Interprofessional Health Care Research Articles

Digital Health Technologies Enabling Partnerships in Chronic Care Management: Scoping Review

BackgroundAn increasing number of patients expect and want to play a greater role in their treatment and care decisions. This emphasizes the need to adopt collaborative health care practices, which implies collaboration among interprofessional health care teams and patients, their families, caregivers, and communities. In recent years, digital health technologies that support self-care and collaboration between the community and health care providers (ie, participatory health technologies) have received increasing attention. However, knowledge regarding the features of such technologies that support effective patient-professional partnerships is still limited.ObjectiveThis study aimed to map and assess published studies on participatory health technologies intended to support partnerships among patients, caregivers, and health care professionals in chronic care, focusing specifically on identifying the main features of these technologies.MethodsA scoping review covering scientific publications in English between January 2008 and December 2020 was performed. We searched PubMed and Web of Science databases. Peer-reviewed qualitative, quantitative, and mixed methods studies that evaluated digital health technologies for patient-professional partnerships in chronic care settings were included. The data were charted and analyzed thematically. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist was used.ResultsThis review included 32 studies, reported in 34 papers. The topic of participatory health technologies experienced a slightly increasing trend across publication years, with most papers originating from the United States and Norway. Diabetes and cardiovascular diseases were the most common conditions addressed. Of the 32 studies, 12 (38%) evaluated the influence of participatory health technologies on partnerships, mostly with positive outcomes, although we also identified how partnership relationships and the nature of collaborative work could be challenged when the roles and expectations between users were unclear. Six common features of participatory health technologies were identified: patient-professional communication, self-monitoring, tailored self-care support, self-care education, care planning, and community forums for peer-to-peer interactions.ConclusionsOur findings emphasize the importance of clarifying mutual expectations and carefully considering the implications that the introduction of participatory health technologies may have on the work of patients and health care professionals, both individually and in collaboration. A knowledge gap remains regarding the use of participatory health technologies to effectively support patient-professional partnerships in chronic care management.

Transforming Knowing in Practice Across Boundaries in Interprofessional Teams

Interprofessional teams merit the hope of bridging fragmented knowing in practice to solve highly complex problems. However, hierarchies, jurisdictional claims, and contradictory approaches between disparate professionals tend to give rise to conflicts and competitive boundary work. This is particularly the case in healthcare. This paper sheds light on how to unlock the potential of transforming knowing in practice in interprofessional teams. Our ethnographic study trailed eight interprofessional healthcare teams, who were tasked with resolving complex chronic cases in children. The paper contributes to the literature by offering a dynamic model that illuminates the progressive stages of knowledge transformation.

Nutrition-related care needs of older patients in hospital: A qualitative multimethod study.

To investigate the nutrition-related care needs of older patients in hospitals. A qualitative multimethod study was performed. By purposive sampling, older patients were included for observations of the nutrition process and interviews from a perioperative unit, an internal Medicine unit, and one acute geriatric care ward of an acute care hospital. Preliminary findings were discussed, validated, and further explored in two focus group discussions with interprofessional nutritional healthcare experts. Seventeen women and five men with a mean age of 86 years participated in patient observations and interviews. Eight experts with at least 10 years of professional experience who were employed in this setting for 3 years or more participated in interviews. Three themes of nutrition-related care needs were elaborated: The need to assess and address older patients' attitudes toward life, the need for nutrition-related education, and the need for food intake support. These care needs added to the development and validation of a new nursing diagnosis "risk for inadequate protein energy nutrition" and in consequence to develop a complex nursing intervention to optimize the nutrition of older patients. It is crucial to assess and understand the patients' attitudes toward life, which affect purposes of treatment, diet, and menu choices. Implementation of assessing nutrition-related care needs of older inpatients is needed. Addressing these care needs within the Advanced Nursing Process can lead to appropriate nursing diagnoses, nursing outcomes, and interventions, which enhance person-centered care, patients' self-care abilities, and consequently patients' nutritional status.

