Interprofessional Collaborative Care Research Articles

An evaluation of the psychometric properties of the Australian Collaborative Practice Assessment Tool

Objectives This study aimed to validate the Collaborative Practice Assessment Tool (CPAT) in the Australian setting and provide a quality instrument in terms of psychometric properties that can be used to measure interprofessional outcomes for both healthcare practitioners and students. The outcomes evaluated include the capacity to work in an interprofessional team, good interprofessional communication skills, leadership skills, ensuring clear division of tasks and roles in a team, effective conflict management, and being actively involved with patients and their families/communities in care. Methods The COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) taxonomy and standards were used as guides for evaluating the psychometric properties of the Australian CPAT, which include evaluations regarding instrument development requirements of sample target and size, content validity, internal structure (structural validity, internal consistency reliability and measurement invariance), and hypotheses testing. CPAT Australia was developed through two stages involving pilot studies and a validation study, both of which included healthcare practitioners and students as participants. A pilot study examined content validity regarding item relevance, item comprehensibility, and instrument comprehensiveness. The validation study was carried out to assess the internal structure of CPAT Australia for aspects of structural validity, internal consistency reliabilities, and configural, metric and scalar measurement invariance. The structural validity was explored using the following three steps: exploratory, confirmatory, and multi-group factor analysis. Construct validity was evaluated to confirm direct and indirect paths of assumptions based on a previously validated model. Data collected between August 2021 and May 2022. Results The content validity evaluation confirmed that all items were relevant, understandable and comprehensive for measuring interprofessional collaborative care in Australia. Three hundred ninety-nine participants contributed to the validation study (n=152 practitioners; n=247 students). The original instrument model of 8-Factor 56-Item was improved in the Australian CPAT. Two items, Item 27 (Physicians assume the ultimate responsibility) and Item 49 (Final decision rest with the physician), were consistently rejected and therefore discarded. The internal structure of the 7-Factor 54-Item solution was confirmed as a suitable model with fit indices meeting COSMIN standards for a good model in practitioner and student cohorts. Configural, metric and scalar invariances were confirmed, indicating the invariance of the instruments when used for the practitioner and student cohorts. The construct validity evaluation indicated that 81.3% of direct and indirect assumptions were accepted, fulfilling the COSMIN requirement of >75% of proposed assumptions being accepted. Conclusion The Australian CPAT with a 7-factor 54-item solution was confirmed as a quality measure for assessing interprofessional education and collaborative practice for both healthcare practitioners and students in Australia with robust psychometric properties.

The Effect of Interprofessional Education on Student Readiness for Collaborative Practice.

Health care reform promotes interprofessional patient-centric health care models associated with improved population health outcomes. Interprofessional education (IPE) programs are necessary to cultivate collaborative care, yet little evidence exists to support IPE pedagogy within nursing and other health science academia. This quasiexperimental study examined differences in pre- and posttest Readiness for Interprofessional Learning Scale (RIPLS) scores following an IPE intervention. The IPE intervention consisted of a video presentation and a debriefing session after a simulated interprofessional collaborative patient care conference that introduced baccalaureate nursing and health science students to the roles and responsibilities of clinicians in team-based primary care. Pre- and postintervention RIPLS scores were analyzed. Pre- and postintervention RIPLS scores increased across all subscales, with distinct variation between nursing and health science student subscales. This IPE intervention had positive effects on students' readiness for interprofessional learning. Additional research is warranted to support health science pedagogy. [J Nurs Educ. 2024;63(5):304-311.].

A feasibility study assessing a program of care for chiropractors managing spinal pain in Canadian Armed Forces personnel

LAY SUMMARY Spinal pain is responsible for a large proportion of pain and disability in the Canadian Armed Forces (CAF). The authors developed and implemented a program of care (PoC) that included communication strategies and care pathways supporting chiropractic care for CAF personnel with spine-related problems. The authors tested the feasibility of implementing the PoC on two select CAF bases and found that it was feasible to implement, with a high rate of completion of patient outcomes, adherence to clinical pathways, and enhanced interprofessional communication and reporting. Participants reported satisfaction with the program. Successful implementation of a PoC could provide guidance and support for interprofessional collaborative care for CAF personnel with spine-related pain.

