Multidisciplinary Practice Research Articles

Integrating the business of oncology during oncology fellowship: An ASCO State of Cancer Care in America (SOCCA) study of professional preparedness and practice expectations among medical oncology fellow physicians in training between 2013 and 2023.

48 Background: The current healthcare climate calls for a deep understanding among physicians on the business side of medicine. Oncology fellows entering clinical practice face key issues related to the business of cancer care, prompting us to explore the preparation from fellowship training for those financial competencies that factor into day-to-day practice. Methods: All fellows taking the 2023 ASCO Medical Oncology In-Training Exam (ITE) were invited to participate in a post-exam survey which included items on perception of preparedness for future practice and expected practice setting. Respondents answering one or more survey items are included in this analysis. Practice setting expectations were compared to findings from the 2013 post-ITE survey (n=1536). Descriptive statistics and Chi-squared tests comparing responses by fellowship year and exam years are presented. Results: Overall, 2184 (97%) of 2231 fellows taking the 2023 ITE participated in this post-ITE survey study, including 704 in their first, 807 in their second, and 673 in their third year of fellowship. Overall, in areas of communication, most felt adequately prepared by their program: communicating with patients about treatment options (98%), multidisciplinary care coordination (97%), electronic records or other healthcare tech use (95%), staying up to date on changes in oncology (95%), and practicing cultural humility (92%). However, in areas on business of oncology, a greater proportion felt under- or unprepared; specifically, 30% of fellows felt unprepared or unsure about discussing the cost of medical care with patients, 35% on obtaining prior authorization, and 45% on participating in alternative payment models. Compared to 2013, the expected practice setting of the 2023 fellows remained unchanged with subsets anticipating an academic practice (62% in 2023 vs 61% in 2013), non-academic practice (hospital/health system or physician/independently owned; 32% in 2023 vs 34% in 2013), government/regulatory (2%), industry (<1%), or other setting (3%). Conclusions: While nearly all oncology fellows reported high levels of preparedness for certain essential components of patient-centered multidisciplinary practice, over a third felt unprepared or underprepared to navigate domains under the business of oncology. These findings highlight the opportunity to augment oncology fellowship training to include financial competencies of clinical practice and care, which collectively form the foundation of cancer care.

Leveraging Design Thinking Methodologies to Overcome Innovation Challenges in Multidisciplinary Research and Practice: A Case Study Approach

Innovation is a critical driver of progress, but multidisciplinary research and practice present unique challenges to innovation due to the diverse perspectives, priorities, and knowledge involved. Design thinking has emerged as a promising approach to overcome these challenges, providing a structured and collaborative framework that fosters creativity and iteration. However, little research has been conducted on the effectiveness of design thinking in multidisciplinary research and practice. The objectives of this study are to (1) assess the effectiveness of design thinking methodologies in fostering successful innovation in multidisciplinary research and practice, (2) identify the key factors that contribute to or hinder the successful application of design thinking in multidisciplinary contexts, and (3) develop a set of best practices for leveraging design thinking in multidisciplinary research and practice. This study will use a case study approach to investigate the application of design thinking in multidisciplinary research and practice. The case studies will be selected based on their level of multidisciplinary, complexity, and innovation challenges. Data will be collected through semi-structured interviews, observation, and document analysis. The data will be analyzed using thematic analysis and triangulation of data sources to ensure validity and reliability. This study is expected to contribute to the understanding of how design thinking methodologies can be leveraged to overcome innovation challenges in multidisciplinary research and practice. The study is also expected to provide insights into the factors that contribute to or hinder the successful application of design thinking in multidisciplinary contexts. Finally, the study will develop a set of best practices for leveraging design thinking in multidisciplinary research and practice that can guide future research and practice in this area. This study is significant because it addresses a critical gap in the literature on the application of design thinking in multidisciplinary research and practice. The study is also significant because it provides practical insights into how design thinking can be leveraged to overcome innovation challenges in multidisciplinary contexts, thereby promoting progress and the advancement of human well-being.