A Guide to a Pharmacist-Led Pharmacogenetic Testing and Counselling Service in an Interprofessional Healthcare Setting.

Genetic predisposition is one factor influencing interindividual drug response. Pharmacogenetic information can be used to guide the selection and dosing of certain drugs. However, the implementation of pharmacogenetics (PGx) in clinical practice remains challenging. Defining a formal structure, as well as concrete procedures and clearly defined responsibilities, may facilitate and increase the use of PGx in clinical practice. Over 140 patient cases from an observational study in Switzerland formed the basis for the design and refinement of a pharmacist-led pharmacogenetics testing and counselling service (PGx service) in an interprofessional setting. Herein, we defined a six-step approach, including: (1) patient referral; (2) pre-test-counselling; (3) PGx testing; (4) medication review; (5) counselling; (6) follow-up. The six-step approach supports the importance of an interprofessional collaboration and the role of pharmacists in PGx testing and counselling across healthcare settings.

A journey through interprofessional education: Students’ perspectives of teamwork in a transforming curriculum

Background. Student engagement in curricular transformation is topical at the University of Cape Town (UCT), including in its Faculty of Health Sciences (FHS). Teamwork, which is essential to contemporary interprofessional healthcare, is an objective of transformative health sciences education. This study offers a contemporary contribution from the perspective of students to earlier work on shared learning at UCT FHS. 
 Objectives. There is a paucity of research literature on this study’s target population. Therefore, a qualitative design was used to explore first-year health sciences students’ perceptions and experiences of teamwork within an undergraduate shared learning programme. 
 Methods. The primary data collection method was focus group discussion. Two additional qualitative methods, free-listing and pile-sorting, were used to expand upon data collected in the focus groups. Results were analysed thematically. 
 Results. The study sample (N=32) included first-year audiology, medical, occupational therapy, physiotherapy, and speech and language pathology students. The findings revealed that although their experiences of teamwork varied, students had a comprehensive perception of what teamwork entailed in their educational context. Therefore, the findings were used to generate a heuristic for teamwork learning for undergraduate health sciences students. 
 Conclusion. The study positions students to contribute tangibly to the curricular transformation process at their university. Students’ perspectives of teamwork may be useful in the future design and delivery of entry-level interprofessional courses aiming to instil teamwork skills.

Collaborative clinical reasoning learning using an integrated care pathway in undergraduate interprofessional education: An explorative study

ABSTRACT Collaborative clinical reasoning (CCR) is part of interprofessional collaborative practice and aims to negotiate and manage patient problems. An integrated care pathway (ICP) can be used as a framework for developing comprehensive patient care, typically in a clinical setting. This study aims to explore the CCR process in undergraduate interprofessional teams and the use of ICP as guidance in discussing a patient’s problem and its comprehensive management. This is a qualitative study following phenomenology and was performed in an interprofessional education (IPE) program held by Health Science Cluster Universitas Indonesia. A total of four observations involving 40 students and four focus-group discussions involving 18 students from different health professions backgrounds were conducted to explore the CCR process using the ICP framework. In-depth interviews with four tutors from different health professions backgrounds and document analysis were also conducted as triangulation processes. This study shows that CCR was held in two stages – individual and group. The ICP framework could be used as a guiding tool in the CCR process to discuss the patient’s management and discharge plan. This study also demonstrates that there are several challenges in this learning process, including the clinical case used in the discussion, the need for prior knowledge and previous exposure to IPE and the ICP framework, and health professions’ dominance during the discussion. This study provides evidence on learning of CCR using the ICP framework as a guiding tool in a pre-licensure IPE program. This approach is useful for preparing students to develop an interprofessional, comprehensive, and holistic health care plan and to help them understand the roles of each profession.