Impact of Initiating a GLP1 Agonist and/or SGLT2 Inhibitor Therapy on De-Escalation and Discontinuation of Insulin and Diabetes Control When Managed by an Interprofessional Collaborative Team.

An FQHC in Denver, Colorado developed and implemented an interprofessional care model to collaboratively manage type 2 diabetes mellitus (T2DM). Utilizing the 340B program, the team protocolized ADA Guidelines to promote the early adoption of first-line medications, glucagon-like peptide1 receptor agonists (GLP1 RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) to improve patient outcomes. To assess the impact of interprofessional collaborative management versus standard care on early initiation of a SGLT2i and/or GLP1 RA as first-line therapies to enhance (1) deprescribing of insulin, (2) reducing overbasalization of insulin through insulin de-escalation, and (3) effectively lowering A1C levels in adult primary care patients with T2DM. This was a retrospective chart review of adult patients with T2DM who were initiated on a GLP1 RA and/or a SGLT2i. To determine the effects of initiating GLP1 RA and/or SGLT2i therapy on insulin usage and glycemic control, the total daily dose (TDD) of insulin before initiation was compared with the most recent TDD post-initiation to evaluate deprescribing. To determine the impact on overbasalization, pre-initiation and post-initiation insulin doses were evaluated. The effectiveness of GLP1 RA and/or SGLT2i in lowering A1C levels was determined by comparing the A1C prior to initiation with the A1C postinitiation. To evaluate the influence of interprofessional collaborative care on insulin deprescribing, overbasalization, and diabetes control, relevant measures were compared between patients receiving collaborative care versus standard care. Of the 60 total patients treated with insulin, 46.6% were deprescribed insulin, with a majority in the interprofessional collaborative group (93.1%) compared to standard care (6.9%). A total of 78.3% of patients benefited from a reduction in A1C following the initiation of a GLP1 RA and/or SGLT2i. The greatest A1C reduction was -2.9% in the group receiving metformin in addition to a GLP1 RA and a SGLT2i. Patients who received interprofessional collaborative care had an average A1c reduction of -2.9% compared to-1.1% with standard care. Most patients initially overbasalized on insulin experienced a reduction in overbasalization after initiating GLP1 RA and/or SGLT2i. There was a notable A1C reduction, de-escalation, and deprescribing of insulin in patients receiving interprofessional collaborative care.

Assessing the Scalability of a Community-Based Self-Management Intervention for Older Adults with Diabetes and other Chronic Conditions – The Aging, Community and Health Research Unit Community Partnership Program (ACHRU-CPP)

Background: A multi-pronged approach was undertaken to assess the scalability of the Aging, Community and Health Research Unit – Community Partnership Program (ACHRU-CPP), a complex, integrated 6-month self-management program for community-living older adults with diabetes and multimorbidity and their caregivers, in two Canadian provinces. The ACHRU-CPP was co-designed by patients, caregivers, home and community-care providers, and researchers, in response to a gap identified by older adults in the self-management of their diabetes and other conditions. The intervention was tested in a feasibility study and an earlier pragmatic trial found that older adults who received the ACHRU-CPP experienced greater improvements in quality of life and self-management, and greater reduction in depressive symptoms, compared to those who received usual diabetes care, at no additional cost to society. Delivered by a collaborative team of primary care providers (registered nurses, registered dietitians) and a community program coordinator, key components include home visits, group wellness sessions, team-based case conferences, caregiver support, interprofessional collaboration, and nurse-led care coordination. Scalability assessment is an integral phase of the current research program, which evaluated the effectiveness and implementation of the ACHRU-CPP in four settings in Ontario (ON) and Prince Edward Island (PEI).
 Methods: Multiple methods were used to assess scalability of the ACHRU-CPP in ON and PEI: an environmental scan, individual key informant interviews, and qualitative and quantitative data from both the foundational studies and the current trial of ACHRU-CPP implementation and effectiveness. The Intervention Scalability Assessment Tool (ISAT) guided data collection and analysis. The environmental scan was conducted with strategic input from Scalability Working Groups in ON and PEI. These groups were comprised of members of the program’s governance structure, including patient and public research partners, researchers, primary care and community service providers and administrators, and policy- and decision-makers. These partners advised on relevant research and policy documents, identified potential key informants (i.e., policy- and decision-makers at the local, provincial, and national levels), and will participate in scalability assessment workshops in ON and PEI in late 2022, to finalize the scalability assessment, and identify components of the intervention to be strengthened, and barriers to be addressed to enhance the scalability of the program, in each province.
 