The role of the multidisciplinary team in surgical management of intractable tubo-ovarian abscess as a late sequelae of challenging Crohn's disease in the modern era: A case report and review of current literature.

Chronic, severe Crohn's disease in a young female patient can result in surgical complexity. The rarity of the presentation of intractable pelvic abscesses within this etiology with additional considerations given to fertility concerns and hence requirement for input from a multi-disciplinary team makes this a vital case in building a consensus for evidence-based surgical management. A 29-year-old nulliparous woman was referred to our tertiary centre for surgical management of Crohn's disease with known tubo-ovarian abscess and abdominoperineal and abdominal wall sinuses. Her previous surgical history included 4 midline laparotomies, subtotal colectomy and proctectomy with stoma formation. The patient underwent egg collection to preserve fertility. This was followed by midline laparotomy and abdominoperineal resection, which involved a retrograde radical modified hysterectomy using the Hudson technique, alongside excision of the perineal sinus, with reconstruction of the perineal defect using an internal pudendal artery perforator gluteal fold flap, and in addition to excision and drainage of the abdominal wall abscess. Involvement was sought from gynecological oncology, colorectal, urology, plastics, stoma, fertility, microbiology, and gastroenterology teams, which enabled successful preservation of end organ function and improvement in patient psychological well-being. This case is a paradigm of surgical challenge, requiring expert gynecological oncology techniques including a retroperitoneal approach, nerve and vessel sparing considerations alongside colorectal and urological procedures. Moreover, we believe that our blueprint for effective multi-disciplinary practice will inform the future management of gynecological surgery. Therefore this report aims to contribute towards the optimum management of the gynecological sequelae of Crohn's disease.

Breaking Down Barriers to Detection and Care in Early-Age-Onset Colorectal Cancer in Canada.

The second Early-Age-Onset Colorectal Cancer Symposium, convened in October 2022, sought solutions to the barriers to early detection and care for colorectal cancer in Canada. This meeting built on a previous symposium, held in 2021 and reported in this journal. Early-age-onset colorectal cancer (EAOCRC) affects increasing numbers of people under the age of 50 in Canada and throughout the developed world. Two main themes emerged from the meeting: the importance of timely detection, and the need for a tailored approach to the care of EAOCRC. Early detection is crucial, especially in light of the later stage at diagnosis and unique tumour characteristics. Symposium participants were strongly in favour of reducing the age of eligibility for screening from 50 to 45, and promoting the development of non-invasive screening techniques such as testing for circulating tumour DNA and biomarkers. Leading approaches to care were described and discussed, which meet the unique treatment needs of younger CRC patients. Multidisciplinary practices within and outside Canada address such factors as fertility, family roles, education, careers and financial responsibilities. These models can be applied in treatment centres across the country.

Professional Public Health Practice in Spain - Insights from the Spanish Public Health White Paper

Abstract Issue/Problem The public health professionals has gained attention during the COVID-19 pandemic. However, the weakness of Spain's public health structures has been exposed during the crisis, which is partly due to the delay in modernising institutions and the low percentage of GDP dedicated specifically to theses public health institutions. In addition, there is a lack of specific training for public health practitioners to acquire the necessary multidisciplinary competences for high quality public health practice. Description of the problem The Spanish Society of Public Health and Health Administration (SESPAS) has developed a white paper of the public health profession. The main objective is to contribute to strengthening the professional practice of public health by identifying some of its problems and agreeing on possible solutions. The specific objectives were to frame public health as a profession, to describe the socio-demographic characteristics of the people affiliated to the associations federated in SESPAS, to carry out a qualitative analysis of the discourse of public health professionals on its meaning, and developing conclusions and recommendations to address public health challenges. Results The demographic and employment data of the 3,467 people belonging to seven SESPAS societies show that, overall, about 60% are women and 40% were under 50 years of age. Undergraduate degrees were Medicine (35.9 %), Nursing (17.4 %) and Pharmacy and Veterinary Medicine (10.4 %), other life science degrees (4.3 %). Key aspects of the meaning of public health, training, employability and career and institutionalisation of public health were collected through 19 interviews and 6 focus groups. Lessons In order to agree on the conclusions and recommendations, a meeting was organised with the participation of 29 members of SESPAS. A total of 25 conclusions and 24 recommendations were drawn. Key messages • White paper is a step forward in the strengthening of public health in Spain. • Public health should develop leadership and advocacy skills for people's health from a multidisciplinary and cross-sectoral practice.