Interprofessional Health Care Education on Substance Use Disorders: Understanding Student Attitudes Toward & Perceptions of Practice

Abstract Date Presented 04/02/2022 Health care students of today are the providers of the future. An interprofessional substance use disorder awareness program offers an opportunity for students to increase their knowledge and empowers them to work with individuals who have substance use disorder without bias or preconceived perceptions. OT practitioners need to ensure students have the knowledge and disposition to treat all patients equally, regardless of their diagnosis or disability. Primary Author and Speaker: Gabriella Santacecilia Additional Authors and Speakers: Rebecca Lacroix, Amy Mattila

Improving the Health of Rural Communities Through Academic-Community Partnerships and Interprofessional Health Care and Training Models.

Health disparities between rural and urban areas are widening at a time when urban health care systems are increasingly buying rural hospitals to gain market share. New payment models, shifting from fee-for-service to value-based care, are gaining traction, creating incentives for health care systems to manage the social risk factors that increase health care utilization and costs. Health system consolidation and value-based care are increasingly linking the success of urban health care systems to rural communities. Yet, despite the natural ecosystem rural communities provide for interprofessional learning and collaborative practice, many academic health centers (AHCs) have not invested in building team-based models of practice in rural areas. With responsibility for training the future health workforce and major investments in research infrastructure and educational capacity, AHCs are uniquely positioned to develop interprofessional practice and training opportunities in rural areas and evaluate the cost savings and quality outcomes associated with team-based care models. To accomplish this work, AHCs will need to develop academic-community partnerships that include networks of providers and practices, non-AHC educational organizations, and community-based agencies. In this commentary, the authors highlight 3 examples of academic-community partnerships that developed and implemented interprofessional practice and education models and were designed around specific patient populations with measurable outcomes: North Carolina's Asheville Project, the Boise Interprofessional Academic Patient Aligned Care model, and the Interprofessional Care Access Network framework. These innovative models demonstrate the importance of academic-community partnerships to build teams that address social needs, improve health outcomes, and lower costs. They also highlight the need for more rigorous reporting on the components of the academic-community partnerships involved, the different types of health workers deployed, and the design of the interprofessional training and practice models implemented.

Interprofessional continuing professional development programs can foster lifelong learning in healthcare professionals: experiences from the Project ECHO model

BackgroundThe success of continuing professional development (CPD) programs that foster skills in lifelong learning (LLL) has been well established. However, healthcare professionals often report barriers such as access to CPD and cost which limit uptake. Further research is required to assess how accessible CPD programs, such as those delivered virtually, impact orientation to LLL. Project Extension for Community Healthcare Outcomes (Project ECHO®) is a CPD model that has a growing body of evidence demonstrating improvements in knowledge and skills. Central to this model is the use of a virtual platform, varied teaching approaches, the promotion of multi-directional learning and provider support through a community of practice. This study aimed to explore whether participation in a provincial mental health ECHO program had an effect on interprofessional healthcare providers’ orientation to LLL.MethodsUsing a pre-post design, orientation to LLL was measured using the Jefferson Scale of Lifelong Learning. Eligible participants were healthcare professionals enrolled in a cycle of ECHO Ontario Mental Health from 2017 to 2020. Participants were classified as ‘high’ or ‘low’ users using median session attendance as a cut-point.ResultsThe results demonstrate an increase in orientation to LLL following program participation (Pre: 44.64 ± 5.57 vs. Post: 45.94 ± 5.70, t (66) = − 3.023, p < .01, Cohen’s d = 0.37), with high ECHO users demonstrating greater orientation to LLL post-ECHO.ConclusionFindings are discussed in the context of self-determination theory and suggest there may be components of CPD programs that more readily support increased motivation for LLL for interprofessional healthcare professionals.

