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Multidisciplinary collaboration in primary care: A systematic review
Abstract
Background:
Several studies have discussed the benefits of multidisciplinary collaboration in primary care. However, what remains unclear is how collaboration is undertaken in a multidisciplinary manner in concrete terms.
Objective:
To identify how multidisciplinary teams in primary care collaborate, in regards to the professionals involved in the teams and the collaborative activities that take place, and determine whether these characteristics and practices are present across disciplines and whether collaboration affects clinical outcomes.
Methods:
A systematic literature review of past research, using the MEDLINE, ScienceDirect and Web of Science databases.
Results:
Four types of team composition were identified: specialized teams, highly multidisciplinary teams, doctor-nurse-pharmacist triad and physician-nurse centred teams. Four types of collaboration within teams were identified: co-located collaboration, non-hierarchical collaboration, collaboration through shared consultations and collaboration via referral and counter-referral. Two combinations were commonly repeated: non-hierarchical collaboration in highly multidisciplinary teams and co-located collaboration in specialist teams. Fifty-two per cent of articles reported positive results when comparing collaboration against the non-collaborative alternative, whereas 16% showed no difference and 32% did not present a comparison.
Conclusion:
Overall, collaboration was found to be positive or neutral in every study that compared collaboration with a non-collaborative alternative. A collaboration typology based on objective measures was devised, in contrast to typologies that involve interviews, perception-based questionnaires and other subjective instruments.
... Significant improvements in patient care were associated with MDT discussion in the four remaining prospective studies. From 18% to 34.5 percent of patients had their treatment programs altered, according to the findings [8][9][10][11][12][13][14][15]. Patients with bladder cancer, rather than kidney cancer, were more likely to have their treatment plans revised, according to one research [13]. ...
... In the second case, the surgical treatment was revised after debate, since the members of the multidisciplinary team (MDT) had differing interpretations of the clinical recommendations. Different writers distinguished between major and minor changes to the treatment plan in four separate prospective and retrospective studies [9]. Among a mixed-cancer population, one research found that 12.4% of the patients analyzed had treatment regimens altered. ...
... Six studies [5][6][7][8][9][10] looked at the relationships between patient survival outcomes and the organization of MDT sessions. No link between MDT discussion and overall survival was discovered in four trials that controlled for confounding factors. ...
Context: Collaboration across different disciplines in healthcare settings is a crucial element that impacts patient outcomes and the occurrence of adverse events. This systematic review and meta-analysis seek to consolidate evidence from multiple studies to assess the influence of efficient interdisciplinary communication and team ownership on patient outcomes and the occurrence of adverse events in healthcare. Method: The study approach for this systematic review and meta-analysis entails doing an extensive search across many electronic databases, such as PubMed/MEDLINE, Embase, Cochrane Library, PsycINFO, and CINAHL. The search technique will utilize a blend of keywords and Medical Subject Headings (MeSH) concepts like "multidisciplinary communication," "ownership in healthcare," "patient outcomes," "adverse events," "systematic review," and "meta-analysis." The utilization of Boolean operators (AND, OR) and truncation will be employed to optimize search sensitivity. Results: Out of the total of 1063 articles initially considered, only 15 articles were found to match the specified criteria for inclusion. A PRISMA chart visually represents the quantity of articles that were identified, screened, and ultimately included in the final review. The articles underwent a final evaluation and were categorized accordingly. A concise summary of the pertinent information taken from each study is provided. Conclusion: Multidisciplinary team (MDT) meetings have a significant influence on patient assessment and management procedures. Nevertheless, there was scant evidence suggesting that MDT meetings led to enhancements in clinical results. Subsequent studies should evaluate the influence of MDT meetings on patient contentment and overall well-being, as well as the frequency of referrals between different fields of expertise.
... [53] Multiple investigations have indicated favorable outcomes associated with collaborative teamwork, encompassing enhanced care continuity, improved coordination, positive changes in patient behavior, alleviation of patient symptoms, and increased satisfaction due to better responsiveness to their needs. [54][55][56] Nonetheless, research also indicates that implementing such collaborative practices can be challenging. [57,58] In real-world scenarios, interprofessional collaboration may face obstacles when healthcare professionals are not fully convinced of its benefits for patients. ...
... Studies have shown that such collaboration improves care continuity, enhances patient satisfaction, and can lead to better health outcomes. [54,56] However, the implementation of collaborative care models is not without challenges. In real-world scenarios, healthcare professionals may not always be convinced of the benefits of interprofessional collaboration, and logistical barriers such as time constraints, poor communication, and lack of coordination can hinder the effectiveness of such approaches. ...
The COVID-19 pandemic has brought unprecedented challenges to healthcare systems worldwide, impacting various aspects of patient care. Polypharmacy, the concurrent use of multiple medications by a single patient, is a significant concern exacerbated by the pandemic. The dual threat of COVID-19 infection and polypharmacy for the same vulnerable group – the elderly and those with pre-existing multimorbidity – is particularly problematic, as polypharmacy has been shown to lead to suboptimal treatment outcomes in many chronic diseases. This comprehensive review explores the multifaceted issues surrounding polypharmacy during the COVID-19 pandemic, addressing its causes, consequences, and potential solutions.
... In the health care context, the abandonment of solo medical practice in primary care in favor of interdisciplinary teamwork has become an international trend driven by policy reforms in most Western countries [73,74,84]. The benefits of this shift have been well documented [74], but also the important professional and organizational challenges that it carries [33]. ...
... In the health care context, the abandonment of solo medical practice in primary care in favor of interdisciplinary teamwork has become an international trend driven by policy reforms in most Western countries [73,74,84]. The benefits of this shift have been well documented [74], but also the important professional and organizational challenges that it carries [33]. Interdisciplinary teamwork dynamics might be particularly difficult when two (or more) self-defined autonomous health providers develop similar roles at the practice level. ...
Background
Solo medical practices in primary healthcare delivery have been abandoned in favor of interdisciplinary teamwork in most Western countries. Dynamics in interdisciplinary teams might however be particularly difficult when two or more autonomous health professionals develop similar roles at the practice level. This is the case of family physicians (FPs) and nurse practitioners (NPs), due to the fact that the latter might accomplish not only the traditional role proper to a nurse, but also several medical activities such as requesting diagnostic exams and prescribing medical treatments. The tensions that this overlap might generate and their implications in regard of the development of professional identities, and consequently of the quality of health care delivered, have been suggested, but rarely examined empirically. The goal of this study is to examine identity work, i.e., the processes of (re)construction of professional identities, of NPs and FPs working together in primary care interdisciplinary teams.
Methods
A longitudinal, interpretive, and comparative multiple (n = 2) case study is proposed. Identity work theory in organizations is adopted as theoretical perspective. Cases are urban primary care multidisciplinary teams from two different Canadian provinces: Quebec and Ontario. Participants are NPs, FPs, managers, and patients. Data gathering involves audio-diaries, individual semi-structured and focus group interviews, observations, and archival material. Narrative and metaphor techniques are adopted for analyzing data collected. Within- and cross-case analysis will be performed.
Discussion
For practice, the results of this investigation will: (a) be instrumental for clinicians, primary care managers, and policy decision-makers responsible for the implementation of interdisciplinary teamwork in primary healthcare delivery to improve decision-making processes and primary care team performance over time; (b) inform continuing interdisciplinary professional development educational initiatives that support competency in health professionals’ identity construction in interdisciplinary primary care organizations. For research, the project will contribute to enriching theory about identity construction dynamics in health professions, both in the fields of health services and primary care education research.
... The term "Interdisciplinary Collaboration" refers to the collaboration of a group of specialists from two or more disciplines working together. [18] "Interprofessional Collaboration" (IPC) is defined as a process in which professionals from several disciplines have common roles and responsibilities in order to be able to respond in a coherent and integrated way to the needs of patients, their loved ones, and the community. [19] Interdisciplinarity is a response to the fragmented knowledge of numerous disciplines. ...
... [24] The concept of "collaboration" in healthcare is a problem-solving process, [6,25] shared decision-making, [1,25] responsibility and the ability to carry out a care plan while working to achieve a common goal. [18,26] Antecedents Individual attributes Belief in interprofessional collaboration care and personal flexibility, [25,27] work experience, age, and gender. [10,19,28] Team attributes ...
Background
“Interprofessional Collaboration” is associated with improving the quality of care. The objective of this study was the analysis of the concept of “Interprofessional Collaboration” using a hybrid model.
Materials and Methods
A hybrid model was used in order to analyze the concept of “Interprofessional Collaboration.” The first phase was the scientific search of texts in all valid electronic databases. The second phase includes fieldwork in which medical, pharmaceutical, and nursing staff were interviewed. Data were collected, reviewed, and analyzed in the third phase.