Multidisciplinary Management of Phyllodes Tumours and Breast Sarcoma: A Cross-sectional Survey of Clinical Practice across the UK and Ireland

AimsPhyllodes tumours and breast sarcomas are uncommon tumours and their rarity poses significant challenges in diagnosis and management. This cross-sectional study was conducted to evaluate the multidisciplinary clinical practice for these tumours across the UK and Ireland, with the aim of identifying gaps in knowledge and providing direction for establishing national guidelines. Materials and methodsAn international survey was adapted and circulated to breast and/or sarcoma surgeons and oncologists in the UK and Ireland through national organisations. Multidisciplinary team (MDT) responses were analysed anonymously. ResultsTwenty-eight MDTs participated in this study, predominately from high-volume units (85.5%). Although only 43% of the surveyed units were part of a trust that holds a sarcoma MDT, 68% of units managed malignant phyllodes and angiosarcoma, whereas 64.5% managed soft-tissue sarcoma of the breast. Across all subtypes, axillary surgery was recommended by 14–21% of the MDTs and the most recommended resection margins for breast surgery were ‘no tumour on ink’ in benign phyllodes (39%) and 10 mm in the remaining subtypes (25–29%). Immediate breast reconstruction was supported by 11–18% of MDTs for breast sarcoma subtypes, whereas 36% and 32% advocated this approach in benign and borderline phyllodes tumours, respectively. Adjuvant radiotherapy and chemotherapy were recommended by up to 29% and 11% of the MDTs, respectively. ConclusionThe results of this study demonstrate a wide variation in clinical practice across the surveyed MDTs. As only 28 MDTs participated in our study, with under-representation from low-volume units, our results might be an underestimation of the variability in practice across the UK and Ireland. This multi-institutional study sheds light on controversial aspects in the management of phyllodes tumours and breast sarcoma, identifies the need for national guidelines to inform best practice, and calls for the centralisation of the management of breast sarcoma within specialist centres.

SAT398 Pubertal Status And Trends In Gender Affirming Treatment Of Transgender And Gender Diverse Youth