 Results: To date, the results of the scalability assessment have identified areas of strength and limitations within the program, most notably issues with health human resources, mixed results regarding the effectiveness of the program, and other resource gaps.
 Conclusion: This study has evaluated the scalability of a community-based program for older adults with diabetes and multiple chronic conditions that integrates primary and community care. It also provides valuable insight on the usefulness and feasibility of the ISAT for assessing scalability, as well as strategies to engage strategic practice, policy, and public partners in the process. 
 Next steps: While scale-up of the ACHRU-CPP may be merited due to the prevalence of diabetes and multimorbidity among older adults, and alignment of this program with health policy, several barriers need to be addressed before scale-up can be recommended.

A grounded theory research protocol on an attempt to practice interprofessional collaborative care by a primary care clinic health professional fresh graduate in diabetes care.

Interprofessional collaborative care (IPCC) can improve the quality of care in patients with chronic diseases in primary care settings. In Malaysia, many medical and healthcare universities have adopted the concept of the interprofessional collaborative practice (IPCP) framework by the World Health Organization (WHO) and implemented interprofessional learning (IPL) in their curriculum to prepare fresh graduates for interprofessional collaboration (IPC) in the health workforce albeit in various degrees. However, there are potential challenges in putting what they have learned into practice, especially in managing chronic diseases due to the complexity of behavior changes required. Diabetes care is a classic example of such chronic disease management. This article presents a qualitative research protocol exploring the processes and challenges of fresh graduates attempting to practice IPC when managing diabetes mellitus (DM) in primary care clinics. A grounded theory (GT) approach will be adopted.

Interprofessional collaboration between prescribers, managers, nursing staff and on-site pharmacists within residential aged care facilities: a mixed-methods study.

A new on-site pharmacist (OSP) intervention within residential aged care facilities (RACFs) is being investigated to help improve medication management. Interprofessional collaboration amongst prescribers, nursing staff and pharmacists is critical to improving RACF medication management. To explore the extent of interprofessional collaboration and the nature of the working relationships between OSPs and prescribers, managers and nursing staff. A mixed-methods study was undertaken within the context of a 12-month cluster randomised controlled trial. Semi-structured interviews were conducted with data analysed using framework analysis, and a survey based upon the Physician-Pharmacist Collaboration Index (PPCI) was distributed at two time points (T1 at 3months and T2 at 9months after OSP commencement) across seven intervention RACFs. The qualitative data (n =33 interviews) findings related to the processes supportive of these relationships e.g. on-site proximity, OSP personality and perceived (or beneficial) benefits of OSPs working with health care team members (such as OSPs being trusted and providing reassurance to RACF health care team members). The PPCI survey mean scores at T1 (n =33) and T2 (n =19) suggested that OSPs were able to establish positive working relationships at 3months and that positive relationships also existed at 9months. The integrated findings suggested that the working relationships between OSPs and health care team members were generally positive. This study is the first to explore interprofessional collaboration between OSPs and health-care team members in RACFs. The findings suggest that OSPs can positively contribute to interprofessional collaborative care within RACFs.