Results
The four main themes extracted in the theoretical phase included: “attributes of individual, team, organizational, and system.” In the fieldwork phase, three themes and seven sub-themes were identified: “Dynamism/effectiveness of collaboration, uncertain boundaries of collaboration, advanced organizational culture.” In the final phase, with the combination of the results of two previous phases, the final definition of the concept was presented: “A process that brings together systems, organizations and individuals from various professions to achieve common interests and goals. Achieving common goals and interests is influenced by individual, team, organizational, and system attributes.”
Conclusions
Defining the concept of interprofessional collaboration and identifying its various aspects can be a practical guide for creating and evaluating it in educational and clinical settings.
... Despite the numerous benefits, their growing need in the post-pandemic era, and the governmental push for widespread adoption, EMR's effectiveness can be hindered by lack of unification, particularly in the US healthcare system [25]. For example, with the growing number of patients with multimorbidity, there has been a growing call to restructure the US primary care system to multidisciplinary care [26,27]. Multidisciplinary care can include (i) collaboration through shared consultations, (ii) co-located teams of highly coordinated healthcare professionals but without shared consultations, (iii) collaboration via referral and counter-referral, which usually has a clinical leader who collates medical information from other specialists and guides the overall care of the patients, and (iv) non-hierarchical continuous horizontal collaboration which lacks a distinctive clinical leader [26]. ...
... For example, with the growing number of patients with multimorbidity, there has been a growing call to restructure the US primary care system to multidisciplinary care [26,27]. Multidisciplinary care can include (i) collaboration through shared consultations, (ii) co-located teams of highly coordinated healthcare professionals but without shared consultations, (iii) collaboration via referral and counter-referral, which usually has a clinical leader who collates medical information from other specialists and guides the overall care of the patients, and (iv) non-hierarchical continuous horizontal collaboration which lacks a distinctive clinical leader [26]. While EMRs can significantly improve healthcare procedures, diagnoses, and symptom management in all four types of multidisciplinary care models, the use of proprietary formats and strict privacy protocols by different EMR systems can impede information sharing between healthcare organizations [28], especially when some of the team members are outside of the primary point of care [27,29]. ...
Background
In recent years, innovation in healthcare technology has significantly improved the efficiency of the healthcare system. Advancements have led to better patient care and more cost-effective services. The electronic medical record (EMR) system, in particular, has enhanced interoperability and collaboration across healthcare departments by facilitating the exchange and utilization of patient data. The COVID-19 pandemic further accelerated this trend, leading to a surge in telemedicine services, which rely on electronic communication to deliver healthcare remotely.
Main body
Integrating artificial intelligence (AI) and machine learning (ML) in healthcare have been instrumental in analyzing vast data sets, allowing for identifying patterns and trends that can improve care delivery and pinpoint potential issues. The proposal of a unified EMR system in the USA aims to capitalize on these technological advancements. Such a system would streamline the sharing of patient information among healthcare providers, improve the quality and efficiency of care, and minimize the likelihood of errors in patient treatment.
Conclusion
A unified electronic medical record system represents a promising avenue for enhancing interoperability within the US healthcare sector. By creating a more connected and accessible network of patient information, it sets the stage for a transformation in healthcare delivery. This change is imperative for maintaining the momentum of progress in healthcare technology and realizing the full potential of recent advancements in patient care and system efficiency.
... Whereas, not having access to onsite physicians and specialists was identified as a challenge. The co-location of team members in a healthcare setting has been noted to facilitate collaboration [47,48]. More specifically, a systematic review of multidisciplinary collaboration found that teams that were co-located in the same space were highly coordinated, leveraging meetings and face-to-face communication [47]. ...
... The co-location of team members in a healthcare setting has been noted to facilitate collaboration [47,48]. More specifically, a systematic review of multidisciplinary collaboration found that teams that were co-located in the same space were highly coordinated, leveraging meetings and face-to-face communication [47]. Similarly, a qualitative study highlighted a number of benefits of the co-location of interdisciplinary teams, including: ease of access, relationship development, team congeniality, collective efficacy, idea exchange, seamless person-centred care, and collaboration [48]. ...
Background
Given growing hospital capacity pressures, persistent delayed discharges, and ongoing efforts to improve patient flow, the use of unconventional environments (newly created or repurposed areas for patient care) is becoming increasingly common. Despite this, little is known about individuals’ experiences in providing or receiving care in these environments.
Objectives
The objectives of this study were to: (1) describe the characteristics of three unconventional environments used to care for patients experiencing a delayed discharge, and (2) explore individuals’ experiences with the three unconventional environments.
Methods
This was a multi-method qualitative study of three unconventional environments in Ontario, Canada. Data were collected through semi-structured interviews and observations. Participants included patients, caregivers, healthcare providers, and clinical managers who had experience with delayed discharges. In-person observations of two environments were conducted. Interviews were transcribed and notes from the observations were recorded. Data were coded and analyzed thematically.
Results
Twenty-nine individuals participated. Three themes were identified for unconventional environments: (1) implications on the physical safety of patients; (2) implications on staffing models and continuity of care; and, (3) implications on team interactions and patient care. Participants discussed how the physical set-up of some unconventional spaces was not conducive to patient needs, especially those with cognitive impairment. Limited space made it difficult to maintain privacy and develop social relationships. However, the close proximity of team members allowed for more focused collaborations regarding patient care and contributed to staff fulfilment. A smaller, consistent care team and access to onsite physicians seemed to foster improved continuity of care.
Conclusions
There is potential to learn from multi-stakeholder perspectives in unconventional environments to improve experiences and optimize patient care. Key considerations include keeping hallways and patient rooms clear, having communal spaces for activities and socialization, co-locating team members to improve interactions and access to resources, and ensuring a consistent care team.
... A common approach for solving complex problems in healthcare is a multidisciplinary approach, where people from multiple disciplines work in parallel (2)(3)(4). Originating in the academic environment, disciplines "are kinds of collectivities that include a large proportion of persons holding degrees with the same differentiating specialization name, which are organized in part into degree-granting units that in part give degree-granting positions and powers to persons holding these degrees" (5). Examples of contributing disciplines are health professions (e.g., medicine, nursing, pharmacy), basic sciences, engineering, social work, architecture, economics, and business. ...
The evolving needs in healthcare education and delivery have led to diverse MD-based dual degree programs offering trainees broader experiences and credential-based credibility after graduation. Medical schools typically implement multidisciplinary or interdisciplinary dual degree training with designs that separate the contributing disciplines chronologically and experientially. As a result, these designs fail to maximize the cohesive learning environment and outcomes possible with a transdisciplinary dual degree design, which integrates the contributing disciplines chronologically, experientially, and conceptually. Though rare, transdisciplinary dual degrees promise transformative educational outcomes and discipline convergence by dissolving traditional discipline boundaries and fostering a new learning environment and professional identity. Therefore, we hypothesize that a transdisciplinary dual degree curriculum yields novel—and potentially better—learning outcomes. ENMED, a transdisciplinary dual degree program collaboratively developed, sponsored, and implemented by Texas A&M University and Houston Methodist Hospital, is testing this hypothesis by training “physicianeers.” This new type of healthcare professional trains simultaneously for the MD and Master of Engineering degrees, thereby integrating medical and engineering expertise to advance health system innovations. Supporting the hypothesis, ENMED’s early experiences suggest its transdisciplinary dual-degree model leads physicianeer trainees to novel perspectives with the potential to transform healthcare systemically.
... Complete preoperative evaluation and exact planning, one of which was the arrangement of the necessary blood products, ensured optimal preparation for the surgeries to be performed. This is the holistic approach that medical researchers are referring to, which shows that multidisciplinary care provides better patient outcomes and leads to lower complications in surgical settings [22,23] . ...
Background
Coronary artery disease (CAD) is a prevalent cardiovascular condition and leading cause of morbidity and mortality worldwide. The management of orthopedic injuries requiring surgical fixation is particularly complex in patients with comorbidities such as diabetes mellitus (DM) and hypertension (HTN). Coordinating the sequence, timing, and execution of coronary artery bypass grafting (CABG) and orthopedic fixation requires careful consideration of the patient’s overall health, surgical risks, and recovery potential.
Case presentation
A 55-year-old male presented with a right distal tibial fracture following a fall. His medical history included HTN, type 2 diabetes mellitus (T2DM), and Kyrle’s skin disease. During his hospital stay, he was diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI). Severe multivessel CAD was confirmed by catheterization. After interdisciplinary consultation, simultaneous CABG and open reduction and internal fixation (ORIF) of the tibial fracture were performed. He was discharged in good condition and showed positive recovery during a one-month follow-up.
