), and total number of narcotic prescriptions (14 and 6) differed between pre-study and study groups, respectively. Separate analysis of only the records of low back pain study patients revealed that 61% were referred for chiropractic care during the study period. Patients who were not referred had more neurological deficits and leg pain but back pain severity and average number of prescriptions was about the same. Referred patients in the study group had about 25% fewer physician visits and imaging requests.ConclusionBased on this study of a single primary care physician, we hypothesize that doctors may change their prescribing behaviours and consultation rate for patients with low back pain when engaged in interprofessional collaborative care. Further research is required to test this observation in the population.

Transitional Care Partners: A hospital-to-home support for older adults and their caregivers

To describe the development, implementation, and preliminary results of the Transitional Care (TLC) Partners, a clinical demonstration program that supports the transition from hospital to home of older veterans. Hospital records of TLC patients to track their hospital and emergency department visits before and after the TLC Partners enrollment. Caregivers of patients completed Preparedness in Caregiving and the Short Form Zarit Burden Scale during the first week of the TLC Partners enrollment and on the week when the services ended. The proportion of patients with one or more emergency department visits and rehospitalization is consistently lower among TLC patients compared to non-TLC patients at 30 and 60 days of hospital discharge. The mean preparedness and burden scores before and after the program essentially remained the same. The description of the implementation of the TLC Partners offers an example of how nurse practitioner-led interprofessional care models can be adapted to the needs of specific healthcare systems, and how they can be monitored to evaluate their reach, effectiveness, and fidelity to the core components of proved care models.

“Acute caring” in the emergency department

The aim of this essay was to discuss the ways in which the dynamics of interprofessional communication and collaboration among healthcare providers ultimately affect patient quality of care in the acute setting. Interprofessionalism describes a care model whereby health providers use complementary skills, knowledge and competencies to provide quality care to a group of patients. These interactions are characterized by trust, respect and an understanding of each other's skill and knowledge. At its best, the interprofessional care model has made great strides in the amelioration of patient outcomes, including reduction in negative outcomes, decreased health access needs and increased patient satisfaction. However, challenges with regard to communication and implementation have translated to a steep learning curve for healthcare providers. As such, a new-found emphasis has been placed on interprofessional education for today's healthcare students with the goal of promoting a more efficient and collaborative philosophy for tomorrow's healthcare teams.

Models of maternity care in rural environments: Barriers and attributes of interprofessional collaboration with midwives

Objectivesinterprofessional primary maternity care has emerged as one potential solution to the current health human resource shortage in many developed nations. This study explores the barriers to and facilitators of interprofessional models of maternity care between physicians, nurses, and midwives in rural British Columbia, Canada, and the changes that need to occur to facilitate such models. Designa qualitative, exploratory framework guided data collection and analysis. Settingfour rural communities in British Columbia, Canada. Two rural communities had highly functional and collaborative interprofessional relationships between midwives and physicians, and two communities lacked interprofessional activities. Participants55 participants were interviewed and 18 focus groups were conducted with midwives, physicians, labour and delivery nurses, public health nurses, community-based providers, birthing women, administrators, and decision makers. Findingsin models of interprofessional collaboration, primary maternity care providers – physicians, midwives, nurses – work together to meet the needs of birthing women in their community. There are significant barriers to such collaboration given the disciplinary differences between care provider groups including skill sets, professional orientation, and funding models. Data analysis confirmed that interprofessional tensions are exacerbated in geographically isolated rural communities, due to the stress of practicing maternity care in a fee-for-service model with limited health resources and a small patient caseload. The participants we spoke with identified specific barriers to interprofessional collaboration, including physician and nurses' negative perceptions of midwifery and homebirth, inequities in payment between physicians and midwives, differences in scopes of practice, confusion about roles and responsibilities, and a lack of formal structures for supporting shared care practice. Participants expressed that successful interprofessional collaboration hinged on strong, mutually respectful relationships between the care providers and a clear understanding of team members' roles and responsibilities. Conclusions and implications for practiceinterpersonal conflicts between primary maternity care providers in rural communities were underpinned by macro-level, systemic barriers to interprofessional practice. Financial, legal, and regulatory barriers to interprofessional collaboration must be resolved if there is to be increased collaboration between rural midwives and physicians. Key recommendations include policy changes to resolve differences in scope of practice and inequitable funding between rural midwives and physicians.

P03.09. Development of an interprofessional model of collaborative care by doctors of chiropractic and medical doctors for older adults with low back pain

Purpose Although low back pain (LBP) is a common reason older adults seek treatment from either medical doctors (MD/DO) or doctors of chiropractic (DC), collaborative care between these providers is rarely reported. The purpose of our study is to develop a model for such collaborative care in LBP patients, based upon an existing integrative medicine model (Hsiao et al., 2006), focusing on four facets of interprofessional collaboration: attitudes, knowledge, referral, and integrative practice.