Healthcare professionals and pregnant and post-natal women's perceptions of interprofessional collaboration in a maternity care facility: A qualitative study from Botswana

ObjectiveTo explore the perceptions of healthcare professionals and pregnant and post-natal women regarding interprofessional collaboration in a maternity care setting in Botswana, a low-to-middle-income country in Sub-Sahara Africa. DesignA descriptive qualitative design using in-depth interviews with forty participants, including healthcare professionals and women in maternity wards. Data were transcribed and thematically analysed. SettingAntenatal, delivery and post-natal maternity wards in a referral hospital that provides basic and specialist care in Botswana. ParticipantsWe interviewed 13 pregnant and post-natal women and 27 healthcare professionals in the maternity care wards. FindingsParticipants perceived several interrelated factors that influenced the delivery of interprofessional collaborative care. Interpersonal factors such as poor communication, disrespectful behaviours and inadequate teamwork practices prevented interprofessional collaboration. Other barriers to collaboration included lack of understanding of each other's roles and responsibilities, ineffective coordination of resources, hierarchical power struggles and poor collaborative leadership. Key conclusionsEffective interprofessional collaboration remains elusive in this maternity care setting. Healthcare systems in low-to-middle-income countries may benefit from interventions for healthcare professionals to learn and practice interprofessional collaborative care.

What do you mean, ‘negotiating?’: Patient, physician, and healthcare professional experiences of navigating hierarchy in networks of interprofessional care

ABSTRACT Interprofessional collaborative practice is a phenomenon that can be fraught with power dynamics between professions, within professions, and between professionals and patients. In the literature, the dominant notion is that conflicting viewpoints and interests arising from unequal power dynamics can be resolved through negotiation. This study examined COPD patients, health professionals, and physician experiences of negotiation within 10 interprofessional collaborative COPD care teams. Physicians, patients, and healthcare professionals each had strikingly different conceptions and experiences of negotiating their perspective with other team members. Our study suggests that negotiation is an idealized notion rather than a relational process embedded in interprofessional collaborative practice. Importantly, we found that the ability and opportunity to negotiate one’s perspective is heavily influenced by one’s position in the workplace division of labor and professional hierarchy. We conclude that “negotiation” is only one approach among many in navigating interprofessional relations. Further, the rhetorical and ideological appeal of “negotiation” may overstate its role in interactions in interprofessional care settings, and lead to a misunderstanding of the power dynamics at play. It may be naïve to assume team members can control their situation through the competitive assertion of their individual perspective in a rational debate. Unfortunately, adopting the language of negotiation uncritically may not offer relevant solutions to structural and collective problems within a healthcare workplace.

Mapping the evidence on clinical activities and outcome measures of pharmacist‐involved collaborative care models in managing diabetes: A scoping review

AbstractObjectiveThis scoping review aimed to map the extent and range of evidence on the clinical activities performed and types of outcomes evaluated in pharmacist‐involved collaborative care models for diabetes management.MethodsThis scoping review was guided by the five‐stage methodological framework developed by Arksey and O'Malley. Publications in the English language were identified from PubMed, EMBASE, and CINAHL and the databases were searched from inception to 31 May 2022. Abstracts, conference proceedings, brief reports, and commentaries were excluded. Key search terms were “interprofessional collaborative care,” “pharmacist,” “type 2 diabetes,” and “outcome.” Microsoft Excel was used for data charting and descriptive computations were conducted using the Statistical Package for Social Sciences.ResultsA total of 208 articles were identified, and after excluding 178 articles (and duplicates), 30 articles were reviewed. Most of the studies (56.7%) were conducted in the United States of America and were randomized controlled trials (50.0%) followed by cohort studies (36.7%). The most common clinical activity identified was provision of health‐ and medication‐related education (80.0%), followed by lifestyle counseling (76.7%) and development of individualized care plan and goal setting (63.3%). Other clinical activities were review of laboratory records, medication review and dose adjustments, optimization of medication adherence, minimization of drug‐related problems, identify referral to other care providers, and conduct physical assessments. HbA1c was the most reported clinical outcome (n = 26, 86.7%), with 11 studies evaluating patient‐reported outcomes (PROs) such as medication adherence, diabetes knowledge, self‐care, quality of life, diabetes distress, and treatment satisfaction.ConclusionClinical activities performed by pharmacists were heterogenous across studies and based on patients' needs. While pharmacist‐involved collaborative care models were posited as person‐centric outcome, PROs were lacking in most studies. Evaluating PROs are essential in guiding the implementation of such people‐centric care models.