Discussion
This case highlights the complexities of managing patients with multiple comorbidities who require both cardiac and orthopedic surgeries. This simultaneous approach allows for efficient treatment, leading to a shorter hospital stay and recovery period. This report supports the feasibility and benefits of simultaneous surgery in complex clinical scenarios, although further studies are required to establish broader guidelines.
Conclusion
Our case emphasizes the importance of a multidisciplinary approach for managing patients with multiple comorbidities who require concurrent surgical intervention. Preoperative planning and specialty coordination ensured optimal outcomes. Further research is needed to develop standardized guidelines for intraoperative care of patients undergoing simultaneous procedures.
... The PCMH comprises five aspects for delivery of holistic care, including a comprehensive care model (e.g., a team of clinicians), patient-centered care (i.e., patients and families are at the center of decision making), coordinated care, accessible services (e.g., shorter wait times, 24 h access), and quality and safety (e.g., evidence-based practice, outcome measurement, patient satisfaction) [3]. This PCMH model of care is well supported in the literature for both adult and pediatric care, including integration of psychology, pharmacy, social work, and dietetics [5][6][7]. As primary care is not defined by the credentialed providers on the team but rather the skill sets needed to optimally support a population, there is also interest in embedding physical therapists (PTs) as a part of the PCMH team [8]. ...
The growing need for collaborative healthcare teams to meet complex health challenges has led to physical therapists (PTs) being embedded in adult primary care settings for many years now. However, this model of care has not been found in pediatrics. This qualitative study sought to gain insights from pediatricians on the potential of embedding pediatric PTs in primary care. Participants were nine pediatricians practicing in both urban and rural, hospital-based and private settings. Semi-structured interviews were recorded, transcribed, and analyzed via thematic analysis per published methods, assuring trustworthiness. Three overarching themes emerged: pediatricians’ priorities aligned with the Quadruple Aim of Healthcare, embedded PTs could fill multiple roles in pediatrics, and they could see a wide variety of patients, highlighting real potential benefits in primary care. Participants endorsed in-office focused treatments, screening to determine optimal care pathways, and ongoing patient follow-up as potential PT roles in this setting. Providers thought that PTs could help manage care for musculoskeletal complaints, high-risk infants, medically complex children, autism, and obesity. An advanced-trained PT having attributes of confidence, adaptability, and open-mindedness was desired. All participants endorsed pediatric primary care PTs as having potentially high value in their practice. This is the first known study on the potential of embedding a PT in the pediatric primary care setting, offering valuable insights from pediatricians to be leveraged in implementation planning.
... Multidisciplinary teamwork is a distinctive feature of primary healthcare reforms in Australia and elsewhere (Brewer et al. 2024;Harris et al. 2016;Saint-Pierre, Herskovic & Sepúlveda 2018), and its importance has been reinforced by the recent Strengthening Medicare Taskforce Report, which recommended strengthening education and training programs "to support an integrated, person-centred team care approach" (Strengthening Medicare Taskforce 2022). ...
Multidisciplinary teams delivering person-centred care are a central feature of primary healthcare reforms in Australia and North America. General practice is a primary healthcare service that prioritises clinical person-centred care. The recent Strengthening Medicare Taskforce Report recognised that a person-centred team care approach needs strengthened education and training programs to support multidisciplinary teams in general practice. While the premise of multidisciplinary care is well established, the strengthening of education and training programs in general practice offers opportunities at the vocational training level and for intra-practice education. This Education in Practice paper discusses the relevance to contemporary general practice of findings from Tasmanian research projects conducted over the past decade, addressing two questions for general practice training: 1. How can approaches to team-based education be tailored to different general practice settings? 2. What strategies are best for delivering interprofessional training in general practice? The challenges presented by these questions are addressed by drawing from a consensus project on best practice in interprofessional training for collaborative primary healthcare, and from projects using in-person and online education and training. We propose a model that uses the clinical training space as a way of promoting multidisciplinary general practice. The model incorporates online and face-to-face spaces, where primary healthcare professionals, patients, practices/teaching organisations, educators and technology are aligned through facilitation and feedback channels in ways that promote collaborative practice. Tasmania, as an island state with close connections between its university, state public health service and general practitioner training, is well placed as a case study for strategic conversations about coordinating general practice education and training to meet the need for an integrated, multidisciplinary primary healthcare workforce.
... Patients interviewed in our qualitative substudy preferred fewer actors in their care pathway and identified their GP as care coordinator. In other countries, care coordination in mental health collaboratives may be performed by someone other than the GP who is not necessarily a caregiver, but a care manager [28]. Some studies have shown that working with a care manager reduces symptoms of depressive disorder and improves patient health education, while facilitating interprofessional communication [2,16,24,26,32,36]. ...
Background: The effectiveness of interprofessional collaboration (IPC) in primary care is unclear. It may have health benefits for patients with cardiovascular or mental health problems. The increase in the prevalence of mental disorders (particularly depressive episodes) in France over the last decade will mobilize both primary care and mental health actors in the future. They have a vested interest in working together to meet the growing needs of the French population. A consultation-liaison with a private psychiatrist was tested over 4 years within a French multi-professional health center (MHC) located in a French rural town. The overall aim of the study was to assess the care needs of GPs and their patients who benefited from this IPC. A study using a mixed methods approach was carried out with the following specific aims: (1) the main objective of the quantitative study was to describe the reasons for referral to psychiatrist by GP. The secondary objectives were to describe the responses given by the psychiatrist and to estimate the association between reasons for referral and patients characteristics; (2) the main objective of the qualitative study was to explore how patients perceived the GP-psychiatrist IPC, and the collaboration they experienced in this MHC. The secondary objectives were to explore their actual experiences in the French mental health system and their perceived needs.
Methods: A convergent parallel design study was set up by combining a retrospective cross-sectional study by analyzing data from the medical records of patients, a qualitative study using semi-directed individual interviews and a non-participant observation with volunteer patients, and an integrative analysis phase to mirror the results of the two sub-studies. The analysis of data from the quantitative study was descriptive, followed by multivariate logistic regression analyses. The analysis of data from the qualitative study was inspired by Grounded Theory. The target population was adult patients who had visited at least one GP in the MHC.
Results: One hundred patients were included in the quantitative study (women: 65%, mean age: 47.2 years), who were seen by the psychiatrist in 117 consultations. Three types of request were made by GPs to the psychiatrist: therapeutic requests (83.7%), diagnostic requests (35.9%), and administrative requests related to work absence (4.2%). After adjustment, patients were more likely to be referred to the psychiatrist for a therapeutic reason if they had depressive or anxiety disorder (AOR = 4.46, 95% CI: 1.57-12.69). Patients with bipolar disorder were more likely to be referred for diagnostic advice (AOR = 10.59, 95% CI: 1.88-59.72). The psychiatrist's response was mainly therapeutic (91.5%): pharmacological in 74.3% of cases and psychotherapeutic in 50.4%. A diagnostic response was given in 41.9% of consultations. Of these diagnostic responses, 48.9% were diagnostic confirmations and 22.4% were alternative diagnoses. Ten patients participated in the qualitative study. They perceived the GP as the coordinator of care and the psychiatrist as the expert. This pair, supported by other actors or approaches, guided the patient with a mental disorder towards holistic rehabilitation. Patients also found the organization of mental health care in France difficult to understand and inadequate (short consultations, too-long intervals between consultations). Four changes in this mental health care system were identified by patients as priorities: proximity and flexibility of mental health care, more interaction between mental health professionals and GPs, patient involvement in theIPC, and integration of other actors or approaches in care. GPs sought support from psychiatrists in situations of diagnostic or therapeutic uncertainty, and when mental health was interfering with work. GPs and their patients agreed that the first provider of mental health care should be the GP, and patients also felt that this IPC could improve emergency management.
Conclusions: GPs in this MHC were involved in the mental health care pathway of their patients who recognized it. However, IPC remained necessary to obtain psychiatric expertise as a second resort in identifiable primary care situations.
... Interdisciplinary network and collaboration between all primary care providers 26,28,31,33,35,36,41 Support offered by more experienced healthcare providers 28,30 If no provider is designated for linking activities, all providers should work together to ensure the service offering 39 Physician acting as a central point for interprofessional and intersectoral collaboration by adding relevant actors to the patient's record 42 Collaboration between the healthcare provider/linking program and the patient/family during the planning stage 24,34,35 Collaboration between providers and COs during linking activities to promote intersectoral collaboration and integration of services from various settings 30,32,35,46,48 Intersectoral collaboration: Building a relationship before referral, sharing relevant information, and/or following up after the service has been established 25 Continuous collaboration between primary care and linking programs 24,27,36,38,40,41,46 in primary care settings can have on patients' well-being and clinical outcomes in a CD management context. [51][52][53][54] During the consultation phase, experts highlighted that the complexity associated with the patient's needs and care management influences the level of interprofessional collaboration required. Thus, for each category of linking activities, barriers may arise as the complexity of the clinical situation increases, requiring more interprofessional concertation to ensure an effective implementation of activities. ...