Abstract Disclosure: C. Lin: None. M. Oransky: None. R. Fader: None. N.R. Malhotra: None. E.M. Baldiserroto: None. C.J. Romero: None. J.D. Safer: None. M. Yau: None. Background: Transgender and gender diverse (TGD) youth seek care to affirm their gender identities and improve quality of life and mental health. Gender affirming care of youth includes pubertal assessment, pubertal suppression with gonadotropin-releasing hormone agonist (GnRHa) and gender-affirming hormone therapy (GAHT). Management choices are made collaboratively among the patient, the patient’s family, and the multidisciplinary treatment team. Objective: We sought to characterize the pubertal status of the TGD youth to consider medical intervention. Method: The medical records of 58 TGD youth referred to pediatric endocrinology from 2020-2022 were retrospectively analyzed. Pubertal assessments were made by visualization of pubic hair and breast development according to the Tanner scale and determination of testicular volume with an orchidometer. We labeled Tanner stage 1 as prepuberty; stages 2-3 as early puberty; and stages 4-5 as late puberty. Results: The median age was 15 years (range 8-18 years). 46.6% were trans girls (n=27), 44.8% were trans boys (n=26), and 8.6% were non-binary (n=1 natal male and n=4 natal female). Of the trans girls, 7.4% were prepubertal (n=2), 51.9% were in early puberty (n =14), and 40.7% were in late puberty (n=11). Of the trans boys, none were prepubertal, 3.6% were in early puberty (n=1), and 96.4% were in late puberty (n=25). Of the non-binary youth, 20% were in early puberty (n=1) and 80% were in late puberty (n=4).For the prepubertal patients, monitoring for onset of puberty without treatment was recommended. Of the 15 patients in early puberty, 73.3% started GnRHa (10 trans girls, 1 trans boy) and 26.7% started GAHT (4 trans girls). Of the 36 patients in late puberty, 2.8% received no treatment (1 trans boy), 25.0% started GnRHa (7 trans girls, 2 trans boys) and 72.2% started GAHT (4 trans girl, 22 trans boy). Of the 5 non-binary patients, 1 patient in early puberty (1 natal female) was treated with GnRHa, and 4 were in late puberty and initiated on GAHT (1 natal male, 3 natal female). Conclusion: In our multidisciplinary practice, trans feminine patients are evenly divided between those who present in early and late puberty. This presents possible implications for fertility preservation strategies. Trans masculine patients overwhelmingly present in late puberty, perhaps owing in part to earlier timing for typical “female” puberty. This means that even prompt initiation of GnRHa therapy cannot entirely prevent the potential future need for chest masculinization surgery. Presentation: Saturday, June 17, 2023

S328 Assessing Multidisciplinary Provider Perspectives and Practice Patterns in Germline Genetic Testing in Patients With Newly Diagnosed Colorectal Cancer in the Universal Testing Era

S328 Assessing Multidisciplinary Provider Perspectives and Practice Patterns in Germline Genetic Testing in Patients With Newly Diagnosed Colorectal Cancer in the Universal Testing Era

Pancreas Cancer Learning Health Network Established to Share Best Practice Across 14 Centers and Improve Patient Outcomes

Pancreas cancer (PC) survival is among the lowest of all malignancies. Clinical trials have failed to significantly improve outcomes. Individual and institutional biases in care result in significant variation in practice, further hindering progress. Learning health networks (LHNs) prospectively collect real world data across centers and test improvements that can rapidly be expanded across centers if deemed successful. Herein, we report preliminary progress from the Pancreas Cancer Canopy Cancer Collective (PC-CCC), the first oncology LHN, established to improve duration and quality of survival in PC. In 2019, we established the PC-CCC with six care centers who engaged in a collaborative design process to create a set of improvement aims, change ideas, and outcome measures. Center team members receive training and coaching in collaborative quality improvement methods, applied to local improvement efforts. Eight more centers joined in 2021, and a shared Canopy outcomes database was built and implemented to inform center-specific and network-wide improvement efforts and allow the LHN to undertake research using real-world data. Current improvement efforts are focused on proactively screening new PC patients for: (1) Clinical trials, (2) pancreas enzymes, (3) palliative care needs, and (4) goals of care conversations. Currently, 14 care centers are active participants in the PC-CCC LHN. Data on a total of 2,002 PC patients are available to date. At presentation to the care center, most patients are female (51%) and have biopsy proven PC (83.9%). Average age is 68 years, and presenting disease status is metastatic (14.5%), resectable (11.4%), locally advanced (10.9%), borderline resectable (8.1%), or not yet staged (40%). For those who received radiation, 75.8% received stereotactic body radiation therapy. Among patients whose chemotherapy regimen was documented, most received 5-fluorouracilbased treatment (52%). Descriptive follow up data (including treatment and outcomes) are being actively updated, to be reported at time of presentation. Creation of a cancer LHN for PC is feasible and has set the stage for improving patient and provider outcomes through iterative community-building, continuous improvement, and sharing of data and multidisciplinary best practices. Additionally, the data obtained from the CCC database can rapidly inform the network how variation in clinical practice across centers can influence outcomes.

Questionnaire for Dental Practitioners to Screen for Trigeminal Neuralgia.

