Multiprofessional Approach Research Articles

Healthcare system intervention for safer use of medicines in elderly patients in primary care-a qualitative study of the participants' perceptions of self-assessment, peer review, feedback and agreement for change.

BackgroundThe elderly population is increasing and with advanced age comes a higher risk for contracting diseases and excessive medicine use. Polypharmacy can lead to drug-related problems and an increased need of health care. More needs to be done to help overcome these problems. In order for new models to be successful and possible to implement in health care they have to be accepted by caregivers. The aim of this study was to evaluate participants’ perceptions of the SÄKLÄK project, which aims to enhance medication safety, especially for elderly patients, in primary care.MethodsThis is a qualitative study within the SÄKLÄK project. The SÄKLÄK project is a multi-professional intervention in primary care consisting of self-assessment, peer review, feedback and written agreements for change. A total of 17 participants from the intervention’s primary care units were interviewed. Most of the interviews were done on a one-to-one basis. The interviews were recorded and transcribed verbatim. A survey was also sent to the primary care unit heads. Qualitative content analysis was used to explore the participants’ perceptions.ResultsThe analysis of the interviews yielded six categories: multi-professional co-operation, a focus on areas of improvement, the joy of sharing knowledge, disappointment with the focus of the feedback, spend time to save time and impact on work. From these categories a theme developed: “Medication safety is a large area. In order to make improvements time needs to be invested and different professions must contribute.”ConclusionsThis study shows that our studied intervention method is feasible to use in primary care and that the multi-professional approach was perceived as being very positive by the participants. Multi-professional co-operation was time consuming, but was also deemed as an investment and an opportunity to share knowledge. Some points of improvement of the method were identified such as simplification of the self-assessment form and clearer instructions for reviewers. In addition, to have an impact on work the focus must lie in areas within the primary care units’ scope.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0334-6) contains supplementary material, which is available to authorized users.

A change in culture: overcoming the problem of sustainability

After attending a Quality Improvement Programme (QIP) workshop, Robert Finnigan noted the lack of hierarchy that led to a multiprofessional approach to making improvements to patients' lives. He believes QIPs need to be supported by a change in culture to overcome the problem of sustainability.

Home parenteral nutrition: a multi-professional approach.

This article explores the complexities of home parenteral nutrition (HPN) and how it has developed as a home therapy. It examines the various indications and treatment options, discussing access and the associated complications. The relationship between the multiprofessional team is paramount to the success of the therapy. Working in partnership with home-care providers is also discussed. It gives an overview of patients receiving parenteral nutrition at home and the impact it has on their lives.

Hospice to home: a patient-centric multi professional community approach.

As people live longer with multidimensional health and end-of-life care needs, palliative care provision is becoming increasingly complex. Demands on hospice services are increasing, therefore new models of care are needed that are accessible to a wider range of patients. Most people prefer to die at home (Gomes et al, 2013a); however, evidence reports that the most common place of death is hospital (53%) (Marie Curie, 2013). This article describes how one hospice developed a model of care working in partnership with statutory services that provided patient-centred care, achieved preferences and prevented unnecessary admissions into hospital. It describes each element of the model and how they work seamlessly together. The evaluation of the model suggests that maximal impact can be gained by focusing service development on expanding and improving care at home. Preventing unnecessary hospital admissions, while simultaneously improving the quality of care, remains the fundamental driver for high-quality end-of-life care.

G468(P) The majority of referrals from gp to general paediatric outpatient clinic could be managed by alternative methods

Aims Audit 100 referrals made to a hospital general paediatric outpatient clinic from General Practice to assess (i) Appropriateness (ii) Possible alternative methods of management Implement alternative and innovative methods of management using a multi-professional approach Improve quality of care for patients Methods Using a proforma, each referral was assessed by 3 people: A Paediatrician (taken from a pool of 3 Consultants), A GP physician (taken from a pool of 2) and A Paediatric nurse specialist Results 76–97% of patients seen in paediatric general outpatients could have been managed with at least one alternative method. The range reflects variation in assessor’s opinions (Figure 1 and Table 1). Conclusions The majority of cases seen in general paediatric outpatients in this sample did not require secondary care. Importantly, this study suggests that, with the support and partnership of secondary care, General Practice has the potential to be able to provide a safe, more rapidly accessible and cost-effective paediatric service than that currently being offered at the level of a general paediatric outpatient clinic. In terms of our progress: (i) Telephone hotline will be rolled out shortly (ii) Rapid access clinic opens in April 2015 (ii) Roll out of Community nurses (multi-professional approach) (iii) Development of email service and virtual clinic (iv) Increased support for GPs

SWEETWISE: developing a multi-professional approach to diabetes mellitus.