Context
Aging and increasing comorbidities in the population are leading to more complex care for patients and primary healthcare providers. Community organizations (COs) may play a role in the services offered to support patients with chronic diseases (PCDs) but there are currently no clear guidelines to support primary healthcare providers in linking patients to COs.
Objectives
The aim of this study was to describe the role of primary healthcare providers regarding linking PCDs to COs by: (1) describing linking activities; and (2) identifying the main facilitators and barriers associated with these activities.
Methods
This scoping review was based on the Arksey and O’Malley method, completed by Levac, Colquhoun, and O’Brien. Related keywords were used in 7 databases to search relevant studies. After the initial screening, 135 full texts were assessed for eligibility by 2 reviewers using inclusion/exclusion criteria. Empirical studies describing activities performed by primary healthcare providers in linking PCDs to COs or describing facilitators or barriers to linking activities were included. Studies describing activities linking to other services than COs or located in emergency departments were excluded.
Results
In total, 28 studies were included. Information reported in the studies was classified into 8 main linking activities: capacity development, patient identification, assessment, information, planning, referral, follow-up, and collaboration. Facilitators and barriers to these activities were related to intrapersonal characteristics of providers and patients, professional practice, work environment, relationships, and external influences. Healthcare providers’ involvement was often adapted according to their field of practice.
Conclusion
This scoping review details the role of primary healthcare providers when linking PCDs to COs in a collaborative and interdisciplinary context, which can be adapted to clinical practice by providers, experts, or stakeholders to support improvement in chronic care management.
... Our findings also highlighted the importance of interprofessional collaboration in implementing extended home visiting programs, aligning with studies asserting that multidisciplinary teams are essential for holistic healthcare delivery [35,36]. A paper looking into Home Visiting Programs in Sweden reached a similar conclusion from a middle manager's point of view [37]. ...
Background
Historically marked by a high infant mortality rate, Sweden’s healthcare reforms have successively led to a robust, decentralized universal child health system covering over 97% of the population 0–5 years. However, inequities in health have become an increasing problem and the public health law explicitly states that health inequities should be reduced, resulting in various government initiatives. This study examines the experiences of Central Child Health Services (CCHS) teams during the implementation of the Child Health Services Accessibility Agreement between the State and the regions starting in 2017. The agreement aimed to enhance child health service accessibility, especially in socio-economically disadvantaged areas, but broadly stated guidelines and the short-term nature of funding have raised questions about its effectiveness. The aim of this study was to understand the experiences of CCHC teams in implementing the Child Health Services Accessibility Agreement, focusing on investment decisions, implementation efforts, as well as facilitators and barriers to using the funds effectively.
Methods
CCHC teams were purposefully sampled and invited via email for interviews, with follow-ups for non-respondents. Conducted from January to October 2023, the interviews were held digitally and recorded with individuals familiar with the agreement’s implementation within these teams. Both authors analyzed the transcripts thematically, applying Braun and Clarke’s framework. Participants represented a cross-section of Sweden’s varied healthcare regions.
Results
Three main themes emerged from the thematic analysis: “Easy come, easy go,” highlighting funding uncertainties; “What are we supposed to do?” expressing dilemmas over project prioritization and partner collaboration; and “Building castles on sand,” focusing on the challenges of staff retention and foundational program stability. Respective subthemes addressed issues like fund allocation timing, strategic decision-making, and the practical difficulties of implementing extended home visiting programs, particularly in collaboration with social services.
Conclusions
This study uncovered the challenges faced in implementing the Child Health Services Accessibility Agreement across different regions in Sweden. These obstacles underline the need for precise guidelines regarding the use of funds, stable financing for long-term project sustainability, and strong foundational support to ensure effective interprofessional collaboration and infrastructure development for equitable service delivery in child health services.
... Due to the multidimensional nature of social constructs and phenomena, social science research often involves collaboration between different disciplines, in recognition of the fact that human behaviour and society are multifaceted and complex. To supplement their corpus of knowledge, researchers might therefore draw appropriate theories, models and approaches from various adjacent or reference disciplines to gain a holistic and comprehensive understanding 50,51 . Thus, in investigating complex social phenomena, interdisciplinarity and transdisciplinarity approaches are utilised to address complex problems that require theoretical insights from multiple academic disciplines (see figure 2). ...
Theoretical frameworks generally serve as the intellectual scaffolding that underpins research processes in the social sciences, providing an analytical lens through which researchers make sense of complex social phenomena. This article is an exploration of the fundamental role of theoretical frameworks in social science research. Firstly, it sheds light on its ontological, epistemological and methodological design imperatives, beginning with an elucidation of the concept of theoretical frameworks within the realm of social science research. Secondly, the significance of integrating theoretical frameworks in the research process is analysed, with an emphasis on the fact that it enhances the rigour and clarity of scholarly inquiry by guiding researchers when formulating research questions and hypotheses and in the interpretation of research findings. It conducts a literature review following an abstract conceptual design in an interpretivist research paradigm. Steps are proposed that can be followed when constructing a theoretical framework, using the construct 'poverty' as example. Since social science research deals with intricate and multifaceted social phenomena, theoretical frameworks provide researchers with a structured lens through which they can make sense of this complexity, offering a systematic way to organise and analyse data and observations. They also ensure that the study is focussed and aligned with existing knowledge and relevant theories. Transdisciplinary Contribution The significance of inter-, multi-and transdisciplinarity in the construction of theoretical frameworks in social science research are expounded by accentuating the ways in which knowledge domains and methodologies of multiple disciplines create a comprehensive 2 understanding of complex social phenomena. A new corpus of knowledge emerges that usually transcends individual disciplines.
... Brokerage mainly involves coordinating services often with non-clinically trained individuals. As such, the other models (clinical case management, strength, intensive case, assertive community treatment and rehabilitation) are useful in multidisciplinary team work [37][38][39]. ...
The collective effort of specialized individuals in every institution helps in contributing to the ultimate success. Malignant liver cells mimic similar actions of coordinated efforts through their unregulated multiplication subsequently resulting in multiorgan failure whence the third most common cause of cancer related mortality globally. Irrespective of the form of liver cancer in the patient, there are significant challenges to the patient, carers, and health professionals. Issues arise in line of decision making and implementation of the best management modality. Due to the complexity, and patient's needs during metastatic processes, multidisciplinary input is a necessity for optimal outcomes. Complications arising from liver cancer tend to impair the patient's functioning. To avert poor hastened outcomes for better prognosis , unique interventions should be from specialized professionals. Patients who are treated successfully may require rehabilitation therapy. In instances when liver cancer is incurable, the best quality of life should be maintained while on supportive chemo-therapy with integration of palliative care.
... Although there has been considerable progress with adoption of LHSs within the last five years, this research has been largely focused on PC settings. PC encompasses a broad array of services and settings, and multidisciplinary care has been highlighted as crucial for improved patient outcomes amidst growing disease burden and ageing populations [67,68]. Indeed, many articles included in the current review reported multidisciplinary interventions [30] and other alternative care models to standard general practice [54], which appear to be increasingly popular. ...
Background
An essential component of future-proofing health systems against future pandemics and climate change is strengthening the front lines of care: principally, emergency departments and primary care settings. To achieve this, these settings can adopt learning health system (LHS) principles, integrating data, evidence, and experience to continuously improve care delivery. This rapid review aimed to understand the ways in which LHS principles have been applied to primary care and emergency departments, the extent to which LHS approaches have been adopted in these key settings, and the factors that affect their adoption.
Methods
Three academic databases (Embase, Scopus, and PubMed) were searched for full text articles reporting on LHSs in primary care and/or emergency departments published in the last five years. Articles were included if they had a primary focus on LHSs in primary care settings (general practice, allied health, multidisciplinary primary care, and community-based care) and/or emergency care settings. Data from included articles were catalogued and synthesised according to the modified Institute of Medicine’s five-component framework for LHSs (science and informatics, patient-clinician partnerships, incentives, continuous learning culture, and structure and governance).
Results
Thirty-seven articles were included, 32 of which reported LHSs in primary care settings and seven of which reported LHSs in emergency departments. Science and informatics was the most commonly reported LHS component, followed closely by continuous learning culture and structure and governance. Most articles (n = 30) reported on LHSs that had been adopted, and many of the included articles (n = 17) were descriptive reports of LHS approaches.
Conclusions
Developing LHSs at the front lines of care is essential for future-proofing against current and new threats to health system sustainability, such as pandemic- and climate change-induced events. Limited research has examined the application of LHS concepts to emergency care settings. Implementation science should be utilised to better understand the factors influencing adoption of LHS approaches on the front lines of care, so that all five LHS components can be progressed in these settings.
