Interprofessional Management Research Articles

Perceptions and attitudes of patients towards medication-related osteonecrosis of the jaw (MRONJ): a qualitative study in England

ObjectiveTo explore the impact of medication-related osteonecrosis of the jaw (MRONJ) on quality of life and to explore the attitudes and perceptions of patients towards the multidisciplinary approach to the...

Nursing Students' Knowledge of the Nurse's Role in the Management of Dysphagia.

The purpose of this study was to evaluate nursing students' knowledge of the nurse's role in the interprofessional management of dysphagia. A quasi-experimental, pretest-posttest educational intervention was used in this study. Thirty-eight pretest and 37 posttest undergraduate nursing students participated. An addendum to the original study assessed knowledge retention in a separate group of nursing students who had received a similar educational intervention 1.5 years prior. Statistically significant changes were found between pretests and posttests. The knowledge retention group performed more poorly in some areas, suggesting that initial instruction was not reinforced beyond the novice level. Educating nursing students about the nurse's role in the management of dysphagia will increase their knowledge, but this knowledge must be reinforced for integration into clinical practice. More research is needed to determine what education nursing students receive on dysphagia and what the role of the nurse is in the management of dysphagia. Dysphagia negatively impacts clinical and rehabilitation outcomes. Because nurses may lack sufficient training in the management of dysphagia, healthcare organizations should offer such training to new hires and then periodically thereafter. Likewise, practicing nurses who serve as preceptors should be prepared to train nursing students and new nurses how to safely manage dysphagia.

Dysphagia: Interprofessional Management, Impact, and Patient-Centered Care.

Dysphagia affects a multitude of people worldwide with tremendous impact on the affected individual, families, and caregivers. Understanding dysphagia, as well as the status of screening, evaluation, and treatment, aids in the knowledge required by a interprofessional team to holistically care for patients with dysphagia and their caregivers. The impact of dysphagia includes potential associated risk and a cascade of effects. Conversations regarding meeting nutrition and fluid needs with consideration for quality of life need to be integrated into the plan of care for individuals with dysphagia.

Interprofessional Management of Allergic Conjunctivitis

Ocular allergies affect a large and increasing number of people in North America. Canada’s statistics are likely to mirror those of the U.S., where up to 40% of the population is affected by ocular allergies. The symptoms and signs of ocular allergies can greatly affect productivity and have a dramatic effect on overall quality of life (QoL). Over the years, many effective treatments have been developed for the management of ocular allergies. For allergic conjunctivitis, topical ophthalmic agents include antihistamines, mast-cell stabilizers, dual-activity agents, steroids, nonsteroidal anti-inflammatory drugs, and other immune-modulating drugs. Oral antihistamines are commonly chosen by patients for all forms of allergy, including allergic conjunctivitis. This review provides a summary of the forms of ocular allergy, with a particular focus on the symptoms and signs, diagnosis, current treatment options, and impact on QoL. More importantly, through multidisciplinary collaboration, a simplified treatment algorithm is proposed for Canadian clinical practice. This algorithm provides practitioners the best possible management strategies based on an individual patient presentation, thereby maximizing treatment efficacy and minimizing the effects on tasks of daily living and QoL.

Interprofessional Assessment and Management 2019: Reporting Referring and Consulting Services

Codes for interprofessional telephone and Internet consultation are changed in Current Procedural Terminology (CPT®) 2019 to include communication via EHR but still include verbal and written reports from the consultant to the referring provider. Get all the details here.

The Global Spine Care Initiative: care pathway for people with spine-related concerns

PurposeThe purpose of this report is to describe the development of an evidence-based care pathway that can be implemented globally.MethodsThe Global Spine Care Initiative (GSCI) care pathway development team extracted interventions recommended for the management of spinal disorders from six GSCI articles that synthesized the available evidence from guidelines and relevant literature. Sixty-eight international and interprofessional clinicians and scientists with expertise in spine-related conditions were invited to participate. An iterative consensus process was used.ResultsAfter three rounds of review, 46 experts from 16 countries reached consensus for the care pathway that includes five decision steps: awareness, initial triage, provider assessment, interventions (e.g., non-invasive treatment; invasive treatment; psychological and social intervention; prevention and public health; specialty care and interprofessional management), and outcomes. The care pathway can be used to guide the management of patients with any spine-related concern (e.g., back and neck pain, deformity, spinal injury, neurological conditions, pathology, spinal diseases). The pathway is simple and can be incorporated into educational tools, decision-making trees, and electronic medical records.ConclusionA care pathway for the management of individuals presenting with spine-related concerns includes evidence-based recommendations to guide health care providers in the management of common spinal disorders. The proposed pathway is person-centered and evidence-based. The acceptability and utility of this care pathway will need to be evaluated in various communities, especially in low- and middle-income countries, with different cultural background and resources.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.