The formation of a local joint professional network (LJPN) in Northamptonshire has led to a joint Continuing professional development initiative and an audit project to determine the take up of annual health checks by patients with diabetes mellitus with dentists, optometrists, pharmacists as well as the usual check with the General Medical Practice team. The findings showed that a significant number of patients (29-50%) do not access available dental, optometry and pharmacy advice. Better collaboration between the professions has the potential to improve health outcomes in diabetes mellitus and other areas where lifestyle modification reduces adverse health risks. A patient advice card (SWEETWISE) was developed by the group and could be used to help educate patients and health professionals.

Educational support for low-performing students in mathematics: the three-tier support model in Finnish lower secondary schools

In 2011, there was a legislative reform regarding educational support in Finland, with a focus on early identification, differentiation and flexible arrangement of support using a multi-professional approach, the three-tier support model. The main aim of this study was to investigate what educational support practices are used with low-performing lower secondary students. An additional aim was to determine how the change in legislation has affected the work of special education and mathematics teachers with regard to mathematics education for low-performing students. Electronic questionnaires were sent to all principals in Swedish-speaking schools in Finland (55 schools, grades 7–9) to be answered by the special education and mathematics teachers. Twenty-seven answers were received from the special education teachers and 42 from the mathematics teachers. The results showed that ‘pull out of the classroom’ was considered the most common way to support the mathematically low-performing students. Teachers were quite satisfied with the efficiency of support and the amount of extra resources for the low-performing students in mathematics. There was almost no change in collaboration or working strategies for either teacher groups due to the change in legislation. The teachers did not experience much change in educational practice after the legislation reform.

134IN - Options and Strategies: Project in Action: Oral Tumour Therapy-Adherence and Safety

ABSTRACT Over the last 20 years, development and use of oral cancer drugs increased to approximately 25% of the available cancer drugs on the market, and has transformed the treatment and care setting profoundly. The increase brought changes the therapy regimens from supervised i.v. applications, to continuous oral administration at the patient's home or care setting. Patient information and monitoring pathways have changed accordingly. Oral drug delivery is often well accepted by patients, fewer visits to the clinic may be a result, is less invasive, increases the independence of both patients and caregivers. We also know that the drawbacks of oral cancer drugs are influenced by factors related to the patient, the healthcare professionals and the medicament itself. Physicians, nurses and pharmacists are challenged by previously unknown problem areas. All involved are challenged with increased and new responsibilities. Actively addressing these problems can alleviate many unwanted effects. The project “Adherence with Oral Tumor Therapies” was realized because: - Patients and their caregivers request more and understandable information, cannot rely alone on web-based sources, have false information from undefined sources. - Healthcare professionals need knowledge regarding side effects, barriers to adherence to oral therapies, and assessment techniques to monitor adherence. - Physicians often have less time to communicate with their patients, nurses are an important link and play an important role in patient education and support. A multiprofessional group of medical oncologists and oncology nurses as well as a pharmacist developed a national project to approach these issues. The working group of five persons and the three task groups developed various sub-projects which supported and defined the goals. The pilot project, built on a modular strategy is based on a multiprofessional approach. Organisational aspects and Educational aspects include the following: - a project Website - general information about oral cancer drugs for professionals - patient drug information sheets (per drug) for downloading in clinical settings - free on-site education program for multidisciplinary teams - project evaluation With relatively simple tools, patients and caregivers feel empowered and adhere better. Disclosure: The author has declared no conflicts of interest.

The role of the clinical nurse specialist in caring for patients with prostate cancer: a narrative review

The role of the clinical nurse specialist in caring for patients with prostate cancer: a narrative review Maria Helena Baena de Moraes Lopes,1 Rosângela Higa21Faculty of Nursing, University of Campinas, Campinas, São Paulo, Brazil; 2Nursing Department, Prof Dr José Aristodemo Pinotti Women’s Hospital, CAISM, University of Campinas, Campinas, São Paulo, Brazil Abstract: Prostate cancer, the leading cancer among men, constitutes a serious public health problem worldwide. Its treatment and care require a multi-professional approach. This descriptive review was conducted to establish the role of the clinical nurse specialist in providing prostate cancer care. The CINAHL, MEDLINE, PubMed, Medscape, LILACS, BDENF, and Cochrane databases were searched to identify relevant publications up to September 2013 written in Portuguese, English, and Spanish, using the Electronic Information Access Program and Coordination for the Improvement of Higher Education Personnel (CAPES) Periodicals Portal in the search system of the Digital Library of the University of Campinas, São Paulo, Brazil. Articles not present in these databases or that did not discuss nursing care for men with prostate cancer and/or their families were excluded. Analysis of 20 studies selected according to these criteria revealed four important aspects of specialized nursing care: care provided 1) at the time of prostate cancer diagnosis; in the 2) pretreatment and 3) posttreatment periods; and 4) in the assistance of partners and family members of men with prostate cancer. The studies included in the analysis showed that physical and psychological problems, such as loss of energy and motivation, functional impairment, and loss of sex life, were relevant to nursing care. They confirmed that nursing care actions for men with prostate cancer should start at the time of diagnosis, when patients must participate in deciding the best course of treatment. During the prostatectomy period, care involves preoperative preparation, which is fundamental for recovery and adaption to postoperative sequelae. Family members, especially partners, should also receive attention and support during this period. The results allowed the conclusion that the role of the clinical nurse specialist in the care of men with prostate cancer is broad and essential, but interventions and new strategies of care need to be evaluated through well-designed clinical studies. Keywords: prostatic neoplasm, nursing care, nurse clinician, prostatectomy, review literature as topic