Objective Trigeminal neuralgia (TN) is a neurological disorder that often presents as severe toothache. The majority of TN patients visit dental clinics first, so TN represents a potential pitfall for dental practitioners. This report describes the development of a trigeminal neuralgia questionnaire (TNQ), assessing 10 characteristics of TN, to assist dentists in screening for TN in dental clinics, and evaluates the effectiveness of TNQ. Materials and Methods Fifty-three patients who visited the TN outpatient department in our institute and completed the TNQ were included in this study. All patients were examined by two neurosurgeons and neuroimaging was performed. Statistical Analysis Patients were classified into a TN group and a non-TN group. TNQ score was retrospectively compared between groups. Furthermore, history and characteristics of TN were investigated in the TN group to clarify the status of the reference situation. Results Thirty-seven cases were assigned to the TN group, and 16 cases to the non-TN group. Mean TNQ score was 8.3 in the TN group and 6.6 in the non-TN group. Setting a TNQ cutoff score of 7 offered 91% sensitivity and 56% specificity for TN. Investigation of the history of the present illness indicated that 39.2% of TN cases were improperly triaged and referred from initial dental clinics, and interdisciplinary practice was insufficient. Conclusion TNQ offers a reliable, convenient method to triage TN patients, and may assist dentists in screening for TN. Multidisciplinary practice is necessary for total management of TN and the TNQ is expected to connect dentists and TN specialists.

Protocol for the development of a multidisciplinary clinical practice guideline for the care of patients with chronic subdural haematoma.

Introduction: A common neurosurgical condition, chronic subdural haematoma (cSDH) typically affects older people with other underlying health conditions. The care of this potentially vulnerable cohort is often, however, fragmented and suboptimal. In other complex conditions, multidisciplinary guidelines have transformed patient experience and outcomes, but no such framework exists for cSDH. This paper outlines a protocol to develop the first comprehensive multidisciplinary guideline from diagnosis to long-term recovery with cSDH. Methods: The project will be guided by a steering group of key stakeholders and professional organisations and will feature patient and public involvement. Multidisciplinary thematic working groups will examine key aspects of care to formulate appropriate, patient-centered research questions, targeted with evidence review using the GRADE framework. The working groups will then formulate draft clinical recommendations to be used in a modified Delphi process to build consensus on guideline contents. Conclusions: We present a protocol for the development of a multidisciplinary guideline to inform the care of patients with a cSDH, developed by cross-disciplinary working groups and arrived at through a consensus-building process, including a modified online Delphi.

A Potential Indicator for Assessing Patient Blood Management Standard Implementation.

(1) Background: Patient blood management (PBM) program as a multidisciplinary practice and a standard of care for the anemic surgical patient has an increasingly important role in reducing transfusions and optimizing both clinical outcomes and costs. Documented success of PBM implementation is not sufficient for implementation of recommendations and correct use at hospital level. The primary objective of our study was to define a composite patient blood management process safety index-Safety Index in PBM (SIPBM)-that measures the impact of screening and treating anemic patients on the efficiency and effectiveness of the patient care process undergoing elective surgery. (2) Methods: We conducted a retrospective comparative study in a tertiary hospital by collecting data and analyzing the Safety Index in PBM (SIPBM) in patients undergoing major elective surgical procedures. (3) Results: The percentage of patients from the total of 354 patients (178 in 2019 and 176 in 2022) included in the study who benefited from preoperative iron treatment increased in 2022 compared to 2019 from 27.40% to 36.71%. The median value of the SIPBM was 1.00 in both periods analyzed, although there is a significant difference between the two periods (p < 0.005), in favor of 2022. (4) Conclusions: Measuring the effectiveness of PBM implementation and providing ongoing feedback through the Safety Index in PBM (SIPBM) increases the degree to which opportunities to improve the PBM process are identified. The study represents a first step for future actions and baselines to develop tools to measure the safety and impact of the patient blood management process in the surgical field.