Abstract P1-08-08: Approach to Prevention and Management of Chemotherapy Toxicities in a Interprofessional Education Program

Abstract Background: Interprofessional collaboration and team-based care in oncology has become increasingly important given the complexity of new therapies and their associated side effect profiles. It has been demonstrated that clear and thorough communication improves patient satisfaction and patient adherence. Previously, students described a deficit of adequate oncology education in their curriculum. Incorporating learners from different educational disciplines to care for oncology patients in a breast clinic is an innovative idea that has not been previously published. Objectives: This study will evaluate patient satisfaction and learners’ competencies and confidence after an interprofessional education collaboration aimed at enhancing chemotherapy education and toxicity management. Methods: A single center study was conducted at the University of Maryland Greenebaum Comprehensive Cancer Center (UMGCCC) from August 2020 through April 2021. Patient population was adults receiving chemotherapy for breast cancer. Learner population was medical and pharmacy students and residents. Learners received a brief educational orientation and then completed education and assessment sessions with patients. Sessions were prior to first chemotherapy, 2-4 days after chemotherapy, and then 1-3 days prior to next cycle of chemotherapy. Surveys of satisfaction and competencies were prospective but chart review for symptoms and interventions were retrospective. Results: 20 learners and 9 patients participated in the experience. Median of 4 encounters per patient were completed. 79 chemotherapy issues/toxicities were identified with 11 (14%) interfering in daily activities. 47 interventions were made and improvement was seen in 44 (56%) problems. Patient survey revealed that all 9 patients (100%) reported they were completely satisfied with education aimed at understanding side effects. One patient reported they were somewhat satisfied with understanding how to use their medication correctly and safely while the other 8 reported very satisfied (89%). Learners self-assessment tool revealed improvement in confidence in teach back (p=0.002) and interprofessional education competencies (p=0.01). Discussion: Incorporating medical and pharmacy learners in interprofessional care can help patients understand their treatment and help in management of toxicity. Limitations of the experience included faculty’s involvement in the discussions and interventions may overestimate the contribution of learners. In addition, the retrospective nature of the chart review may underestimate the symptoms for patients and overestimate the proportion of problems that were improved. Citation Format: Alison Duffy, Drashti Vasaiwala, Ciera Bernhardi, Justin Lawson, Paula Rosenblatt. Approach to Prevention and Management of Chemotherapy Toxicities in a Interprofessional Education Program [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-08-08.

Evaluation of an implementation package to deliver the COPD CARE service

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide and is estimated to be the leading cause of death in the next 15 years. Patients with...

Clinical pharmacy practitioners’ semi-visible labor: building referral relationships in interprofessional collaborative care

ABSTRACT Clinical pharmacy practitioners (CPP) in the Veterans Health Administration (VHA) prescribe medications and help manage chronic conditions such as diabetes, and they are increasingly working as part of interprofessional clinical teams. The challenges of integrating a new role in a clinical team are documented, but we know less about strategies new healthcare providers use to overcome these challenges. We studied how clinical pharmacy practitioners integrated into clinical teams. We conducted telephone interviews with clinical pharmacy practitioners (n = 53) and members of their clinical teams (n = 74), which were recorded, transcribed, and coded for concepts and themes. We identified four major themes. We found CPP perceived VHA as a “safe haven” for interprofessional care but found it necessary to build other prescribers’ trust and confidence in their clinical skills to establish the referral relationships they needed for full integration. To facilitate their integration, CPP engaged in relational, untracked labor, which we characterize as semi-visible labor. While both CPP and clinical team members perceived CPPs’ semi-visible labor as vital for implementing and maintaining strong interprofessional collaborations, such labor may be unsustainable as a long-term strategy for integrating CPP in clinical teams.