... Άλλοι επιςτιμονεσ που ςτελεχϊνουν τισ διεπιςτθμονικζσ ομάδεσ είναι γενικοί ι οικογενειακοί ιατροί, νοςθλευτζσ, διατροφολόγοι, κοινωνιολόγοι, ψυχολόγοι, ψυχοκεραπευτζσ και εργοκεραπευτζσ. το μεγαλφτερο ποςοςτό τουσ, οι μελζτεσ καταλιγουν ςτο ςυμπζραςμα πωσ οι διεπιςτθμονικζσ ομάδεσ πετυχαίνουν καλφτερο αποτζλεςμα ςτο ςφνολο τθσ φροντίδασ των αςκενϊν (Saint-Pierre et al., 2018). ...
The aim of this study is to highlight the role of pharmacists in the management of pharmacotherapy in elderly patients in Greece. Similar studies conducted in other foreign countries have also emphasized the importance of pharmacists’ presence for the benefit of patients in all aspects of their health. Greek pharmacists seem to have both the scientific knowledge and the necessary professional training to effectively attend to an elderly patient. Their qualifications are considered crucial in reducing polypharmacy and the occurrence of adverse drug reactions as well as in achieving better compliance of patients to their treatments. Nevertheless, the effective provision of pharmaceutical care by the pharmacists presupposes the elimination of serious obstacles such as the extensive bureaucracy and the lack of recognition of their value by both the state and other health professionals.
... 28 Further, it is plausible that the exercising of discretion by healthcare professionals in their meetings with patients, central to Lipsky's theories on street-level bureaucracy, can in uence the dynamics of teamwork and collaboration, and the development of collaborative relationships between professionals in primary care typically evolve on a case-by-case basis and rely on personal knowledge and trust. 29 It might therefore be useful for those involved with implementing the FCP role to consider how to facilitate the development of effective and sustainable multidisciplinary teamworking, whilst taking into consideration the different scopes of different professions as well as the local needs and expertise, to foster positive collaboration in order to enhance patient outcomes. ...
Background
The First Contact Practitioner role have been established in England to expand multidisciplinary working in primary care. First Contact Practitioners, including podiatrists, paramedics, physiotherapists, dietitians, and occupational therapists, undergo less foundational training than General Practitioners. Health Education England commissioned The University of Central Lancashire to deliver a module for First Contact Practitioners to support the development of the knowledge, skills, and attitudes required to provide safe and effective care in primary care. This study investigated the utility of the module as perceived by First Contact Practitioners who had completed the module and their clinical mentors, and their perceptions about how the First Contact Practitioner role meets the clinical realities of primary care.
Methods
Using a qualitatively driven mixed-methods approach, we collected data via online surveys and semi-structured interviews. We explored the empirical material using a reflexive and creative method, and used Lipsky’s theories on street-level bureaucracy as a theoretical frame of reference.
Results
Twenty-one students and six clinical mentors completed the survey, six students and two clinical mentors were interviewed. We found that perceptions about the utility of the module is influenced by personal circumstances, professional identity, and mentoring experience, and that profession-specific competence typically fall short of the capabilities required for the primary care gatekeeper role. The participants indicated that a clear definition of the First Contact Practitioner role is missing, which might sit in contrast to policymakers’ perception that there is a clear blueprint for the implementation of the role.
Conclusions
Our findings can inform and guide postgraduate training for healthcare professionals wanting to pursue a career in primary care, as well as employers that implement public policy at the street level. Our study can guide policymakers, who in their endeavour to improve public services must allow autonomous practitioners to interpret and show discretion in their meetings with patients, but also offer clear guidelines, job descriptions, and roadmaps.
... Through recruiting multidisciplinary team members such as district nurses, therapists, social workers, pharmacists, care-coordinators and social prescribers to work as part of a comprehensive primary care team, we can provide a more coordinated approach to tackle a full spectrum of health issues. 9 This model fosters stronger patient-provider relationships, improves patient satisfaction and empowerment, and is more cost-effective than the fragmented services currently being implemented in parts of England. Other interventions to help GPs improve integrated care include reducing their administrative burden through training non-clinical staff to take on some of this work; and improving working arrangements and the integration of health records across the primary-secondary care interface to reduce duplication of data entry and improve the accuracy of records. ...
... [78][79][80][81] This extended to the reliance pharmacists had in day-to-day work, also consistently reported in primary care literature. 21,[82][83][84][85][86] These results were similar to other research including examples of physicians requiring their intervention with patients instead of the pharmacists directly interacting with patients 87 ; concerns regarding "jurisdictional trespassing" 20,71,85 ; limited access to patients and/or withholding referral 84 ; and pharmacists who passed responsibility onto physicians. 88 Allowing others to control the pharmacists' role may reduce the pharmacists' accountability in their teams. ...
... Gli ostacoli includono la mancanza di modalità efficaci per fornire e ricevere informazioni sulla cura del paziente e di chiarezza del ruolo professionale. 2,28,31,46,47 La revisione ha identificato tra le barriere a livello di team lo squilibrio percepito dai membri del team rispetto a questioni come la gerarchia e il potere, esperienze di collaborazioni negative, comportamenti non professionali o sconsiderati e il non sentirsi parte del team. 42,48 Le collaborazioni di gruppo possono essere influenzate dalle dimensioni del gruppo, 30 dalla comunicazione frammentata senza riunioni di gruppo formali o informali, 49,50 dalla carenza di personale, dall'inadeguatezza delle risorse, dalla discriminazione, dalla mancanza di rispetto, dalla sfiducia e da relazioni demotivanti sul lavoro. ...
L’interprofessionalità tra evidenze scientifiche e best practiceT.M. Attardo, L. Tesei, A. Montagnani L’impatto della collaborazione interprofessionale nell’organizzazione e nella qualità di curaF. Dentali, G. Catania La nutrizione nei pazienti terminali: quali migliori approcciP. Gnerre, G. Riggi, G. Filannino L’iperglicemia e l’ipoglicemia: come prevenirle, come gestirleT.M. Attardo, A. Morselli La sindrome ipocinetica: cosa non ha funzionato? La collaborazione interprofessionale può fare la differenza?M. Frualdo, S. Brovarone, M. Piasentin, S. Lenti L’impatto dell’interprofessionalità sull’incidenza delle infezioni correlate all’assistenzaI. Lo Burgio, A. Toccaceli, D. Dalla Gasperina La cirrosi epatica: quali strategie clinico-assistenziali per migliorare la qualità di vita dei pazientiP. Piccolo, N. Cosentino L’interprofessionalità come strumento per un corretto management del deliriumP. Gnerre, R. Rocchi, D. Clemente Il giro visita congiunto come strumento per una migliore cogestione dei pazientiF. Dentali, A. Vitiello La dimissione dall’ospedale: percorso di condivisione del teamO. Para, R. Rapetti, S. Di Bernardino Quando l’interprofessionalità coinvolge anche il paziente: come fare buona sanità oltre la curaL. Tesei, D. Manfellotto Pillole di interprofessionalità: decalogo FADOI/ANIMO: punti comuni e rilevanti per creare collaborazioni tra professionistiT.M. Attardo, L. Tesei
... There are collaboration with healthcare professionals, such as physicians and nurses to ensure that the software meets clinical needs and aligns with best practices in patient care. Clinicians provide insights into workflow requirements, data relevance, and usability from a healthcare perspective (Saint-Pierre et al, 2018). The fourth research question examines the primary concerns and considerations regarding data security and privacy in the context of big data analytics in medical and therapeutic software. ...
The topic of Big Data inciting revolutionary change in the global healthcare sector has been around for decades. The core principle is the use of constantly collated data to improve healthcare services and increase accuracy and accessibility throughout the subfields. An under-researched area is the use of Big Data in medical software development, further emphasising the growing intersection of modern medicine and advanced product development. The potential of Big Data analytics in this cross-section lies in the direct conversion of personnel-sourced information into actionable insights for patient-centric software development. These software products, while not replacing traditional medical practices and physical attention, have been proven to increase accessibility and speed of management when developed and deployed accurately. Dynamism is crucial to the developmental process to ensure individual assistance for each patient. These products include applications for telemedicine, applications for bionic prosthetic management, e-diagnostic databases, online therapy applications, and assistive technology and sensory management aids. This approach requires the hands-on collaboration of medical professionals, software engineers, big data analysts, and quality assurance experts to design curate, and implement well-tested and detail-oriented data warehouse to serve as dynamic reference points for the development of these products. This paper is a review of global research in big data analytics improving modern medicine, and the work done so far in big data improving technological development. This reports aims to find a bridge between the two branches of big data applications for future purposes and potentially commercialized projects.