Peri-procedure experiences during minimalist transcatheter aortic valve implantation: insights from patients' perspectives

Abstract Funding Acknowledgements Type of funding sources: None. Background There is growing evidence to support the implementation of a streamlined clinical pathway to optimise outcomes, improve program capacity, and facilitate safe early discharge home after transcatheter aortic valve implantation (TAVI). In the peri-procedure phase, the adoption of a minimalist approach has accelerated the rapid transition from the use of general anaesthesia to default strategies ranging from conscious sedation to local anaesthesia only. Little is known of patients’ perspectives with undergoing minimalist TAVI. We aimed to explore what could be learned from this episode of care to inform multidisciplinary practice. Methods We conducted a prospective single centre qualitative study of TAVI patients within the first week of their discharge home, using purposeful sample to recruit a diverse population. We conducted individual interviews, using a semi-structured interview guide informed by pilot work and current evidence; open-ended questions were designed to explore patients’ perspectives of their peri-procedural experiences, inclusive of their recall of the procedure, interactions with team members, and the overall care received. Data were analyzed using interpretive description, a methodological approach appropriate to inform the knowledge needs of applied disciplines and conducive to generating new ideas and augment existing knowledge in the context of clinical practice. Results We recruited 15 participants, including 5 women, median age 82 (IQR 77,86); all patients had severe symptomatic aortic stenosis and multiple co-morbidities. TAVI was conducted using a transfemoral approach, with local anaesthesia only (n=4) or minimal sedation (n=11). Median length of stay was 1 day; one participant required a new permanent pacemaker; all participants were discharged home. The overarching theme of "I want to be a member of my Heart Team during my procedure" emerged; this aspiration, request and/or need was illustrated by three main themes: (1) "Who am I to them?", (2) "How can I be a good patient?", and (3) "How do I manage this complex wave of emotions?". Conclusions The rapid emergence of minimally invasive options for the treatment of valvular heart disease has established a new standard of care. Peri-procedure care initially informed by surgical practices have now shifted to most patients being conscious during TAVI and cared for by a smaller clinical team. The awareness of patients’ perspectives, and their inclusion in the Heart Team’s dynamics and processes offer important insights to optimise patients’ experiences of procedural care and clinical outcomes.

Translated article] Advances in the work of multidisciplinary teams for the care of patients with severe uncontrolled asthma. A post-COVID vision (TEAM 2.0 project)

Asthma is a chronic respiratory disease with a high health, social and economic impact, particularly in the case of Severe Uncontrolled Asthma (SUA). For this reason, new strategies are especially necessary to improve its approach, with a personalized approach to each patient and from a multidisciplinary perspective, in addition to integrating the new telemedicine and telepharmacy practices promoted as a result of the COVID-19 pandemic.In this context, the TEAM 2.0 project (“Work in Multidisciplinary Asthma Teams”) has been developed, following the TEAM project carried out in 2019, with the aim of updating and prioritizing good multidisciplinary work practices in SUA in a post pandemic context and analyze the progress made.A coordinating group, made up of eight multidisciplinary teams of hospital pharmacists, pulmonologists, and allergists, carried out an updated bibliographic review, sharing of good multidisciplinary practices, and analysis of advances. Through five regional meetings with other experts with experience in SUA, the good practices identified were shared and subjected to debate, evaluation and prioritization.In total, 23 good multidisciplinary work practices in SUA, grouped into five work areas: 1) Organization of work in multidisciplinary teams, 2) Patient education, self-management and adherence, 3) Health results, data monitoring and persistence, 4) Telepharmacy and experiences implemented during the COVID-19 pandemic and 5) Training and research, were evaluated and prioritized by 57 professionals from the field of Hospital Pharmacy, Pulmonology, Allergology and Nursing. This work has made it possible to update the roadmap of priority actions to continue advancing in optimal models of care for patients with AGNC in a post-COVID-19 context.