Why Seek a Doctorate-Prepared Nurse to Join Your Team?

Increasing numbers of doctoral-prepared nurses are joining interprofessional health care teams. Interestingly, the evolving doctoral programs for nurse leaders can be confusing to other health care professionals. Advanced education for nursing leaders is driven by a growing need for cost-effective implementation of evidence-based practices. Professional nursing organizations and nursing education programs have redefined education to respond to the call for knowledgeable experts to lead evidence-based quality improvements. As interprofessional health care management teams face the daunting task of selecting team members, an understanding of the differences in nursing doctoral programs is needed. A doctor of nursing practice degree-prepared nurse can strengthen the health care team by providing a skill set that includes not only the ability to translate evidence into best practice, but also the ability to communicate effectively with all members of the interprofessional team.

Case of an Obstetric Patient With Hemophagocytic Lymphohistiocytosis

Hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially fatal condition that is characterized by an overproduction of inflammatory cytokines by the immune system. Progressive illness, septic shock, and death can occur if the disease is not diagnosed and treatment initiated early. The authors describe the presentation, differential diagnosis, and evidence-based interprofessional management of HLH in a 1,200-bed Magnet®-designated institution.

Working towards developing an interprofessional pain management curricula for clinicians

Pain management receives minimal attention in the education of healthcare professionals. An environmental scan was conducted to assess the current pain management educational programs with a focus on interprofessionalism within a competency-based education framework in order to determine gaps before implementing the future master’s-level Interprofessional Pain Management degree program to be implemented at Western University. This paper outlines the methods used in the scan, keywords for the search, and key findings. The findings highlight several current interprofessional pain management programs, the need for a conceptual framework for interprofessional pain education, consistent core values/principles, and competency-based education embedded in interprofessional pain management and future directions.

Content validation of an interprofessional learning video peer assessment tool

BackgroundLarge scale models of interprofessional learning (IPL) where outcomes are assessed are rare within health professional curricula. To date, there is sparse research describing robust assessment strategies to support such activities. We describe the development of an IPL assessment task based on peer rating of a student generated video evidencing collaborative interprofessional practice. We provide content validation evidence of an assessment rubric in the context of large scale IPL.MethodsTwo established approaches to scale development in an educational setting were combined. A literature review was undertaken to develop a conceptual model of the relevant domains and issues pertaining to assessment of student generated videos within IPL. Starting with a prototype rubric developed from the literature, a series of staff and student workshops were undertaken to integrate expert opinion and user perspectives. Participants assessed five-minute videos produced in a prior pilot IPL activity. Outcomes from each workshop informed the next version of the rubric until agreement was reached on anchoring statements and criteria. At this point the rubric was declared fit to be used in the upcoming mandatory large scale IPL activity.ResultsThe assessment rubric consisted of four domains: patient issues, interprofessional negotiation; interprofessional management plan in action; and effective use of video medium to engage audience. The first three domains reflected topic content relevant to the underlying construct of interprofessional collaborative practice. The fourth domain was consistent with the broader video assessment literature calling for greater emphasis on creativity in education.ConclusionsWe have provided evidence for the content validity of a video-based peer assessment task portraying interprofessional collaborative practice in the context of large-scale IPL activities for healthcare professional students. Further research is needed to establish the reliability of such a scale.

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.

An informatics approach to inter-professional management of low back pain: a feasibility study using the Omaha System

BackgroundLow back pain (LBP) is a complex health care issue that often involves multiple providers across various care settings. Health information technology holds promise to improve care delivery by providing...

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.

