Interprofessional Care Models Research Articles

Transforming primary care: scoping review of research and practice

PurposeThe purpose of this paper is to reflect on research evidence and practice experience of transforming primary care to a more integrated and holistic model.Design/methodology/approachIt is based on a scoping review which has been guided by primary care stakeholders and synthesises research evidence and practice experience from ten international case studies.FindingsAdopting an inter-professional, community-orientated and population-based primary care model requires a fundamental transformation of thinking about professional roles, relationships and responsibilities. Team-based approaches can replicate existing power dynamics unless medical clinicians are willing to embrace less authoritarian leadership styles. Engagement of patients and communities is often limited due to a lack of capacity and belief that will make an impact. Internal (relationships, cultures, experience of improvement) and external (incentives, policy intentions, community pressure) contexts can encourage or derail transformation efforts.Practical implicationsTransformation requires a co-ordinated programme that incorporates the following elements – external facilitation of change; developing clinical and non-clinical leaders; learning through training and reflection; engaging community and professional stakeholders; transitional funding; and formative and summative evaluation.Originality/valueThis paper combines research evidence and international practice experience to guide future programmes to transform primary care.

Medication recommendation by physiotherapists: A survey of Québec physiotherapists' opinions regarding a new interprofessional model of care with pharmacists.

To improve the efficiency of the health care system, new interprofessional models of care are emerging. In 2015, two provincial professional colleges, regulating the practice of physiotherapists and that of pharmacists in the province of Québec, Canada, developed a new interprofessional model of care. This model is designed to guide non-prescription medication recommendations by physiotherapists treating patients in primary care with neuromusculoskeletal disorders (NMSKD) with the collaboration of pharmacists. To assess Québec physiotherapists' interests to use this model and explore their opinions concerning their ability to recommend non-prescription medications to patients in primary care with NMSKD. An email invitation to complete an electronic survey was sent in February 2016 to all the Ordre professionnel de la physiothérapie du Québec's registered physiotherapists. The survey included a questionnaire with 31 questions divided into 5 sections. Descriptive analyses and Chi-square tests (χ2 ) were performed to compare proportions (%) across demographic and clinical characteristics. Two hundred twenty-five physiotherapists completed the full survey. Of these, 70% of respondents knew of the model of care, but only 15% had previously used it. Perceived workload increase was one major reason reported for this lack of use (51%). Most of the respondents had a positive perception of this model and interactions with pharmacists and were confident regarding their ability to safely recommend medication (63%). However, 63% believed that further training was necessary to enable physiotherapists to provide efficient and safe non-prescription medication recommendations to patients with NMSKD. Overall, physiotherapists have a positive perception of this model, but there remain opportunities for increased integration into practice. Most respondents believe that additional training is required regarding non-prescription medication recommendations.

An overview of systematic reviews on the collaboration between physicians and nurses and the impact on patient outcomes: what can we learn in primary care?

BackgroundPrimary care needs to be strengthened in order to address the many societal challenges. Group practices in primary care foster collaboration with other health care providers, which encourages care co-ordination and leads to a higher quality of primary care. Nursing roles and responsibilities expanded over time and nurses have been found to often provide equal high-quality chronic patient care compared to physicians, even with higher patient satisfaction. Inter-professional collaboration between primary care physicians and nurses is a possible strategy to achieve the desired quality outcomes in a strengthened primary care system. The objective of this research is to synthesize the evidence presented in literature on the impact of collaboration between physicians and nurses on patient outcomes in primary care or in comparable care settings.MethodsA systematic review of peer-reviewed reviews was performed in four databases: COCHRANE, MEDLINE, EMBASE and CINAHL. All studies from 1970 until May 22 2016 were included in the search strategy. Titles, abstracts and full texts were respectively reviewed. At least two of the three authors independently reviewed each of the 277 abstracts and 58 full texts retrieved in the searches to identify those which contained all the inclusion criteria. Two authors independently appraised the methodological quality of the reviews, using the AMSTAR quality appraisal tool.ResultsA total of eleven systematic reviews met all the inclusion criteria and almost fifty different patient outcomes were described. In most reviews, it was concluded that nurses do have added value. Blood pressure, patient satisfaction and hospitalization are patient outcomes where three or more systematic reviews concluded better results when physicians and nurses collaborated, compared to usual care. Colorectal screening, hospital length of stay and health-related quality of life are outcomes where collaboration appeared not to be effective.ConclusionsCollaboration between physicians and nurses may have a positive impact on a number of patient outcomes and on a variety of pathologies. To address future challenges of primary care, there is a need for more integrated inter-professional collaboration care models with sufficiently educated nurses.

