The IMPACT clinic: Innovative model of interprofessional primary care for elderly patients with complex health care needs

Sunnybrook Health Sciences Centre, Primary Care Research Unit, 2075 Bayview Ave, Room E3-49, Toronto, ON M4N 3M5. .
Canadian family physician Medecin de famille canadien (Impact Factor: 1.34). 03/2013; 59(3):e148-55.
Source: PubMed


The growing number of elderly patients with multiple chronic conditions presents an urgent challenge in primary care. Current practice models are not well suited to addressing the complex health care needs of this patient population.
The primary objective of the IMPACT (Interprofessional Model of Practice for Aging and Complex Treatments) clinic was to design and evaluate a new interprofessional model of care for community-dwelling seniors with complex health care needs. A secondary objective was to explore the potential of this new model as an interprofessional training opportunity.
The IMPACT clinic is an innovative new model of interprofessional primary care for elderly patients with complex health care needs. The comprehensive team comprises family physicians, a community nurse, a pharmacist, a physiotherapist, an occupational therapist, a dietitian, and a community social worker. The model is designed to accommodate trainees from each discipline. Patient appointments are 1.5 to 2 hours in length, during which time a diverse range of medical, functional, and psychosocial issues are investigated by the full interprofessional team.
The IMPACT model is congruent with ongoing policy initiatives in primary care reform and enhanced community-based care for seniors. The clinic has been pilot-tested in 1 family practice unit and modeled at 3 other sites with positive feedback from patients and families, clinicians, and trainees. Evaluation data indicate that interprofessional primary care models hold great promise for the growing challenge of managing complex chronic disease.

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Available from: Ross Upshur, Apr 11, 2014
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    • "Resources to support research in the development and evaluation of techniques are needed to foster goal explication and alignment. Innovative approaches to primary care delivery for patients with multi-morbidities such as the Inter-professional Model of Aging and Complex Treatments (IMPACT) [22], and other team based and multi-disciplinary approaches to treatment and care may be appropriate venues for implementing and testing goal setting strategies for individuals with complex health issues that move beyond the traditional patient-physician consultation. "
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    ABSTRACT: Goal setting is a recommended approach in clinical care that can help individuals with multi-morbidities and their caregivers manage chronic conditions. In this paper, the types of goals that were important for older persons with multi-morbidities were explored from the perspectives of patients, their caregivers and physicians. Comparisons of goals were made across each patient, caregiver and physician triad to determine alignment. The study was a qualitative descriptive study facilitated through semi-structured one-on-one interviews. The study took place between May and October 2012 at a Family Health Team located in Ontario, Canada. The sample included 28 family medicine patients, their informal caregivers and family physicians. Socio-demographic data were analyzed via descriptive statistics in SPSS Version 17. Open ended questions pertaining to patient goals of care were analyzed thematically using NVivo9. Themes were derived on patient care goals for each of the participant groups (patients, caregivers and family physicians). Following this, alignment of goals across each of the triads was examined. Goal alignment was defined as concurrence on at least one goal by all three parties in a particular triad (i.e., patient, caregiver and family physician). Just over half of the patients were male (56%); they had an average age of 82.3 years and 4.61 health conditions. Most of the caregivers were female (82%); and 61% were a spouse of the care recipient. At the aggregate level, common goals expressed among patients, caregivers and family physicians were the maintenance of functional independence of patients and the management of their symptoms or functional challenges. Despite these common goals at the aggregate level, little alignment of goals was found when looking across patient-caregiver and physician triads. Lack of alignment tended to occur when patients had unstable or declining functional or cognitive health; when safety threats were noted; and when enhanced care services were required. The data suggest that goal divergence tends to occur when patients are less medically stable. While goal divergence may be expected due to the different roles and responsibilities of each of the players involved, these perspectives should be illuminated when building care plans. Further research is required to observe the extent to which goal setting occurs in family practice as well as how it can be embedded as a standard of practice.
    BMC Family Practice 09/2013; 14(1):133. DOI:10.1186/1471-2296-14-133 · 1.67 Impact Factor
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    ABSTRACT: Full text available at
    12/2013; Institute for Clinical Evaluative Sciences., ISBN: 978-1-926850-45-0
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    Canadian family physician Medecin de famille canadien 01/2014; 60(1):14-6. · 1.34 Impact Factor
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