Children would taste anything: foreign body ingestion – a multidisciplinary perspective and clinical practice algorithm

Foreign body ingestion is a frequent issue among the pediatric population, children under 4 years old being at high risk. The authors reviewed the literature considering the importance of a quick diagnosis and prompt distinction between various types of foreign bodies, thus resulting in the best therapeutic approach. The most common foreign bodies ingested are cited to be coins, button batteries, magnets and food bits. As for therapeutic approaches, references don’t place upper endoscopy as key curative method, in some cases outpatient follow-up is a better choice. Foreign body ingestion complications are usually rare, but sometimes life threatening (coins generate aorto-esophageal fistulas, fish bones cause intestinal perforation, magnets lead to intestinal obstructions and erosions). After carefully consulting the latest guidelines regarding management of foreign body ingestion, we put together an instructive diagram outlining curative procedures in these cases. This review summarizes diagnostic and therapeutic methods for the most common swallowed objects and provides a brief, concise, easy to use clinical practice algorithm, thus giving clinicians an excellent tool to manage these cases.

General health and working conditions of Flemish primary care professionals

BackgroundThe Quintuple aim explicitly includes ‘health and wellbeing of the care team’ as requirement for the care of patients. Therefore, we examined working conditions, work engagement and health status of professionals active in primary care in Belgium (Flanders), and how these are interrelated.MethodsData of the cross-sectional ‘Health professionals survey of the Flemish Primary care academy’ of 2020 were examined. We performed logistic regression analyses to study the relationship between working conditions and self-reported dichotomized health of primary care professionals (sample size = 1033).ResultsThe majority of respondents (90%) reported having a good to very good general health and has a strong work engagement. Quality of employment was high, in particular regarding job security and supportive relations with colleagues, while less in terms of proper rewards and job career opportunities. Working as self-employee (vs. as salaried employee), and in a multidisciplinary group practice (vs. other organizational settings) were positively related to health. Work engagement and all dimensions of employment quality were related to general health, but work family balance, proper rewards, and perceived employability were independently positively related to self-reported health.ConclusionNine out of 10 Flemish primary care professionals working in diverse conditions, employment arrangements and organizational settings report good health. Work family balance, proper rewards, and perceived employability were important for primary care professionals’ health, and could provide opportunities to further strengthen the job quality and health of primary care professionals.

P27 An innovative multidisciplinary approach to optimizing the dermatology service for patients with chronic spontaneous urticaria, psoriasis and atopic dermatitis

Abstract The aim of this work was to optimize multidisciplinary practice in the dermatology department of our teaching hospital and to integrate pharmacist independent prescribers (PIPs) into the dermatology team, establish multidisciplinary patient pathways and evaluate patient satisfaction with pharmacist-led clinics. One dermatology lead pharmacist and three specialist pharmacists completed training in dermatologist-led clinics, and multidisciplinary patient pathways were developed. A pharmacist-led clinic for patients with chronic spontaneous urticaria (CSU) was established and delivered under the indirect supervision of a dermatologist. Pharmacist-led eczema and psoriasis clinics were then established, in which care is delivered by PIPs working alongside dermatologists to facilitate medical input when required. Patient satisfaction with the PIP service was evaluated by the administration of anonymized questionnaires sent to patients seen by PIPs over a 1-month period. Patients rated (poor, fair, good, excellent) 11 items and provided free-text comments. Over an 18-month period, dermatologists referred 53 of their 63 patients (84%) with CSU to the pharmacist-led clinic and PIPs delivered 150 CSU appointments. In the 12 months since establishing eczema and psoriasis multidisciplinary pathways, PIPs have delivered 279 eczema and 342 psoriasis appointments. PIPs have 30-min appointments for patients to discuss medication-related issues, assess response to treatments and demonstrate a holistic approach to patient care, including cardiovascular risk assessments. An estimated 400 h of dermatologist time was released over an 18-month period of gradual rollout of clinics as PIPs reviewed return patients, managed repeat prescribing for approximately 550 patients with CSU, psoriasis and eczema (homecare), and supported drug protocol development. In turn, PIPs reported increased job satisfaction. PIP consultations were rated excellent by 85% of eczema responders [85% response rate; 43% female, median age 38 years (range 19–84)] and 89% of psoriasis responders [90% response rate; 44% female, median age 50 years (range 15–77)]. All free-text comments (n = 34) were positive, with two suggestions for improvement (better explanation of pharmacist appointment, online appointments). Thematic analysis of comments revealed appreciation of ‘care and compassion’ (n = 20), ‘multidisciplinary team service delivery’ (n = 15), ‘ensuring patient understanding’ (n = 17), ‘pharmacist knowledge’ (n = 13), ‘professionalism’ (n = 8) and ‘medical team input’ (n = 4). There have been no patient complaints or adverse outcomes related to pharmacist-led clinics since the clinics were launched. Dermatology PIPs have successfully integrated into the dermatology multidisciplinary team, receiving support to develop their clinical roles. Pharmacist-led clinics substantially increase the overall capacity of the dermatology service, while patients report high satisfaction and appreciation of PIP consultation skills and the quality of the service.