... In line with what is mentioned above and according to their role, we propose three other groups of healthcare providers. We qualified nurses, physiotherapists, and pharmacies as "closest proximity providers" and medical laboratories and radiology practices as "intermediate proximity providers" to underline the required complementarity of these professions for the diagnosis and treatment of patients alongside the GPs which promotes a better patient-centered integrated approach of care [27,28]. It also refers more broadly to their role in the healthcare system with regards to ambulatory shift (return to home and coordination process linked to a growing and changing demand for care due to the increased prevalence of chronic disease and multimorbidity). ...
Background
Increasing inequalities in accessibility to primary care has generated medical deserts. Identifying them is key to target the geographic areas where action is needed. An extensive definition of primary care has been promoted by the World Health Organization: a first level of contact with the health system, which involves the co-presence of different categories of health professionals alongside the general practitioner for the diagnosis and treatment of patients. Previous analyses have focused mainly on a single type of provider while this study proposes an integrated approach including various ones to define medical deserts in primary care.
Method
Our empirical approach focuses on the first point of contact with the health system: general practitioners, proximity primary care providers (nurses, physiotherapists, pharmacies, laboratories, and radiologists), and emergency services. A multiple analysis approach was performed, to classify French municipalities using the information on the evolution and needs of health care accessibility, combining a principal component analysis and a hierarchical ascending classification.
Results
Two clusters of medical deserts were identified with low accessibility to all healthcare professionals, socio-economic disadvantages, and a decrease in care supply. In other clusters, accessibility difficulties only concern a part of the health supply considered, which raises concern for the efficiency of primary care for optimal healthcare pathways. Even for clusters with better accessibility, issues were identified, such as a decrease and high needs of health care supply, revealing potential future difficulties.
Conclusion
This work proposes a multi-professional and multi-dimensional approach to medical deserts based mainly on an extensive definition of primary care that shows the relevance of the co-presence of various healthcare professionals. The classification also makes it possible to identify areas with future problems of accessibility and its potential consequences. This framework could be easily applied to other countries according to their available data and their health systems’ specificities.
... The participants concurred with the interrelatedness of the professions within medicine and healthcare in providing the best care in acute, chronic diseases and disorders management. Positive effects of working as a team includes better care continuity and coordination, beneficial changes in patient behaviour, improvement of patient symptoms and satisfaction [42,44,45]. Such inter-profession role may resulted in effective multidisciplinary care in community-based treatment and rehabilitation. ...
Background
The Malaysian Allied Health Profession Act (Act 774) regulates the practice of allied health practitioners in Malaysia, with two described professions viz. allied health profession (AHP) and profession of allied health (PAH). While AHPs have been clearly identified by the law, comprehensive implementation of the act requires development of specific criteria in defining any profession as PAH in the Malaysian context. Hence, the research aims to explore and identify the criteria for defining such professions for healthcare policy direction in Malaysia.
Methods
This research utilised two methods of qualitative research (document review and focus group discussions (FGDs) involving 25 participants from four stakeholders (higher education providers, employers, associations and regulatory bodies). Both deductive and inductive thematic content analysis were used to explore, develop and define emergent codes, examined along with existing knowledge on the subject matter.
Results
Sixteen codes emerged from the FGDs, with risk of harm, set of competency and skills, formal qualification, defined scope of practice, relevant training and professional working within the healthcare team being the six most frequent codes. The frequencies for these six codes were 62, 46, 40, 37, 36 and 18, correspondingly. The risk of harm towards patients was directly or indirectly involved with patient handling and also relates to the potential harms that may implicate the practitioners themselves in performing their responsibilities as the important criterion highlighted in the present research, followed by set of competency and skills.
Conclusions
For defining the PAH in Malaysia, the emerged criteria appear interrelated and co-exist in milieu, especially for the risk of harm and set of competency and skills, with no single criterion that can define PAH fully. Hence, the integration of all the empirically identified criteria must be considered to adequately define the PAH. As such, the findings must be duly considered by policymakers in performing suitable consolidation of healthcare governance to formulate the appropriate regulations and policies for promoting the enhanced framework of allied health practitioners in Malaysia.
... • Highlighting patient experiences can raise public awareness of the importance of home care encounters and the need for a person-centred approach in healthcare, potentially leading to increased support and investment in home care services. Saint-Pierre et al., 2018), they usually perform the nursing measures alone (Larsson Gerdin et al., 2021). During daytime hours, patients in a specified region have an assigned home care nurse for their caregiving needs. ...
Aim:
To explore and describe older persons' unique experiences of care encounters with home care nurses in a real-life context.
Background:
The increasing number of older persons in society contributes to increases in age-related impairments compromising their quality of life. Future care consists of "hospitals at home" where care encounters occur in a person's private domain, partly becoming a clinical workplace. Scant research has focused on how older persons experience care encounters with home care nurses and needs to be highlighted.
Design:
Multiple-case study.
Methods:
The cases relied on replication logic and five purposive sampled older persons were interviewed. Data were analysed using qualitative content analysis and differences within and between cases were explored and findings across the cases were replicated.
Findings:
The cross-analysis emerged in three categories: "Nursing routine rules the care encounters", "Lack of knowledge and information" and "Dependency on support from others".
Conclusions:
Our research has found that older persons face challenges while receiving home care, including limited engagement in their care and the need for enhanced support. Implementing person-centred care in homes poses ethical challenges that require careful consideration. Home care nurses should prioritise understanding each patient individually, recognising them beyond their patient role, which necessitates more thorough and time-sensitive care encounters.
Reporting method:
Findings were reported using COREQ guidelines.
Patient or public contribution:
Patients were interviewed and contributed with data for this study.
Implications for the profession and patient care:
This study emphasises the need to prioritise individualised care in home settings and listen to the voices of older individuals to enhance quality.
... The number of people with chronic conditions has increased relative to the total population, resulting in a greater need for primary care (PC) professionals to collaborate interprofessionally and strengthen relationships with one another (1,2). Working in mono-and multidisciplinary group practices offers new possibilities and challenges in the context of care continuity and care coordination (3,4). ...
Introduction: Despite numerous attempts to improve interprofessional collaboration and integration in primary care, patients, care providers, researchers, and governments are still looking for tools and guidance to do this more efficiently. To address these issues, we decided to develop a generic toolkit, based on sociocracy and psychological safety principles, to guide care providers in their collaboration within and outside their practice. Finally, we reasoned that different strategies should be combined to obtain integrated primary care. Who is it for, and who did we involve and engage with? The results of this study and subsequently the toolkit are ‘directly’ useful for care providers, academics and policymakers. Development of the toolkit consisted of a multiyear co-development process. Data originating from 65 care providers, through 13 in-depth interviews and five focus groups were analysed and subsequently evaluated in eight co-design workshop sessions, organised with a total of 40 academics, lecturers, care providers and members of the Flemish patient association. Findings from the qualitative interviews and co-design workshops were gradually, and inductively adapted and transformed into the content for the IPCI toolkit. Results: Ten themes were identified: (i) awareness of the importance of interprofessional collaboration, (ii) the need for a self-assessment tool to measure team performance, (iii) preparing a team to use the toolkit, (iv) enhancing psychological safety, (v) developing and determining consultation techniques, (vi) shared decision making, (vii) developing workgroups to tackle specific (neighbourhood) problems, (viii) how to work patient-centred, (ix) how to integrate a new team member, and (x) getting ready to implement the IPCI toolkit. From these themes, we developed a generic toolkit, consisting of eight modules. What is the learning for the international audience? What are the next steps? In this study, we describe the multiyear co-development process of a generic toolkit for the improvement of interprofessional collaboration and integrated care. Inspired by a mix of interventions from in and outside healthcare, a modular open toolkit was produced that includes aspects of Sociocracy, concepts such as psychological safety, a self-assessment tool and other modules concerned with meetings, decision-making, integrating new team members and person and population-centred care. Upon implementation, evaluation and further development and improvement, this compounded intervention should benefit the complex problem of interprofessional collaboration in primary care.
An Introduction to Community and Primary Health Care provides a comprehensive and practical explanation of the fundamentals of the social model of health care approach, preparing learners for professional practice in Australia and Aotearoa New Zealand. The fourth edition has been restructured into four parts covering theory, key skills for practice, working with diverse communities and the professional roles that nurses can enter as they transition to primary care and community health practice. Each chapter has been thoroughly revised to reflect the latest research and includes up-to-date case studies, reflection questions and critical thinking activities to strengthen students' knowledge and analytical skills. Written by an expert team of nurse authors with experience across a broad spectrum of professional roles, An Introduction to Community and Primary Health Care remains an indispensable resource for nursing students and health professionals engaging in community and primary health care.