The Merck Lectureship: Communication: The key to improving the prostate cancer patient experience

In 2010, an estimated 24,600 Canadian men were diagnosed with prostate cancer (Canadian Cancer Society, 2011). Upon diagnosis, men and their family members begin an arduous journey of information gathering surrounding prostate cancer and its various forms of treatment. Men have to consider the impact a treatment may potentially have on their quality of life and, frequently, they experience decisional conflict and require support. In May 2008, the Prostate Cancer Assessment Clinic opened to receive men for an evaluation of a possible prostate cancer. Our inter-professional model of care provides support, guidance and education to our patients from assessment to diagnosis and treatment planning. A major goal of our diagnostic assessment unit has been to improve the patient experience. Communication is defined as "to make known, to exchange information or opinions" (Cayne, Lechner, et al., 1988). Nursing is the critical link for information exchange that is patient-centred and collaborative. The focus of this paper will highlight the development and implementation of nurse-led initiatives within our program to improve the prostate cancer patient experience. These initiatives include: a patient information guide, prostate biopsy care, patient resources, community links, surgery education classes and implementation of a decision aid. Communication is the key.

Clinician's Commentary on Cott et al.

The article by Cott et al.1 in this issue of Physiotherapy Canada explores two models by which physiotherapists can be incorporated into Family Health Teams (FHTs) in Ontario and details the challenges and opportunities associated with these models. The article is a timely one: this issue has been uppermost in the minds of physiotherapists in Ontario, and the lessons are valuable for those in other provinces, where similar inter-professional models of health care are being set up. It is also critically important to the profession, since physiotherapists were excluded from FHTs in Ontario and, to date, have not made an effective argument to be included.2

Role of community pharmacists in asthma - Australian research highlighting pathways for future primary care models.

Asthma is one of the most common chronic conditions affecting the Australian population. Amongst primary healthcare professionals, pharmacists are the most accessible and this places pharmacists in an excellent position to play a role in the management of asthma. Globally, trials of many community pharmacy-based asthma care models have provided evidence that pharmacist delivered interventions can improve clinical, humanistic and economic outcomes for asthma patients. In Australia, a decade of coordinated research efforts, in various aspects of asthma care, has culminated in the implementation trial of the Pharmacy Asthma Management Service (PAMS), a comprehensive disease management model.There has been research investigating asthma medication adherence through data mining, ways in which usual asthma care can be improved. Our research has focused on self-management education, inhaler technique interventions, spirometry trials, interprofessional models of care, and regional trials addressing the particular needs of rural communities. We have determined that inhaler technique education is a necessity and should be repeated if correct technique is to be maintained. We have identified this effectiveness of health promotion and health education, conducted within and outside the confines of the pharmacy, in public for a and settings such as schools, and established that this outreach role is particularly well received and increases the opportunity for people with asthma to engage in their asthma management.Our research has identified that asthma patients have needs which pharmacists delivering specialized models of care, can address. There is a lot of evidence for the effectiveness of asthma care by pharmacists, the future must involve integration of this role into primary care.

Clinician's Commentary

Clinician's Commentary

Clinician's Commentary

Clinician's Commentary

Learning to Get Along: Interprofessional Simulation for Health Care Providers

Since the inception of Brock University's nursing program in 2001 the Nursing Department and the local health system have developed a collaborative relationship. In planning for implementation of a new interprofessional model of care the coordinators from the health system approached the Nursing Department about using simulation as a method for developing and disseminating interprofessional core competencies.

Improving geriatric transitional care through inter‐professional care teams

The aim of this study was to examine the impact of the use of an inter-professional care team on patient length of stay and payer charges in a geriatric transitional care unit. An analysis of de-identified administrative records for transitional care patients for the 12-month period (2003-2004) cared for by the inter-professional team (n = 163) and cared for by traditional single provider care model (n = 176) was carried out. We conducted logistic regression on length of stay and charges controlling for patient demographics and acuity levels. The inter-professional care team patients had significantly shorter lengths of stay, fewer patient days and lower total charges. Patient diagnosis and acuity were similar across groups. This study provides empirical evidence of the impact of an inter-professional care model in providing cost-effective transitional care in a nursing home setting. Evidence of shorter lengths of stay, shorter patient days and lower charges suggests benefit in the development and financing of inter-professional care teams for transitional care services.

Mapa emocional de equipos de atención primaria en Andalucía

Objective To evaluate the dynamics and establish the emotional map of 8 primary care teams. Design Descriptive, cross-sectional and multi-site study. Setting Primary care centers in Granada, Cádiz and Málaga, Spain. Participants Simple random sampling of 8 health centers and 272 primary care professionals. Main measurements A self administered questionnaire with 10 Likert-type questions. Answers were classified by items, media and mode. Results Leadership is not integrated (0.42 points). Relationships between workers show rivalry, burnout and little sensation of being part of a team, but they are united by support and trust. There is a moderate enthusiasm of team objectives (1.36 points). Professional self esteem is generally positive (1.89 points). Conclusions Emotional climate of the teams recorded medium values. Aspects as regards integrating leadership and increased enthusiasm towards the common work project need to be improved, following the inter-professional collaborative care model.