SP0214 Differences across Europe in the Delivery of Patient Education – What Should BE Done?

BackgroundPatient education (PE) is “a planned, interactive process between patients and health professionals (HPs), aimed at supporting and enabling patients to manage their life with arthritis and optimising their health...

Multiprofessional Primary Care Units: What Affects the Clinical Performance of Italian General Practitioners?

Multiprofessional primary care models promise to deliver better care and reduce waste. This study evaluates the impact of such a model, the primary care unit (PCU), on three outcomes. A multilevel analysis within a "pre- and post-PCU" study design and a cross-sectional analysis were conducted on 215 PCUs located in the Emilia-Romagna region in Italy. Seven dimensions captured a set of processes and services characterizing a well-functioning PCU, or its degree of vitality. The impact of each dimension on outcomes was evaluated. The analyses show that certain dimensions of PCU vitality (i.e., the possibility for general practitioners to meet and share patients) can lead to better outcomes. However, dimensions related to the interaction and the joint works of general practitioners with other professionals tend not to have a significant or positive impact. This suggests that more effort needs to be invested to realize all the potential benefits of the PCU's multiprofessional approach to care.

DEVELOPMENT OF A HOSPICE RESEARCH STRATEGY THROUGH ORGANISATIONAL CONSENSUS

BackgroundA strategic approach to the development of a portfolio of research gives direction and enables an organisation to plan, fund and conduct research systematically. At Princess Alice Hospice, a strategic...

Features and organization of Pain Centers in the Lazio Region, Italy, in 2011.

Evidence on pain management highlights the importance of a multidisciplinary approach in order to achieve optimal therapeutic results. Such programs can be guaranteed by the Centers for Pain Management (CPMs), in which multidisciplinary teams are able to provide advanced and specialized activities for the assessment, diagnosis and treatment of chronic benign pain. To date, information related to healthcare supply and the organizational structure of these centers in Italy is incomplete. The aim of this paper was to provide an overview of the healthcare network of the CPMs in the Lazio region. A descriptive survey was conducted in all the 37 CPMs existing in the Lazio region in 2011 of which 28 participated. CPMs were located either in Universities or in public or private hospital facilities. They included a clinic, a Day Hospital service, Day surgery and day-beds. CPMs were managed by anaesthesiologists who, in most instances, did not work in a multidisciplinary team. The number of other health professionals available, such as nurses, psychologists and physiotherapists, was limited. CPMs mainly provided drug therapy, Complementary Alternative Medicine (CAM) and complex interventional treatments. The median waiting time was 30 days. The clinics were not homogeneously distributed in the region with a higher concentration in Rome (56%), followed by other provinces of the Lazio region (26%) and the province of Rome (18%). Clearly, Rome was the city which offered the greatest range of healthcare services and the highest number of consultations with patients, which significantly differed from those of the other areas (χ²=19.6 p<0.01). In 2011, the availability of CPMs was not equally distributed throughout the territory, and there was an over-utilization of the facilities in Rome and an under-utilization in the provincial areas. Moreover, this study showed a lack of a multi-professional approach to chronic pain management.

Positive health outcomes following health-promoting and disease-preventive interventions for independent very old persons: Long-term results of the three-armed RCT Elderly Persons in the Risk Zone

The aim of this study was to analyze the long-term effect of the two health-promoting and disease-preventive interventions, preventive home visits and senior meetings, with respect to morbidity, symptoms, self-rated health and satisfaction with health. The study was a three-armed randomized, single-blind, and controlled trial, with follow-ups at one and two years after interventions. A total of 459 persons aged 80 years or older and still living at home were included in the study. Participants were independent in ADL and without overt cognitive impairment. An intention-to-treat analysis was performed. The result shows that both interventions delayed a progression in morbidity, i.e. an increase in CIRS-G score (OR=0.44 for the PHV and OR=0.61 for senior meetings at one year and OR=0.60 for the PHV and OR=0.52 for the senior meetings at two years) and maintained satisfaction with health (OR=0.49 for PHV and OR=0.57 for senior meetings at one year and OR=0.43 for the PHV and OR=0.28 for senior meetings after two years) for up to two years. The intervention senior meetings prevented a decline in self-rated health for up to one year (OR=0.55). However, no significant differences were seen in postponing progression of symptoms in any of the interventions. This study shows that it is possible to postpone a decline in health outcomes measured as morbidity, self-rated health and satisfaction with health in very old persons at risk of frailty. Success factors might be the multi-dimensional and the multi-professional approach in both interventions. Trial registration: NCT0087705.