Novel malignant bowel obstruction (MBO) management program for women with advanced gynecological cancer.

158 Background: Malignant bowel obstruction (MBO) is a common and challenging clinical predicament in women with advanced gynecological cancers. However, there is a lack of evidence-based guidelines or innovative approaches to improve patient care and quality of life. We implemented an inter-professional MBO management program incorporating a nurse-led ambulatory symptom management algorithm and multidisciplinary care conferences (MCC) as hallmarks of this program. Methods: Princess Margaret Cancer Centre has piloted an inter-professional MBO management program that supports women with advanced gynecological cancers who are at risk of/have developed MBO. The MBO team includes oncologists (medical, surgical, gynecologic and radiation), palliative care physicians, diagnostic and interventional radiologists, home parenteral nutrition physicians, specialized oncology nurses, dietitians, pharmacists and social workers. Complex MBO cases are discussed at regular MCC to derive treatment consensus. A symptom-driven MBO management algorithm has been devised and all patients are educated with a personalized bowel symptom management and dietary plan. For outpatient care, patients with MBO are proactively monitored by our specialized oncology nurses via phone or an eHealth bowel application to facilitate communication of symptoms and early intervention. Access to community services and home palliative care services are utilized to support care at home. All patients are enrolled into a prospective database to assess care impact and quality. Results: A total of 145 patients have been followed through the MBO management program over 12 months. At time of data cutoff, 14 had MBO (3 inpatients and 11 outpatients) and 22 were deemed at risk of MBO. Majority patients are managed as an outpatient and avoided unnecessary emergency department episodes. Detailed methodology and data analyses will be presented. Conclusions: A successful novel MBO program incorporating inter-professional care model and nurse-led ambulatory symptom management algorithm optimizes patient care in this vulnerable population and foster collaboration in implementing best practice clinical processes.

A ‘How-To-Guide’ for teaching and assessing Collaborator Role competencies in family medicine residency and health professional training programs

Introduction: Collaborative practice competencies are essential for safe, effective practice in today’s health care system. Providing learners with formal teaching and assessment opportunities is a requirement for accreditation in medicine and other health professional programs. However, identifying and assessing a trainee’s ability to competently collaborate in practice across educational contexts remains challenging. Further, without common assessment tools for collaborative practice teaching opportunities, ensuring comparability of collaborative practice learning experiences is difficult. To address these challenges, the College of Family Physicians of Canada tasked an interprofessional group of educators to develop a practical ‘How to Guide’ to support educators and facilitate practice change in how we assess and teach the Collaborator Role competencies. As educators, we are often required to work from a variety of educational frameworks: programmatic evaluation objectives, key and enabling competencies and clinical domains of care as examples. By leveraging specific observable behaviours of collaborative practice, the ‘How to Guide’ links these frameworks and provides practical strategies for teaching and assessing these behaviours across educational contexts. Through these practical tools and strategies for teaching and assessment we expect not only to facilitate these processes but also to encourage consistency of programming and to ensure that health professional learners are supported in the attainment of these collaborator competencies. Purpose: This interactive workshop is designed to support educators in medicine and other health professions with teaching and assessing collaborator competencies. With reference to the CanMEDS 2015, participants will reflect on how they teach and assess the collaborator role within their own contexts; compare these opportunities with collaborator role teaching and assessment strategies implemented in Canada; and consider how the ‘How to Guide’ for the Collaborator Role can support their teaching and assessment of collaborative practice competencies. Learning objectives: By the end of this workshop participants will be able to: 1. Identify opportunities to teach and assess the collaborator role in their teaching context. 2. Describe common teaching and assessment practices for collaborator role competencies 3. Access and apply the How to Guide to support their teaching and assessment of the collaborator role. Targeted Population and Stakeholders: Teachers / preceptors, program directors, health professional educators, medical residents and health professional learners, curriculum developers and assessment leads Timeline: This work took place from 2013 to 2016 to coincide with the release of the 2015 CanMEDS framework. The How-To-Guide will accompany the roll-out across Canada for the 2017 CanMEDS FM (Family Medicine) competency framework. Sustainability and Transferability: The How-To-Guide is relevant to all health professional educators in their role of preparing future health professionals to be competent to practice in integrated and interprofessional care models. The How-To-Guide was created by an interprofessional group of educators to ensure its relevancy to all health professional training programs. The guide is expected to be available for educators on an ongoing basis for the next decade. Its revision would likely coincide with the 10 year-review of the College of Physicians and Surgeons Canada CanMEDs framework in 2025. This workshop will be facilitated in both English and French.