Sağlık hizmetleri, bireylerin ve toplumların sağlığını korumayı, iyileştirmeyi ve geliştirmeyi hedefleyen geniş bir hizmet spektrumunu içermektedir. Bu hizmetlerin kalitesinin artırılması, maliyetlerin düşürülmesi ve erişilebilirliğin sağlanması noktasında yenilikçilik büyük bir önem taşımaktadır. Sağlık hizmetlerinde yenilikçilik, yeni teknolojilerin, yöntemlerin ve fikirlerin geliştirilmesi ve hayata geçirilmesi anlamına gelir. Kuruluşlar, sağlık harcamalarını kontrol altında tutmanın, yaşlanan nüfusun artan gereksinimlerine yanıt vermenin ve daha bilinçli ve talepkâr bir tüketici kitle-sini tatmin etmenin yollarını ararken, yenilikçilik fırsatları önemli ölçüde artış göstermektedir.
İnovasyon (yenilikçilik), günümüz ekonomilerinin ve toplumlarının temel dinamiklerinden biri olarak değerlendirilmektedir. Teknolojik geliş-meler, iş modellerindeki yenilikler ve hizmet sunumundaki dönüşümler, yenilikçiliğin ana unsurları arasında bulunmaktadır. Sağlık hizmetleri sektörü de bu dönüşümden etkilenmiş olup, yenilikçi yaklaşımlar aracılığıyla hastalara daha yüksek kalitede hizmet sunma amacı benimsenmiştir. Bu çalışma sağlık hizmetlerindeki inovasyon teorilerini ortaya koyarak rehberlik sağlamaktadır
The article discusses the latest approaches to the role and place of social workers in healthcare, related to the transition of many countries, including Ukraine, to a new disability assessment model – bio-psychosocial. The aim of the research is to determine the role of a social worker in multidisciplinary teams providing rehabilitation assistance in a rehabilitation facility, and to substantiate the optimal tool for assessing the degree of disability of individuals with limitations in daily functioning. The considered methods of disability assessment in different countries made it possible to state the application of different approaches and the possibility of involving social workers in this process. It is stated, that the implementation of ICF principles in the health care system significantly increases the role of social workers, who assess the level of limitation of a person’s vital activities in separate domains. The authors show that there is currently no universal tool for assessing ICF domains. Most countries develop their own assessment tools for use in the context of social policy, but the basis is the universal health and disability assessment tool developed by WHO experts (WHO Disability Assessment Schedule, WHODAS). The article analyzes the experience of Korea, Taiwan, the Netherlands, and Sweden regarding the assessment of violations carried out by a medical social worker. The necessity and expediency of the participation of social workers as part of an interdisciplinary team is proved. It is substantiated that the new role of the social worker in the field of health care is that he/she, as a member of the multidisciplinary team of the rehabilitation institution, should participate in the process of determining disability in addition to assessing social needs. The authors proposed a tool for assessing the degree of limitation of a person’s vital activities in accordance with WHODAS 2.0, which will contribute to the effective implementation of the ICF in Ukraine.
Background
China is transforming its hospital-centric service delivery system into a people-centered integrated care model, with service delivery organized around the health needs and expectations of people.
Objective
To guide reforms and align with public expectations, this study profiles successful integration in primary health care from the public perspective.
Methods
Guided by the rainbow model of integrated care, semi-structured interviews were conducted in six provinces in China. A total of 58 interviewees completed the interviews. Tape-based analysis was used to produce narrative summaries. Researchers listened to the recordings and summarized by 30-s segments. Thematic analysis was performed on summaries to identify thematic families.
Results
Five themes and 16 sub-themes were generated. Respondents’ expectations were primarily on three themes: clinical integration (such as interaction between professional and client, continuity, and empowering and engaging individuals), functional integration (such as resources management, quality improvement, and reforming payment systems), and system integration (such as institutional distribution and supervision). Yet a few interviewees mentioned professional integration (multi-disciplinary collaboration) and organizational integration (inter-organizational strategy).
Conclusions
Qualitative data were used to reveal public perceptions of successful primary health care integration. Service processes, institutional distribution, regulation, resource management, and quality improvement are more visible to the public and will be priorities for future efforts. Whereas inter-organizational strategies and multi-disciplinary collaboration have been shown to facilitate service improvements. Future efforts could consider how policy efforts can be grounded in visible service delivery through management practices.
The role of education staff in supporting social, emotional, and mental health (SEMH) difficulties is critical, however access to specialist mental health input can be difficult. Digitally‐mediated service delivery was implemented during the COVID‐19 pandemic and may be integrated in a post‐COVID‐19 world to support education staff. Using a systems change evaluation framework, this study explored staff perceptions of a digitally‐mediated, multidisciplinary model for SEMH needs in primary school settings. Participants were education staff ( n = 6) from five participating schools in a rural county in the UK and the multidisciplinary team ( n = 7). Focus groups were conducted at baseline, 12 months, and 24 months during a 2‐year pilot project. Thematic analysis was used to analyse the data. Education staff and the multidisciplinary team perceived progress over time in relation to increased capacity (for early intervention) and improved coordination (between relevant children's services). Digitally‐mediated service delivery facilitated changes in practice that were empowering for education staff and supportive in meeting communication needs. This study provides preliminary support for acceptability of digitally‐mediated team communication as an enhanced model of SEMH service provision in primary school settings in the UK.
Purpose
This study aims to examine the associations of collaboration measured as social network characteristics with perceived job demands, job control and social support in primary healthcare professionals.
Design/methodology/approach
A cross-sectional study design incorporating social network analysis was utilized. Wellbeing surveys with a network questionnaire were sent to care personnel (physicians, nurses and allied health workers) of Finnish primary healthcare in December 2022 ( n = 96). Correlation coefficients and multivariate linear regression modeling were used to analyze the associations.
Findings
Higher level of collaboration (measured as number of connections in the network) was associated with lower perceived job demands and higher job control. Care professionals’ frequency of collaboration and proportion of connections with the same occupation (homophily) were borderline associated with social support, indicating further research needs. Larger professional networks, perhaps enabling better teamwork and sharing of workload or information, may directly or indirectly protect from job strain.
Practical implications
Work-related collaboration in primary care should be encouraged and large support networks need to be promoted further. Individuals, especially allied health workers, working in multiple locations or as a sole member of their occupation group in the work community need to be provided with adequate social support.
Originality/value
Social network analysis has been proposed as a tool to investigate care integration and collaboration, but direct analyses of network measures and validated wellbeing instruments have remained absent. This study illuminated the role of collaboration structures in work-related wellbeing of care professionals by showcasing the potential of social network analysis.
Synchronous virtual visits aid in longitudinal primary care and fulfill unmet needs for patients and clinicians. Virtual visits are widely accepted for specialty consultation and follow-up; however, novel systems-based programs and processes may support earlier engagement.
Evaluate primary care clinician attitudes and perspectives on patient information obtained team-based, nurse-led virtual visits ahead of face to face visits.
Study occurred in a large, regional, multispecialty group practice in Eastern Pennsylvania.
Participants included primary care physicians, nurse practitioners, and physician assistants.
Virtual visits are a component of a large, unified network strategy called the Patient Partnership Model which incorporates technology and remote care to achieve improved access and patient satisfaction.
Survey of participating primary care clinicians assessing impact of at-hand medical history, social history, and medications on delivering face to face primary care. Weighted mean of satisfied participants was 3.61 on a 5-point Likert scale.
Participants reported satisfaction and acceptability of team-based virtual visits, noting high satisfaction with information exchange and actionability of notes. Participants reported ongoing opportunities to enhance medication reconciliation. Virtual visits continue to evolve and may serve varying roles in primary care.
The rising percentage of chronic diseases calls for more comprehensive patient treatment since they pose intricate problems beyond the scope of the conventional biomedical model. The combination of biopsychosocial and mental health techniques is being investigated in this review as a novel approach to the management of chronic illnesses. The biopsychosocial model emphasizes the necessity for a multifaceted approach to therapy by acknowledging the relationship between biological, psychological, and social aspects in the course of a disease and the well-being of its patients. Additionally, treating the psychological burden of chronic disease, enhancing patients' quality of life, and building resilience are all made possible by mental health treatments, including consciousness, psychological counseling, and psychotherapy. The assessment investigates the available data to support the efficacy of these integrated treatments, points out gaps in the body of knowledge, and discusses potential future routes for clinical research and practice. This article summarizes various viewpoints to emphasize the significance of patient-centered, tailored care in managing chronic illnesses and the potential benefits of combining biopsychosocial and mental health approaches to improve treatment results. This collaborative strategy presents a viable way to enhance the general well-being of people with chronic diseases and their physical health.
Objective:
To explore the views of general practitioners and physiotherapists on the current model of care for patients with musculoskeletal disorders in Norwegian primary care, and if the English First Contact Practitioner model, where patients have access to multiple professional groups with musculoskeletal health expertise, could inform service development.