WOC nursing and multi-professional team approach

WOC nursing and multi-professional team approach

Methodological issues on the epidemiology of non motor symptoms in Parkinson's desease

The increasing interest in non-motor symptoms in Parkinson's disease due to the widening knowledge in the neurobiological field, brought to considering PD as a complex disease. This requires a proper characterization of the natural history of the disease using the appropriate epidemiological tools, along with the implementation in clinical practice of a standard a multi-professional approach. Available evidence on the frequency of non-motor symptoms in PD is reported in studies with very heterogeneous designs and diagnostic measures, and using a great variety of epidemiological estimates. In particular, there are no studies reporting the frequency of non-motor symptoms in a cohort of incident PD patients using point prevalence, incidence rate, and cumulative incidence. A mini-review of cross-sectional and longitudinal studies on three non-motor symptoms/conditions (dementia, depression, ICDs) in patients with PD confirms these premises and highlights the need of higher quality studies, both from a methodological and a clinical point of view.

Methodological Issues on the epidemiology of non motor symptoms in Parkinson's disease.

The increasing interest in non-motor symptoms in Parkinson's disease due to the widening knowledge in the neurobiological field, brought to considering PD as a complex disease. This requires a proper characterization of the natural history of the disease using the appropriate epidemiological tools, along with the implementation in clinical practice of a standard a multi-professional approach. Available evidence on the frequency of non-motor symptoms in PD is reported in studies with very heterogeneous designs and diagnostic measures, and using a great variety of epidemiological estimates. In particular, there are no studies reporting the frequency of non-motor symptoms in a cohort of incident PD patients using point prevalence, incidence rate, and cumulative incidence. A mini-review of cross-sectional and longitudinal studies on three non-motor symptoms/conditions (dementia, depression, ICDs) in patients with PD confirms these premises and highlights the need of higher quality studies, both from a methodological and a clinical point of view.

Priorities for the multi-professional approach to primary care

Priorities for the multi-professional approach to primary care

Global Cardiovascular Disease Prevention

The global epidemic of cardiovascular disease (CVD) calls for multidisciplinary and multiprofessional approaches to the management of this condition, with strategic emphasis on prevention, treatment, and control. In addition, there is increasing recognition that effective prevention and management of CVD requires a diverse workforce skilled in the social, environmental, and policy determinants of health. Nowhere are these approaches and strategies brought together and more closely aligned than in the field of preventive cardiovascular nursing. This executive summary of "Global Cardiovascular Prevention: A Call to Action for Nursing" includes key points from the 6 papers written by the Preventive Cardiovascular Nurses Association and published in July-August 2011 as a supplement to the Journal of Cardiovascular Nursing and the European Journal of Cardiovascular Nursing. This supplement addresses innovative efforts to stem the current global epidemic of CVD and emphasizes the need for effective team-based interventions for lifestyle and behavior changes across the life span. Social solutions, strategies for working with key players to develop interactive models, as well as coordinated multilevel policies, partnerships, and programs that are culturally relevant and context specific are examined. Such approaches are urgently needed to reduce death and disability from CVD in the United States and globally. Nurse leaders and other members of the healthcare team are well positioned internationally to meet these challenges.

Modern Biotechnologies to Treat “Difficult Lesions”

Diabetes mellitus is a disease with a heavy impact on social-health. About 15% of the over 200 million patients affected by diabetes in the world have lesions on the legs of various kind, among which pure ischemic, neuro-ischemic, and neuropathic lesions, or lesions caused by local infections; in addition, 50% of these patients require limb amputation. A typical characteristic of the diabetic person is the lack of the earliest symptom of peripheral arterial diseases: the “ intermittent ” claudicatio that often occurs together with sensory neuropathy and causes a decreased perception of pain. Therefore, the primary and secondary prophylaxes of the diabetic foot lesions are one of the main aims of the Health Care Program. The present review shows the various types of advanced medications used in our facility to treat severe wounds, highlighting the fact that a multidisciplinary and multi-professional approach is essential to any Health Organization for dealing with the increasingly heavy lesions of hospitalized patients. Thanks to a growing awareness by the healthcare professionals and the considerable improvements in the patients' lifestyle, the solution solving the current problems comes from the opening of new specialized centers for the treatment of diabetic foot lesions in hemodialysed patients by means of multi-skilled figures, among which dermatologists, vascular surgeons, diabetologists, plastic surgeons, nephrologists, and specialist nursing staff.