Development of an Integrated National Model of Care for Eating Disorder Services across Multiple Settings

Introduction: (comprising background and problem statement) Eating disorders have the highest mortality and morbidity of all of the mental health conditions, with top causes of death including cardiac and suicide (Arcelus, 2011). Patients with eating disorders present across the age range and transition across multiple service boundaries including primary care, mental health, paediatrics, acute medicine, and emergency departments. Evidence based treatment improves eating disorder outcomes substantially (Lock, 2015). Ireland has had no public eating disorder service to date. With a growing incidence, the development of a national clinical programme for eating disorders was prioritised by HSE. Description of policy context and objective: The development of a national eating disorder services is part of HSE’s national strategy and clinical programme which aims to deliver integrated, accessible clinician developed care to patients. In the absence of existing policy and service for eating disorders, a national working group was established in order to develop an integrated Model of Care for HSE eating disorder services. Targeted population: The Model of Care for eating disorders targets all patients with DSM V/ ICD 10 eating disorders (approximately 188, 895 patients in Ireland will develop eating disorders in their lifetime; estimated incidence in Ireland is approximately 1756 cases per annum). Child, adolescent and adult patients are included at all stages of illness and levels of severity. Settings include mental health, primary care and acute hospitals. Highlights: (innovation, Impact and outcomes) The working group comprised of 16 clinicians from both child and adult services representing stakeholder groups (psychiatry, psychology, social work, OT dietetics and nursing), a national manager, and national patient support group representative. This geographically spread group took an incremental approach to developing the model of care, progressing from papers on uniprofessional roles and views, though a patient and evidence lens, towards an interprofessional collaborative consensus model of care which was strongly evidence based. External consultation with other HSE national clinical programmes in paediatrics, acute medicine and primary was integrated into the document. This 360 degree approach to developing the national model of care enabled individual positions to be addressed and has ensured acceptability and feasibility across multiple professions, settings and services. Comments on transferability: This 360 degree incremental approach to Model of Care design is adaptable to other complex disorders presenting to multiple service settings and which require an integrated approach. Conclusions: (comprising key findings, discussion and lessons learned) The initial stages of working group formation, when stakeholders described their roles and individual perspectives to the group, was key to addressing professional tribalism and moving towards a collaborative group stance and model of care. Patient representation at all meetings was essential to this, as it kept patient values and needs central to this varied group of stakeholders. External consultation in the later stages but before completion, enabled future interagency collaboration. Integrated pilot projects are now being developed across these programmes as the model of care moves towards implementation.

Addressing rural and remote access disparities for patients with inflammatory arthritis through video-conferencing and innovative inter-professional care models.