School nurses’ perceptions and experiences with an interprofessional concussion management team in the secondary school setting

ABSTRACTFollowing a concussion, both cognitive and physical rest are imperative aspects of injury management. The inclusion of academic adjustments and the formation of an interprofessional concussion management team (ICMT) provide a mechanism to manage academic issues following a concussion. As one of the sole healthcare providers presents during school hours, the school nurse may offer unique insight regarding the infrastructure of an ICMT in the secondary school setting. The purpose of this study was to explore school nurses’ perceptions of and experiences with an ICMT for adolescents following a concussion in the secondary school setting. The consensual qualitative research approach was used to guide this study. Semi-structured individual telephone interviews were conducted with 15 school nurses employed in the secondary school setting across the United States. During data analysis, themes and categories were established based on a consensus process by the research team. Study findings indicated that school nurses identified several stakeholders regarding the concussion management team that are essential to include in the concussion management process. In addition to the school nurse, participants perceived an ICMT should include a physician, athletic trainer, school counsellor, teachers, and other stakeholders such as the patient and their parents. Additionally, participants discussed their perceptions of their own role as a member of an ICMT in the secondary school setting. The inclusion of an ICMT to aid the recovery following a concussion is vital to ensure proper care for the adolescent patient. Furthermore, the school nurse and athletic trainer must effectively collaborate, when possible, to ensure that concussed adolescents are allowed sufficient cognitive rest via the incorporation of academic adjustments during the recovery process.

Integrated care coordination by an interprofessional team reduces emergency department visits and hospitalisations at an academic health centre

ABSTRACTPeople with chronic behavioural and physical health conditions have higher healthcare costs and mortality rates than patients with chronic physical conditions alone. As a result, there has been promotion of integrated care for this group. It is important to train primary care residents to practice in integrated models of care with interprofessional teams and to evaluate the effectiveness of integrated care models to promote high-quality care for this at-risk group. We implemented an integrated, interprofessional care management programme for adults with chronic mental and physical health needs as part of a curriculum for family medicine and family medicine psychiatry residents. We then evaluated the clinical effectiveness of this programme by describing participants’ healthcare utilisation patterns pre- and post-enrolment. Patients enrolled in the programme were approximately 60–70% less likely to utilise the emergency room and 50% less likely to be admitted to the hospital after enrolment in the programme compared to before enrolment. The odds of individual attendance at outpatient primary care and mental health visits improved after enrolment. In the context of the implementation of integrated behavioural and physical healthcare in primary care, this interprofessional care management programme reduced emergency department utilisation and hospitalisations while improving utilisation of primary care and psychiatry outpatient care. Further studies should focus on replication of this model to further discern the model’s cost-savings and health promotion effects.

Formal interprofessional education needed to prepare professional case managers of the future

Abstract Demands for greater accountability and transparency in health care are increasing the visibility of professional case managers, including to fulfill the crucial care coordination role. While the competency of professional case managers can be assured through board certification, there is a growing need for preparation of case managers as they transition into the practice. This concern is also highlighted by recent research in the case management field, in which 89% of respondents said they use on-the-job training as their primary method to learn case management. Given the interdisciplinary nature of case management, there is a greater need to address how health and human services professionals are prepared for the advanced practice of case management. With few formal education programs in case management, greater dialogue and cooperation among interprofessional educators and case management leaders are needed to ensure a robust case management workforce development pipeline is established, with more professionals from multiple disciplines entering at earlier stages in their careers.

Importance of an Interprofessional Team Approach in Achieving Improved Management of the Dizzy Patient.

Because of its multifaceted nature, dizziness is difficult for clinicians to diagnose and manage independently. Current treatment trends suggest that patients are often referred to the otolaryngologist for intervention despite having a nonotologic disorder. Additionally, many individuals with atypical presentations are often misdiagnosed and spend a significant amount of time waiting for consultation by the otolaryngologist. Few studies have alluded that implementation of an interprofessional team approach in the diagnosis and management of the dizzy patient can improve clinical decision-making. However, to the authors' knowledge, there is no information specifically quantifying the outcomes and potential benefits of using an interprofessional balance care team approach. To compare dizziness diagnoses trends and referral practices with and without the use of an interprofessional management approach within a university healthcare system. Over the course of a 3-yr period, a retrospective review of the diagnosis and management of dizziness was performed with and without implementation of an interprofessional team. To observe potential differences, year 3 incorporated the interprofessional management approach while years 1-2 did not. The two periods were then compared to each other. A total of 134 patients referred to a university hearing clinic for a vestibular and balance function evaluation. Diagnoses and management trends were examined with descriptive statistics (percentages and frequencies). Fisher's exact tests, analysis of contingency tables, were conducted to evaluate the influence of interprofessional management on dizziness diagnoses and treatment patterns. Results demonstrated that before implementation of an interprofessional team approach, (1) referring clinicians used unspecific dizziness diagnosis codes (e.g., dizziness and giddiness), (2) a low number of patients with dizziness were referred for balance function testing, (3) diagnoses remained unspecific following the balance function assessment, and (4) the most frequently occurring vestibular diagnoses were unilateral vestibular hypofunction and benign paroxysmal positional vertigo. Following the use of an interprofessional management approach, it was determined that (1) disease-specific diagnoses increased, (2) patients with dizziness were referred for balance function testing mainly by otolaryngologists, (3) dizziness was considered to be multifaceted for a greater number of patients, (4) a larger percentage of patients were referred to a specialist other than the otolaryngologist as a result of their diagnosis, and (5) patients reported reduction or resolution of their symptoms. An interprofessional management approach for the dizzy patient can lead to more specific diagnoses and provide alternative referral pathways to other health-care professionals (e.g., audiologists, physical therapists, and pharmacists) in an effort to reduce over-referral to one specialist. Future studies should address the utility of an interprofessional team approach in the overall management of patients with dizziness.