Advancing Health Equity Through Equity-Centered Leadership Development with Interprofessional Healthcare Teams

IntroductionEvents of spring 2020—the COVID19 pandemic and re-birth of a social justice movement—have thrown disparities in disease risk, morbidity, and mortality in sharp relief. In response, healthcare organizations have shifted attentions and resources towards equity, diversity, and inclusion (EDI) issues and initiatives like never before. Focused, proven equity-centered skill and mindset development is needed for healthcare professionals to operationalize these pledges and stated aims.AimThis article highlights program evaluation results for this Clinical Scholars National Leadership Institute (CSNLI) specific to EDI. We will show that CSNLI imparts the valuable and essential skills to health professionals that are needed to realize health equity through organizational and system change.SettingInitial cohort of 29 participants in CSNLI, engaging in the program over 3 years through in-person and distance-based learning offerings and activities.Program DescriptionThe CSNLI is a 3-year, intensive leadership program that centers EDI skill development across personal, interpersonal, organizational, and systems domains through its design, competencies, and curriculum.Program EvaluationA robust evaluation following the Kirkpatrick Model offers analysis of four data collecting activities related to program participants’ EDI learning, behavioral change, and results.DiscussionOver the course of the program, participants made significant gains in competencies related to equity, diversity, and inclusion. Furthermore, participants demonstrated growth in behavior change and leadership activities in the areas of organizational and system change. Results demonstrate the need to center both leader and leadership development on equity, diversity, and inclusion curriculum to make real change in the US Healthcare System.

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.

Clinicians’ attitudes towards a co-leadership structure for maternity emergency teams: An interview study

ABSTRACT Shared leadership improves team performance in many domains and is present in some interprofessional healthcare teams. Despite the dominant paradigm of a singular obstetrician leader in maternity emergencies, co-leadership, a specific form of shared leadership, has been identified as a potentially beneficial to clinical care. This qualitative interview study addresses the gaps in knowledge regarding clinician attitudes toward co-leadership and how a co-leadership structure might be implemented within a maternity care setting. Twenty-five clinicians (midwives, obstetricians and anaesthetists) working in the birthing units of two tertiary maternity units were interviewed and a conventional content analysis conducted. Clinicians viewed co-leadership as potentially beneficial to patient care through improved leadership performance and co-leader back up behavior. Implementation of co-leadership was thought to require a supportive organizational culture, agreed patient management protocols and the participation in simulation training. Enacting co-leadership required adaptable leadership sharing practices, effective communication, and high levels of trust between the co-leaders. These findings inform the future implementation strategies for co-leadership in interprofessional healthcare teams.

Interprofessional Leadership Development: Role of Emotional Intelligence and Communication Skills Training.

IntroductionAmong the many skills required for leading interprofessional health care teams, emotional intelligence and communication skills are critical to building professionalism, establishing patient trust, and providing optimal patient care. Nonetheless, these skills are often overlooked in medical training. We implemented a 2.5-hour workshop for interprofessional trainees to self-assess, reflect, and apply their emotional intelligence and communication skills.MethodsParticipants were interprofessional trainees, including internal medicine residents, medical students, and graduate students in clinical pharmacy, physician assistant, and health psychology training programs. The workshop consisted of reflective activities to self-assess emotional intelligence and communication styles; a didactic presentation focused on leadership, emotional intelligence, and communication styles; and a teamwork activity to apply emotional intelligence and communication skills.ResultsForty-four trainees participated in this workshop. After the workshop, trainees reported increased knowledge about positive strategies to communicate with team members, felt more comfortable working with other professionals to encourage positive team dynamics, and were more prepared to encourage leadership in their interprofessional teams. Examination of learner evaluations suggested that residents endorsed higher mean ratings than the other learner groups in knowledge attainment (p = .02) and meeting all learners' needs (p = .01).DiscussionThis workshop enhanced our trainees' self-reported comfort, awareness, and preparedness regarding using emotional intelligence and communication strategies. An interprofessional approach can be beneficial for leadership training in the health professions.

The Struggle is Real: Understanding Helping Behaviours in Obstetrical Teams Using Interprofessional Simulation

Interprofessional (IP) healthcare team members frequently encounter challenges that require them to seek help; yet we understand little about how team members enact such helping behaviours. Given that IP simulation mimics the complexities health care teams experience in clinical practice whilst attending to educational goals, our study seeks to explore helping behaviours in IP teams in an obstetrical simulation context.