The aim of the present study was to evaluate whether rheumatoid arthritis (RA) patients followed longitudinally using video-conferencing and inter-professional care support have comparable disease control to those followed in traditional in-person rheumatology clinics. This was a randomized controlled trial for 85 RA patients allocated to either traditional in-person rheumatology follow-up or video-conferenced follow-up with urban-based rheumatologists and rural in-person physical therapist examiners. Follow-up was every 3months for 9months. Outcome measures included disease activity metrics (disease activity in 28 joints with CRP measure score [DAS28-CRP], and RA disease activity index [RADAI]), modified health assessment questionnaire (mHAQ), quality of life (EuroQOL five dimensions questionnaire [EQ5D]) and patient satisfaction (nine-item visit-specific satisfaction questionnaire [VSQ9]). Of 85 participants, 54 were randomized to the video-conferencing team model and 31 to the traditional clinic (control group). Dropout rates were high, with only 31 (57%) from the video-conferencing and 23 (74%) from the control group completing the study. The mean age for study participants was 56years; 20% were male. Mean RA disease duration was 13.9years. There were no significant between-group differences in DAS28-CRP, RADAI, mHAQ or EQ5D scores at baseline or over the study period. Satisfaction rates were high in both groups. We found no evidence of a difference in effectiveness between inter-professional video-conferencing and traditional rheumatology clinic for both the provision of effective follow-up care and patient satisfaction for established RA patients. High dropout rates reinforce the need for consultation with patients' needs and preferences in developing models of care. While use of video-conferencing/telehealth technologies may be a distinct advantage for some patients, there may be loss of travel-related auxiliary benefits for others.

Investigating student perceptions at an interprofessional student-run free clinic serving marginalised populations

ABSTRACTMany health profession schools have student-run free clinics (SRFCs), but their educational relevance has not been well studied. The aim of this study was to evaluate the learning experiences and skills developed among interprofessional healthcare students at an SRFC serving marginalised populations, in order to provide data for ongoing programme improvement and recommendations for other SRFCs based on lessons learned. Under 1:1 supervision with a preceptor, interprofessional students completed three clinical shifts at an SRFC and attended a reflection session. A total of 101 out of 105 participants answered semi-structured pre- and post-programme surveys (response rate: 96%). Descriptive statistics and descriptive thematic analyses were used for quantitative and qualitative data, respectively. Numerous skills derived from learning objectives common to many healthcare professions were addressed while participating at the SRFC. Valued programme elements included working with and learning about inner city populations in an interprofessional care model. Interprofessional SRFCs encourage student learning about resources for inner city populations and interprofessional collaboration while providing an opportunity to develop skills related to the formal curriculum. This may provide a workable strategy to address an interprofessional education gap in the healthcare professional curriculum.

Interprofessional Management of Cancer Survivorship: New Models of Care.

To examine interprofessional models of care and care delivery for cancer survivorship, focusing on nursing as key providers of care. National summary statements and literature review. The need for cancer survivorship care is established. Treatment summaries and survivorship care plans are mandated documents expected to guide the delivery of survivorship care. However, the optimal delivery method, infrastructure, provider, and (cost-) effectiveness for the delivery of cancer survivorship care is unknown. Utilizing commonly occurring scenarios in cancer survivorship, this article discusses the visit structure, content care delivery structure, and possible care providers. These real-life situations can help the cancer care community to develop optimal algorithms of care and identify members of the interprofessional team for the survivorship care delivery.

The Evolution of the Dental Assisting Profession.

The objectives of this article are to describe the dental assistant's role in the dental delivery system; assess the educational structure of the dental assisting profession; and project factors likely to impact the future role of the dental assistant. The article summarizes the current status and trends of the dental assisting profession including general responsibilities, credentialing, and regulation. An overview of the workforce and parameters of employment is provided with a description of the broad scope of practice, education, and licensure options, which vary by state. Existing academic models and enrollment trends in accredited dental programs are included, as are the strengths and weaknesses of the current educational system. Multiple factors may impact the future of this profession. To address the anticipated increase in the demand for and responsibilities of dental assistants, curricular revisions will be needed to prepare for implementation of interprofessional care models in which dental assistants will play a vital role. Well-educated dental assistants will be needed to support viable models of dental care and wellness in the U.S. Enhanced career opportunities and varied employment environments may increase job satisfaction and practice longevity. As protection of the public is of the utmost importance in the dental profession, this evolving dental clinician must be formally educated in all aspects of clinical practice and be permitted to perform delegated patient care, as legally allowed by their states. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Barriers to information provision regarding breast cancer and its treatment.