Management of Visual Deficits with Neurological Etiology – Implications for Practice Patterns and Inter-professional Collaboration

To investigate and describe: 1. occupational therapy practice patterns as it relates to low vision and visual dysfunction, 2. what occupational therapy practitioners perceive as their level of competence in addressing vision and how competence is achieved, 3. the importance of inter-professional management to provide comprehensive care and best practice for visual deficits, 4. potential practice guidelines for the management of visual deficits resulting from neurological etiology.

Advancing Interprofessional Primary Health Care Services in Rural Settings for People with Chronic Low Back Disorders: Protocol of a Community-Based Randomized Controlled Trial.

BackgroundChronic low back disorders (CLBDs) are a substantial burden on individuals and societies, and impact up to 20% of Canadians. Rural and remote residents are approximately 30% more likely to have CLBDs. Reduced access to appropriate team-based health services, including physical therapy, is a key factor that may magnify the impact of CLBD on pain, physical function, overall quality of life, health-related system costs, and individual costs.ObjectiveThe purpose of this project is to evaluate the validity, comparative effectiveness, costs, barriers, and facilitators of an interprofessional management approach for people with CLBDs, delivered via telehealth.MethodsThis project will examine 3 different health care delivery options: (1) in-person nurse practitioner (NP); (2) in-person physical therapist (PT); and (3) a team approach utilizing an NP (in-person) and a PT joining via telehealth. Validity of the telehealth team care model will be explored by comparing the diagnostic categorization and management recommendations arising from participants with CLBD who undergo a team telehealth, in-person NP, and in-person PT assessment. Comparative effectiveness and costs will be examined using a community-based randomized controlled trial in a rural Saskatchewan community with limited PT services. The 3 arms of the trial are: (1) usual care delivered by a local rural NP; (2) a local NP and an urban-based PT joining via telehealth; and (3) face-to-face services by a PT traveling to the community. Patient-reported outcomes of pain, physical function, quality of life, satisfaction, and CLBD care-related costs will be evaluated up to 6 months after the intervention. Patient and provider experiences with the team telehealth approach will be explored through qualitative interviews.ResultsThe study was funded in July 2013 and the University of Saskatchewan Biomedical Research Ethics Board approved the study in November 2013. Participant recruitment began in September 2014 and data collection was completed in December 2015. Analysis is in progress and results are anticipated in 2017.ConclusionsCLBD is a widespread public health problem, particularly in rural and remote areas, which requires new innovative approaches to deliver appropriate health care. The results of this project will inform the development of evidence-informed approaches and community-based implementation strategies to improve access to PT services in primary health care settings in other rural and remote underserved areas. Findings might also provide a framework for cost-effective and patient-centered models of service delivery for the management of other chronic conditions.ClinicalTrialClinicalTrials.gov NCT02225535; https://clinicaltrials.gov/ct2/show/NCT02225535 (Archived by WebCite at http://www.webcitation.org/6lqLTCNF7)

Impending Central Retinal Vein Occlusion

Central retinal vein occlusion (CRVO) may present with varied clinical manifestations, ranging from mild blurred vision and scattered retinal hemorrhages to severe vision loss, optic nerve swelling, pronounced retinal hemorrhages, collateral retinal vessel formation and neovascularization. Impending CRVO, also known as partial CRVO, is a relatively poorly-defined sub-classification of the CRVO condition. Those affected are either asymptomatic or may complain of mild, often transient episodes of blurring of vision and present with venous dilation and tortuosity but only a few widely scattered flame-shaped retinal hemorrhages. As an impending CRVO may be the prodromal phase of an acute CRVO, this diagnosis requires careful monitoring of the patient for progression. The following case outlines the differential diagnosis, sequelae and inter-professional management of an impending central retinal venous occlusion.