Identification of Latent Safety Threats in an Interprofessional Training Involving On-Site Simulation in a Birthing Unit in Response to the COVID-19 Pandemic

We aimed to detect different types of latent safety threats (LSTs) in the setting of suspected or positive COVID-19 pregnant patients in the Birthing Unit using a training program involving on-site simulations. We hypothesized that providing simulation-based training in the actual care areas would greatly help identify high risk events that could affect staff and patient safety. We conducted a prospective observational study between April 15 and May 06 2020 involving 65 interprofessional health care workers (eg. obstetricians, residents, nurses, midwives) over the course of 8 training sessions. Training scenarios involved presentation of suspected COVID-19 patient to the Birthing Unit, donning & doffing with observer and lastly, transportation of a suspected COVID-19 patient to the operating room for non-urgent cesarean section. LSTs were recorded by two facilitators and further subcategorized into themes; Gaps in Knowledge & Training, Maintenance & Equipment and System & Processes. Areas of improvement and proposed solutions were documented after each simulation and post-simulation surveys were sent to participants. The number of participants involved in on-site simulations was 65. Eighty-one LSTs were observed across all the 3 scenarios amongst any theme: scenario 1 (n = 42, 51.8%), scenario 2 (n = 14, 17.2%) and scenario 3 (n = 25, 30.9%). Amongst the different themes of LSTs, Gaps in Training & Knowledge comprised (n = 29, 35.8%), Maintenance & Equipment comprised (n = 46, 56.8%) and Systems & Processes comprised (n = 6, 7.4%) of total LSTs. There were 80 Areas of Improvement and Proposed Solutions drawn from these recorded LSTs. Fifty participants completed post-simulation surveys. Pre-simulation surveys revealed only 10% of participants felt very prepared to care for a suspected or positive COVID-19 patient in the birthing unit, while 92% responded in the same way post-simulation. Pregnant women with suspected or confirmed COVID-19 presenting to birthing units pose numerous infection control issues. Simulation-based exercises may greatly help units prepare by identifying LSTs. Post-simulation surveys further allowed us to see the benefits.

Partnership between patients and interprofessional healthcare providers along the multifaceted journey to medication adherence.

Partnership between patients and interprofessional healthcare providers along the multifaceted journey to medication adherence.

How Do Students Enact Group Reasoning Within Online Interprofessional Education?

Background: The capability of an interprofessional healthcare team to reach a shared understanding through group reasoning is critical to good healthcare delivery. Models for clinical reasoning have proved useful but remain focused on individual cognitive processes. Whilst interprofessional education has steadily gained real-world traction, it is unclear how interprofessional student groups practice group reasoning when performing online tasks. Method: We analyzed the group reasoning processes with two teams of health professional students in an online interprofessional education task (n = 13). Two simulated interprofessional team meetings about a palliative case were audio recorded, transcribed, and deductively analyzed to determine the mechanisms of team deliberation using a previously published study of group reasoning.Results: The reasoning mechanisms outlined in a previous study (informationaccumulating, sense-making, and decision-making) were evident in an analysis of student group reasoning. In particular, students focused on sharing and agreeing on information, and to a lesser extent, recording information. Conclusion: Attention to the mechanisms of action may be useful to facilitate teaching interprofessional reasoning. Group reasoning may benefit from focusing student attention on these stages: 1) prioritizing and sequencing of options, methods for exposing agreement about shared information, shared understanding of the situation, and options; 2) techniques for critically evaluating information so that opportunities arise to identify when information may disrupt existing understandings; and 3) development of documentation tools to assist recording of the process.