Women with breast cancer require information about their cancer and its treatment during the process of treatment decision-making, yet it is unclear if there are barriers to information support. This study explores the experience of making treatment decisions in breast cancer, paying particular attention to the barriers experienced to the provision of information. Using a grounded theory methodology, semi-structured interviews were conducted with 22 women with invasive breast cancer exploring the experience of treatment decision-making. Data was organized using ATLAS.ti software and analyzed using constant comparisons. Analysis of the data showed that barriers to cancer and treatment information include intrapersonal and interpersonal communication challenges (emotional distress, patient-provider communication, "making it personal," access to information) which reside at different levels of the breast cancer experience (individual, dyad, group, organization). A model is provided to depict this experience. Women want information about their cancer and its treatment and experience barriers to information provision at various levels. Satisfactory information provision cannot occur without addressing barriers at every level. Utilizing interprofessional models of care may minimize existing barriers to information provision and empower patients to make satisfying treatment decisions that are consistent with their individual wishes.

Incentives and disincentives for treating of depression and anxiety in Ontario Family Health Teams: protocol for a grounded theory study

IntroductionThere is strong consensus that prevention and management of common mental disorders (CMDs) should occur in primary care and evidence suggests that treatment of CMDs in these settings can be...

Understanding Clinical Complexity the Hard Way: A Primary Care Journey.

Ten years ago, complexity was not a term often used in primary care. In the last decade, however, the population seen in primary care has shifted, posing substantial challenges for both primary care providers and health systems. In this essay, I will document the approaches that evolved in an academic family practice environment to address the challenges posed by complex patients typified by multiple concurrent chronic conditions and social determinants challenges. I will describe the research that lead to the creation, implementation and evaluation of an inter-professional model of care and associated outcomes. I will describe how this work subsequently led to the evolution of clinical models and research projects designed to reframe the discourse around complexity as well as move forward on elaborating new policy, clinical and service delivery innovations. I will conclude with some thoughts about what I see as the major challenges in the short and immediate term for research and practice, drawing on 15 years of practice and research experience with complex populations.

Rutgers/FOCUS wellness center: An innovative practice and an investment in the future of Newark

Abstract Interprofessional Care Models are becoming core concepts for academic programs. However, in clinical settings there are few opportunities for implement this model. The School of Nursing at Rutgers University began a journey to establish an innovative practice model that would provide the learning experiences that nurses and other professions could participate in. An overview of the program and descriptions of the challenges and benefits are presented here.

Cognitive Behavioral Therapy as an Integral Component of Interprofessional Care

Integrated care, using an interprofessional team model of care, is emerging as the standard for health care in the United States. Even though this is the standard for care, this is not always the care actually delivered. There are major opportunities for cognitive behavioral therapists (CBT) to deliver care in this model and to help advance the integrated, interprofessional delivery of care. These opportunities, and the challenges to developing a highly functioning interprofessional team are explored. ABCT members are encouraged to explore how their practice can be more aligned with interprofessional practice.

An Interprofessional Model of Care for the Pregnant Woman with Complex Psychiatric Illness