Grounding theories of W(e)Learn: A framework for online interprofessional education

Interprofessional care (IPC) is a prerequisite for enhanced communication between healthcare team members, improved quality of care, and better outcomes for patients. A move to an IPC model requires changing the learning experiences of healthcare providers during and after their qualification program. With the rapid growth of online and blended approaches to learning, an educational framework that explains how to construct quality learning events to provide IPC is pressing. Such a framework would offer a quality standard to help educators design, develop, deliver, and evaluate online interprofessional education (IPE) programs. IPE is an extremely delicate process due to issues related to knowledge, status, power, accountability, personality traits, and culture that surround IPC. In this paper, a review of the pertinent literature that would inform the development of such a framework is presented. The review covers IPC, IPE, learning theories, and eLearning in healthcare.

A Conceptual Framework for Interprofessional and Co-Managed Care

Interprofessional care has been promoted by some policy makers and health professionals as a response to rising health care costs and threats to patient safety. Proponents suggest that interprofessional models of care can reduce fragmentation and lower costs through improved coordination between different health professionals. These models encourage the collaboration of supplementary skills between different health care professionals. Effective collaborative models of interprofessional care may be influenced by several variables germane to the interaction and structure of the team of health professionals--temporality, urgency, and degree of structured authority--and the author examines the importance of each variable in delivering interprofessional care. Co-managed models of care have also been proposed. Recent state health reform efforts have catalyzed the adoption of co-managed care models by expanding the autonomy of alternative providers through the broadening of scope of practice. These scope-of-practice changes are intended to permit greater diagnostic and therapeutic authority of nonphysician providers. This effort seems aimed at enhancing the competition between provider groups in the market and expanding consumer choices. Herein, the author presents a conceptual framework to describe different models of interprofessional and co-managed care. The author also considers interprofessional and co-managed care models in the context of the health reform movement. Some of the challenges are considered, as policy makers consider the options for facilitating further development of interprofessional models of practice and the implications for curricular modifications at academic health centers.

Of life and limb: Interprofessional model of care for vascular amputees

Of life and limb: Interprofessional model of care for vascular amputees

Environmental scan of interprofessional collaborative practice initiatives

Interprofessional collaboration in health care is high on the policy agenda in Canada. There is evidence that governments, academic institutions, regulatory bodies and health services are developing directions, policies and strategies with collaboration in mind. The Ottawa Hospital (TOH) received governmental funding to implement The Ottawa Hospital Inter-Professional Model of Patient Care©. Prior to implementing our model, we conducted an environmental scan to identify initiatives related to interprofessional collaboration in clinical settings. A historical method was used to understand the chronological development of interprofessional collaboration within the health field over the last 10 years. Critical browsing was used to search, select and summarize information found on the web. Fifty-two documents were critically reviewed; 27 documents were retained for further analysis and inclusion. The information was analyzed according to three main parameters: source, summary and relevance to our project. The five broad themes identified are: promotion, networking, evidence, resources and linkage between interprofessional education and care. This seems an accurate reflection of the current state of this area; there is active promotion and networking, concrete frameworks and funds but few published results regarding the efficacy of implementing IPC in health care organizations. As experience with the approach accumulates, evidence should grow.

Interprofessional work in child and adolescent mental health services

New ways of tackling the increased volume and complexity of emotional and behavioural problems are required in the face of demands from government, practitioners and parents. Policy imperatives have tended to focus on structural changes combined with calls for better cooperation between professionals in order to enhance service provision for troubled children. This article presents findings from a 2 year formative evaluation of a new multidisciplinary team offering a preventive resource within the child and adolescent mental health service. Team members were recruited from three different professional backgrounds. This description and discussion of their effectiveness in working together offers an innovative model of interprofessional care and provides valuable lessons for child and adolescent mental health services seeking to establish closer interprofessional working.

Collaboration improves the quality of care: methodological challenges and evidence from US health care research

At the present time when interprofessional collaboration in practice is reaching new levels of interest related to health care system changes in both the UK and the US, a key question being raised is: What are the outcomes and costs of interprofessional collaborative models of care? The purposes of this paper are to: (a) summarize past research efforts, primarily in the US, to examine whether interprofessional collaboration improves the outcomes of care, (b) articulate the continuing conceptual and methodological challenges associated with efforts to examine this relationship, (c) present more recent research in the US in which investigators have overcome some of the conceptual and methodological barriers to this type of research, and (d) identify gaps in knowledge and areas for future research on the relationship between collaborative models of care and care outcomes.