Conclusion: Mental health and legal responses to the adolescent mental health crisis: Raising the bar on best interests and promoting family connectedness in divorcing families

AbstractWe are currently facing an unprecedented increase in adolescent mental health problems resulting in alarmingly high levels of depression, anxiety, and suicidality. Significant mental health problems among youth pose unique challenges to families in the process of separation and divorce, as well as to family law professionals across all disciplines. The current adolescent mental health crisis calls for new ways of approaching our work with high conflict families to promote family connectedness and shift away from adversarial approaches that may exacerbate conflict and further destabilize families. As a conclusion to the special issue on adolescent mental health needs, the authors make multidisciplinary best practices recommendations and advocate for systems level changes in recognition of the needs of youth in crisis at this pivotal developmental stage.

Just visiting: A qualitative study of Australian allied health professionals' experiences working in residential aged care facilities during the COVID-19 pandemic.

Internationally, the COVID-19 pandemic has negatively impacted health professionals' experiences of delivering effective care. The experiences of health professionals are important: poor experience has been associated with poorer patient outcomes and high staff turnover. This study aimed to narratively explore the impact of the COVID-19 pandemic on the experience of delivering allied health (AH) care in Australian residential aged care (RAC). Semistructured interviews were conducted in February-May 2022 with AH professionals who had experience working in RAC during the pandemic. Interviews were audio-recorded, transcribed verbatim and thematically analysed in NVivo 20. Twenty-five per cent of interview transcripts were independently analysed by three researchers to create a coding structure. Three themes were identified from interviews with 15 AH professionals to describe experiences delivering care pre-COVID-19, during COVID-19, and perceptions of care delivery in future. Prepandemic AH in RAC was believed to be under-resourced, delivering low-quality and reactive care. During the pandemic, pauses in, and the slow resumption of, AH services exacerbated professionals' feelings of being undervalued in resident care and in the workforce. Participants were optimistic about the impact AH could have in RAC in future if practice was embedded, multidisciplinary and funded appropriately. AH professionals' experiences of delivering care in RAC are often poor, regardless of the pandemic. Further research on multidisciplinary practice and health professional experience in RAC is needed.

Myositis interstitial lung disease and autoantibodies.

The aim of this review is to examine and evaluate published literature associated with idiopathic inflammatory myopathies (IIM) and interstitial lung disease (ILD) based on myositis specific autoantibodies (MSA) and the potential clinical significance of each autoantibody subtype for the practicing clinician. The review is a comprehensive search of literature published in PubMed from the year 2005 and onward coinciding with the surge in the discovery of new MSAs. Additionally, we comment on recommended multidisciplinary longitudinal care practices for patients with IIM-ILD with regard to imaging and other testing. Treatment is not covered in this review.