Poster Presentation Background Caring for a severely ill, suicidal pregnant woman with a history of concomitant drug abuse and violence is uncommon. When caring for such women and their families, diversions from standards of care may occur. Thus, to mitigate the potential challenges for such a woman, an interprofessional approach to care was developed to ensure not only optimal care for the woman and her fetus, but also to provide a safe, therapeutic, working environment for staff. Case In this case, the woman was a homeless, multiparous, 39‐year‐old with a history of drug abuse, severe depression, multiple suicide attempts, and violence. Her obstetric history was significant for a previous term vaginal delivery. She arrived by ambulance at 23 weeks gestation to an obstetric triage setting with bleeding following cocaine use. She admitted the desire to kill herself during this stay. Immediate consultation was obtained from psychiatry, social work, and obstetrics. After a brief in‐patient stay, the woman was discharged to a homeless shelter and given prescriptions for psychiatric medications. As the pregnancy progressed, the woman's mental health deteriorated and violent, psychotic behavior was exhibited. Risk management, hospital security, ethics, and the obstetric care team met to develop a comprehensive plan. These meetings occurred throughout the pregnancy and included updates on condition, delivery, and postpartum planning. The decision to commit the woman involuntarily was made. The woman was scheduled for a term induction of labor and the interprofessional care plan was utilized throughout her stay. She had a normal vaginal delivery and provided skin‐to‐skin care for her healthy infant. A petition was filed for a child abuse and neglect form at the time of birth, which meant the woman would not have custody of the infant. The woman was eventually discharged to her psychiatric facility, and the infant was discharged to care of the maternal grandmother. Discharge to outpatient care occurred at 2 weeks postpartum. A follow up report was obtained of the woman's suicide shortly thereafter. Conclusion Utilizing concepts of ethical and moral care coupled with interprofessional coordination can minimize maternal and neonatal morbidity and provide a safe environment for the woman, family, and the care team. This case illustrates the need for early postpartum follow‐up for women with depression.

An interprofessional care model for evaluating autism spectrum disorders (ASDs) among low-income children.

An interprofessional care model for evaluating autism spectrum disorders (ASDs) among low-income children.

Testing an Interprofessional Collaborative Practice Model to Improve Obesity-related Health Outcomes with a Statewide Consortium

s / Journal of Interprofessional Education & Practice 1 (2015) 48e77 66 multiple disciplines to work side-by-side with a patient will be an impediment to adopting inter-professional care models in their own future practices.

Implementation of an electronic health records system within an interprofessional model of care

Implementation of electronic health records (EHR) systems is challenging even in traditional healthcare settings, where administrative and clinical roles and responsibilities are clearly defined. However, even in these traditional settings the conflicting needs of stakeholders can trigger hierarchical decision-making processes that reflect the traditional power structures in healthcare today. These traditional processes are not structured to allow for incorporation of new patient-care models such as patient-centered care and interprofessional teams. New processes for EHR implementation and evaluation will be required as healthcare shifts to a patient-centered model that includes patients, families, multiple agencies, and interprofessional teams in short- and long-term clinical decision-making. This new model will be enabled by healthcare information technology and defined by information flow, workflow, and communication needs. We describe a model in development for the configuration and implementation of an EHR system in an interprofessional, interagency, free-clinic setting. The model uses a formative evaluation process that is rooted in usability to configure the EHR to fully support the needs of the variety of providers working as an interprofessional team. For this model to succeed, it must include informaticists as equal and essential members of the healthcare team.

Integrating telehealth services into a remote allied health service: A pilot study.

The continuity of care for people with neurological conditions in a remote northwest Queensland town as services are currently only available intermittently. Mixed methods design using questionnaires and staff review of the program and processes. Intermittent community rehabilitation service for clients with neurological conditions has been offered in Mount Isa and is supported by a similar fulltime service in Townsville. Both services use a unique client-centred, student-assisted, interprofessional model of care. Understanding participant experiences by obtaining feedback from clients, students and allied health professionals (AHPs) regarding their experiences of using telehealth in this setting. Previous clients of the North West Community Rehabilitation service were offered a review assessment using telehealth by an interprofessional team. Using telehealth enabled the client, remote AHP and students in Mount Isa to be connected to expert assistance in Townsville. The findings suggest that telehealth was useful in a community rehabilitation setting to provide review services for clients. This improved continuity of care for these clients because without this telehealth assessment, the clients would have had to wait up to 12 months for the next service period in Mount Isa or travel to a major urban centre to access a similar service. Feedback from clients, students and AHPs was positive; however, some challenges were identified. Recommendations for future service delivery using telehealth are outlined in the paper.