The Role Of Supportive Care To Overcome Depression and Improve Quality Of Life In Patients With Lung Cancer In Pulmonary Hospital

Supportive care is an interprofessional collaborative care approach between health personnel, modified through affirmative therapy, psychotherapy, and zoning, to optimize health services for information needs, emotional, spiritual, social or physical during diagnostic treatment or follow-up phase for patients with lung cancer. However, so far, hospital health personnel rarely use supportive care methods. Therefore, the aim of this study was to analyze the impact of implementing supportive care on depression and quality of life in lung cancer patients. The method used is a quasi-experimental design or pre-experimental design with a post-test approach of control group design. The sample size employed in this study was 44 respondents. The results showed that supportive care had a significant effect on depression and quality of life of lung cancer inpatients. A further recommendation from this study is that hospitals are expected to apply supportive care methods and carry out further research to develop innovative models of supportive care

Perceptions of Healthcare Providers about Pharmacists' Clinical Roles in Patient Care in Ghana.

Background: Clinical pharmacy practice is distinguishable from the dispensing model by its focus on direct patient care. To function effectively in this role, pharmacists need to have clinical competencies, hence the establishment of the Doctor of Pharmacy (PharmD) program. In Ghana, the PharmD program is in its early stages; graduating its first set of pharmacists in 2018. There is therefore need to understand how these recent PharmD graduates are engaging in clinical roles and the perceptions of other health professionals they need to work collaboratively with. Methods: Four different focus group discussions (FGDs) were conducted with physicians, nurses and pharmacists in separate sessions. Questions explored perceptions of the clinical roles of pharmacists. The FGDs were audio-recorded and transcribed verbatim. A thematic analysis of the transcripts was conducted. Results: Perceptions around the roles of clinical pharmacists were in two categories - (1.) Roles associated with the provision of direct patient care [(i.) assurance of appropriateness, and (ii.) optimization of pharmacotherapy; and (2.) Roles involving participation in inter-professional collaborative care with other healthcare professionals through their (i.) contribution of pharmacotherapy expertise, and (ii.) input in interprofessional education and practice. Conclusion: Findings from the study highlight perceived contributions of pharmacists, and potential for more relevance to clinical care, while also drawing attention to the emergence of clinical roles of pharmacists in healthcare systems in a global context. There is continuing need for advocacy for the pharmacy profession and policy changes in healthcare delivery models to maximize potential benefits of clinical pharmacists to health outcomes.

Online simulation-based education in graduate education: Initial implementation and content revision description.

Treating those with mental illness frequently requires collaboration among health care providers from different disciplines as well as easy access to care. Neither interprofessional collaboration (IPC) nor accessible care can be assumed to automatically occur or be available in the busy health care environment. Early and deliberate exposure of graduate students in health care disciplines to interprofessional educational activities is imperative to strengthen IPC. Empirical evidence supports the linkage between interprofessional education (IPE) early-on in training and IPC. Additionally, early and focused training of graduate students in health care disciplines to telebehavioral health (TBH) can help promote care access. The current literature supports TBH as an effective treatment approach that enhances access to care. Thus, the creation of educational activities for graduate students in health care disciplines that use early exposure and training in both: IPE and TBH approaches to enhance IPC can position future providers to provide quality patient care, especially given the COVID-19 pandemic implications on health care and education. This article describes the authors' experience in implementing and evaluating an interprofessional, simulation-based educational activity in psychopharmacology using a TBH approach in graduate nursing and psychology students. This quality improvement process used the plan-do-study-act cycle of continuous quality improvement to establish the initial implementation and the 11 steps of the International Nursing Association for Clinical Simulation and Learning standards of best practice to then refine this educational activity. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Exploring nurses' role in guiding residents' workplace learning: A mixed-method study.