Establishment and evaluation of scalable COVID-19 vaccine clinics at a large university

BackgroundPrevious large-scale vaccination clinics have been successful before the coronavirus disease 2019 (COVID-19) pandemic; however, owing to the strict storage requirements and pharmaceutical preparation needed for the COVID-19 vaccines, careful thought and planning were necessary to successfully deploy these clinics immediately after vaccine availability. The focus of this manuscript is to describe the development and implementation of COVID-19 vaccination clinics in a large public university, using professionals from within and outside of its health sciences schools. ObjectivesThe primary objective of this project was to (1) implement COVID-19 vaccination clinics for university faculty, staff, students, and community members. Additional objectives of the clinics were to (2) actively incorporate pharmacy, nursing, and medical students into the clinic workflow; (3) promote interprofessional collaboration among faculty and students; and (4) assess patient satisfaction. Practice descriptionThe School of Pharmacy faculty, in conjunction with the Office of Strategic Initiatives, planned and coordinated COVID-19 vaccination clinics from December 2020 to July 2021. Students and faculty from schools of pharmacy, nursing, and medicine were used. COVID-19 vaccinations were offered to university faculty, staff, and students and community members based on the Centers for Disease Control and Prevention priority groups. The clinic processes were designed such that they could be scaled from 100 to 2,000 participants per day. Practice innovationThe School of Pharmacy led approach was adjustable depending on the number of patients, continuously monitored and adaptable. The importance of pharmacists as part of the interprofessional health care team was exemplified by faculty and students involved. Evaluation methodsAll patients receiving COVID-19 vaccinations at the clinics were e-mailed anonymous surveys for assessment of the quality of the vaccination encounter after completion of their primary vaccine series. ResultsMore than 15,000 COVID-19 vaccinations were provided through the clinics from December 2020 to July 2021. Professional staffing totaled 3352 hours for the 48 clinics. Thirty-eight percent of the vaccinated patients responded to the clinic satisfaction survey with predominately excellent ratings. ConclusionCOVID-19 vaccination clinics can be successfully planned and implemented in a scalable fashion in a large university setting using an interprofessional team approach.

Responding to vulnerable patients with multimorbidity: an interprofessional team approach

BackgroundPeople with multimorbidity, who may be more vulnerable to certain social determinants of health, often require care by an interprofessional primary healthcare (PHC) team that can tailor their approach to address the multiple and complex needs of this population. This paper describes how the needs of vulnerable patients experiencing multimorbidity are identified and provided care by innovative interprofessional PHC teams during an innovative one-hour consultation, outside of usual care.MethodsThis was a descriptive qualitative study. Forty-eight interviews were conducted with 20 allied healthcare professionals: (e.g., social work, pharmacy); 19 physicians (e.g., psychiatry, internal medicine, family medicine); and 9 decision makers. The thematic analysis was iterative using an individual and team approach to identify the main themes and exemplar quotations for illustration.ResultsParticipants described patients with multimorbidity who were vulnerable as those experiencing major challenges accessing and navigating the healthcare system. Mental health issues were a major contributor to being vulnerable and often linked to common social determinants of health. Cultural factors were identified as potentially causing patients to be vulnerable. Participants articulated how the collaborative nature of the team generated new ideas and facilitated creative recommendations designed to meet the specific needs of each patient.ConclusionsThis one-time consultation went beyond the assessment of a patient’s multimorbidity by including a psycho-social-contextual understanding of vulnerability within the healthcare system. Findings may have important clinical and policy implications in the adoption and implementation of this approach and further assist vulnerable patients with multimorbidity in having their complex needs addressed.

Making Family-Centered Care for Adults in the ICU a Reality.

Despite the value of family-centered care (FCC) in intensive care units (ICUs), this approach is rarely a reality in this context. This article aims to increase the likelihood that ICU-based care incorporates best practices for FCC. Consistent with this goal, this article begins by overviewing FCC and its merits and challenges in ICUs. It then offers a systemic framework for conceptualizing FCC in this challenging environment, as such a model can help guide the implementation of this invaluable approach. This systemic framework combined with previous guidelines for FCC in the ICU are used to inform the series of recommended best practices for FCC in the ICU that balance the needs and realities of patients, families, and the interprofessional healthcare team. These best practices reflect an integration of the existing literature and previously published guidelines as well as our experiences as healthcare providers, family members, and patients. We encourage healthcare leaders and interprofessional ICU healthcare teams to adopt these best practices and modify them for the specific healthcare needs of the patients they serve and their families.