Understanding residents' workplace learning could be optimized by not only considering attending physicians' role but also the role of nurses. While previous studies described nurses' role during discrete activities (e.g. feedback), a more profound understanding of how nurses contribute to residents' learning remains warranted. Therefore, we used the educational concept of guidance and explored the extent to which residents' and nurses' perceptions align regarding nurses' guiding role and which reasons they provide for their perceptions. This mixed-method study was conducted at four Dutch university medical centres in 2021. We simultaneously collected quantitative and qualitative data from 103 residents and 401 nurses through a theory-informed questionnaire with a Likert-scale and open-ended questions. We analyzed quantitative data to explore respondents' perceptions of nurses' guiding role by using anova. The thematically analyzed qualitative open comments explored respondents' reasons for their perceptions. Nurses indicated to provide significantly more support (p = .01) and guidance on learning from patient care (p < .01) than perceived by residents. Moreover, nurses indicated that attending physicians did not always involve them in guiding residents, whereas residents perceived nurses were being involved (p < .001). Themes suggest that nurses and residents could be divided into two groups: (i) respondents who felt that guiding was inextricably linked to good interprofessional collaboration and patient care and (ii) respondents who saw the guiding role as limited and emphasised the distinct fields of expertise between nurses and physicians. Residents and nurses felt that nurses played an important role in guiding residents' workplace learning. However, some residents did not always perceive to be guided. To further capitalise on nurses' guiding role, we suggest that residents can be encouraged to engage in the learning opportunities nurses provide to achieve optimal team-based patient care.

Interprofessional Collaboration Competencies of Nursing Students, Nurse Practitioner Students, and Paramedics in a Simulated Palliative Home Care Setting: A Pilot Study

Background: Post-secondary institutions do not adequately prepare future professionals to provide quality palliative care. Furthermore, the competencies necessary for interprofessional collaborative practice in home-based palliative care are poorly described in the scientific literature. A palliative care simulation involving standardized patients and paramedics would be a strategy to educate nursing students and nurse practitioner students who have little opportunity to experience interprofessional collaborative palliative care in the home.

Interprofessional Collaborative Practice Improves Access to Care and Healthcare Quality to Advance Health Equity.

Healthcare disparites exist in cardiovascular care, including heart failure. Care that is not equitable can lead to higher incidence of heart failure, increased readmissions, and poorer outcomes. The Heart Failure Transitional Care Services for Adults Clinic is an interprofessional collaborative practice that provides guideline-directed medical therapy and education to underserved patients with heart failure. Little is known regarding healthcare equity and quality metrics in relation to interprofessional teams. Thus, the purpose of this study was to examine if an interprofessional collaborative practice care delivery model can affect access to care and healthcare quality outcomes in underserved patients with heart failure. As evidenced by control charts over a two and a half year period, the Heart Failure Transitional Care Services for Adults Clinic was able to show improvements in access to care and quality metrics results without variation. An interprofessional collaborative practice can be an effective delivery model to address health equity and quality of care outcomes.

Healing trauma with interprofessional collaboration and trauma-informed perinatal care: A qualitative case study.

The interprofessional education collaborative (IPEC) core competencies (CCs) describe standards for effective interprofessional health care practice and education; these standards are updated periodically based on stakeholder feedback. The purpose of this project was to use a qualitative case study approach to describe one multiparous birth trauma survivor's fifth birth experience with an interprofessional birth care team (IBCT) and to juxtapose her experiences and perspectives with the IPEC core competencies (IPEC CCs). This approach enabled us to identify strengths and gaps in the standards for interprofessional health care education and practice specific to perinatal care. One in-depth, open-ended, semi-structured interview was conducted to elicit the participant's fifth birth experience. Information from her previous births and the IPEC CCs was used to design the interview guide, and we used independent, deductive, consensus coding to identify themes from verbatim transcripts. Three themes were identified: (a) Establishing a therapeutic patient-provider relationship; (b) Prioritizing communication, respect, and knowledge in person-centered care; and (c) Shared decision-making as the crux of collaborative care. The participant's narrative elevated person-centered, trauma-informed care (TIC) principles as critical to effective interprofessional birth care and as essential threads for the IPEC CCs. One survivor's positive experience after prior birth trauma illustrates the critical role IPEC CCs may play in collaborative perinatal care provided by IBCTs. In our analysis, we also identify the need to explicitly incorporate TIC principles and person-centered language in health care competencies that support the standards for perinatal health care education and practice.