Design, setting, and subjects:
We analysed interviews with five GPs and 11 physiotherapists and used Lipsky's theories about street-level bureaucracy and Foucault's theories of mechanisms of power and institutional structures to explore task shifting and cooperation between different professions.
Results and interpretation:
The empirical material reflected a multi-faceted discourse about skill-mix in primary care, where financial factors, perceptions about competence, and task preferences moderated attitudes to task shifting. Competition and cooperation coexist between the professions, and the seemingly gradual blurring between historical hegemony and new models of care creates both alliances and rivalries. Examples of deviations from the Choosing Wisely principles and evidence-based practice indicate that both general practitioners and physiotherapists balance the roles of patient advocate, gatekeeper, and homo economicus, in a context where task shifting is challenged by established practice. It appears that the management of patients with musculoskeletal disorders is fragmented and to some extent reflects a supply-driven system.
Patients with neurological illnesses have many palliative care needs that need to be addressed in the outpatient clinical setting. This review discusses existing models of care delivery, including services delivered by neurology teams, palliative care specialists, telehealth, and home-based programs. We review the existing literature that supports these services and ongoing limitations that continue to create barriers to necessary clinical care for this vulnerable patient population.
Die verschiedenen Gesundheitsberufe befassen sich mit unterschiedlichen Aspekten des Patientenwohls, haben jedoch alle das gemeinsame Ziel, die Gesundheit des Patienten zu verbessern. Die Qualitätssteigerung in der Gesundheitsversorgung ist eine natürliche Folge der interprofessionellen
Zusammenarbeit. Dazu gehören Kommunikation, Vertrauen, Zusammenarbeit und Engagement zwischen den verschiedenen Berufsgruppen (z. B. Apotheker, Allgemeinmediziner und Krankenpfleger). In dieser Ausgabe tauchen wir in die lebendige Welt der interprofessionellen Zusammenarbeit in der Primärversorgung ein, stellen Beispiele für inspirierende Kooperationen und sich neu entwickelnde Lehrstrategien vor, beschreiben Mittel und Wege sowie Hindernisse und liefern Instrumente und Empfehlungen für erfolgreiche interprofessionelle Unternehmen. Gemeinsam erzielen wir bessere Resultate!
Purpose
Online medical teams (OMTs) have emerged as an innovative healthcare service mode that relies on the collaboration of doctors to produce comprehensive medical recommendations. This study delves into the relationship between knowledge collaboration and team performance in OMTs and examines the complex effects of participation patterns.
Design/methodology/approach
The analysis uses a dataset that consists of 2,180 OMTs involving 8,689 doctors. Ordinary least squares regression with robust standard error is adopted for data analysis.
Findings
Our findings demonstrate a positive influence of knowledge collaboration on OMT performance. Leader participation weakens the relationship between knowledge collaboration and team performance, whereas multidisciplinary participation strengthens it. Passive participation and chief doctor participation have no significant effect on the association between knowledge collaboration and OMT performance.
Originality/value
This study provides valuable insights into how knowledge collaboration shapes OMTs' performance and reveals how the participation of different types of members affects outcomes. Our findings offer important practical implications for the optimization of online health platforms and for enhancing the effectiveness of collaborative healthcare delivery.
Effective leadership in contemporary settings often demands collaboration across diverse disciplines. This systematic term paper explores various multidisciplinary working models aimed at promoting collaborative leadership within organizations. This term paper was geared towards examining multidisciplinary working model, in order to know whether it promotes collaborative leadership in organizations. Contextually, the paper drew examples from the health and social care sectors. By synthesising findings from a range of scholarly sources, this term paper elucidates the principles, structures, and strategies underpinning successful collaborative leadership initiatives in organisational practices. Additionally, the term paper highlights emerging trends, challenges, barriers, and opportunities in implementing multidisciplinary working models and comes up with diametrical findings: though a multidisciplinary approach maintains its effectiveness in the organizational working process, there exist other models, such as inter-professional and interdisciplinary models, which have proven to be more beneficial and effective, especially in the social care and health care sectors.
Background
Solo medical practices in primary healthcare delivery have been abandoned in favor of interdisciplinary teamwork in most Western countries. Dynamics in interdisciplinary teams might however be particularly difficult when two or more autonomous health professionals develop similar roles at the practice level. This is the case of family physicians (FPs) and nurse practitioners (NPs), due to the fact that the latter might accomplish not only the traditional role proper to a nurse, but also several medical activities such as requesting diagnostic exams and prescribing medical treatments. The tensions that this overlap might generate and their implications in regard of the development of professional identities, and consequently of the quality of health care delivered, have been suggested, but rarely examined empirically. The goal of this study is to examine identity work, i.e., the processes of (re)construction of professional identities, of NPs and FPs working together in primary care interdisciplinary teams.
Methods
A longitudinal, interpretive, and comparative multiple (n = 2) case study is proposed. Identity work theory in organizations is adopted as theoretical perspective. Cases are urban primary care multidisciplinary teams from two different Canadian provinces: Quebec and Ontario. Participants are NPs, FPs, managers, and patients. Data gathering involves audio-diaries, individual semi-structured and focus group interviews, observations, and archival material. Narrative and metaphor techniques are adopted for analyzing data collected. Within- and cross-case analysis will be performed.
Discussion
For practice, the results of this investigation will: (a) be instrumental for clinicians, primary care managers, and policy decision-makers responsible for the implementation of interdisciplinary teamwork in primary healthcare delivery to improve decision-making processes and primary care team performance over time; (b) inform continuing interdisciplinary professional development educational initiatives that support competency in health professionals’ identity construction in interdisciplinary primary care organizations. For research, the project will contribute to enriching theory about identity construction dynamics in health professions, both in the fields of health services and primary care education research.
This article uses role theory as a lens to explain the experiences of social workers working within healthcare multidisciplinary teams, which are characterised by interprofessional dominance and subordination. A qualitative case study design was used to explore and describe the experiences of social workers in working with other healthcare practitioners in multidisciplinary teams. A purposeful sampling technique was used to select sixteen participants from a particular health district. Data were collected through interviews and analysed using thematic analysis. Professional power dynamics, a sense of agency with a need for collaborative contribution, and a lack of understanding of the social work profession are three themes that summarise the findings. The article concludes that the ineffective management of multidisciplinary themes creates a barrier to different professionals’ ability to communicate, work and learn together. The article recommends preparatory training for multidisciplinary team members and the need for a structured framework for interprofessional engagement. Keywords: collaboration, healthcare, healthcare practitioner, multidisciplinary team, social worker, teamwork
The aim of this systematic review is to synthesise the current literature on the experiences and perspectives of healthcare workers and students in developing, implementing, and evaluating IPECP initiatives in rural healthcare settings. Reported enablers and barriers that facilitate or hinder healthcare worker participation in IPECP evaluation and research in rural healthcare settings will be identified. Further, reported enablers and barriers authors faced while conducting IPECP research through to the reporting stage will be identified.
The current study highlights the importance of collaborative care in managing cognitive disorders. It unites healthcare professionals, carers, and patients into a cohesive team, ensuring comprehensive care. The patient-centred approach prioritizes autonomy and collaborative decision-making. Carers are acknowledged as indispensable team members and given the necessary support. Future modifications to this paradigm will accommodate technological advances and shifting healthcare environments. Despite obstacles, collaborative care remains a hope for people with cognitive disorders.
Interprofessional working must be approached within health promotion interventions using systematic methods to identify areas of suboptimal collaboration. We designed a qualitative study with a purposive sample of seven French therapeutic patient education programs. Semi-structured individual interviews were conducted with 14 healthcare providers and seven clinician leaders (coordinators) involved in patient education. We used the same interview guide and thematic grid regardless of the professional's profile to compare their perceptions on elements affecting outcome, participation and sustainability of programs. Healthcare providers and coordinators addressed non-convergent issues at both ends of a continuum from a micro-level nested in the program delivery to a macro-level corresponding to the structured implementation and sustainability of the program. Meso-level issues featured convergent perspectives. Our methodology could be used at the level of health services in a health system to provide a complete recovery of stakeholders' perspectives (without "blind spots" from one stakeholder or another). In our study, we focused on patient education in the French health system and pointed out possible considerations to optimize the functioning of programs. Such considerations include specific training plan development, encouraging reflection on the content and use of initial assessment, leading sessions in pairs to save on work time, and communication on the ins and outs of organizational imperatives that require healthcare providers' contributions.
O termo apoio social, na Enfermagem, está presente na CIPE® e na SNOMED-CT, porém ele não possui atributos, tornando-o um conceito imaturo. A análise de conceito é uma estratégia para clarificar o fenômeno, facilitar sua identificação e aplicação prática, em especial, por meio de teorias de médio alcance. O objetivo desta pesquisa foi analisar o conceito de apoio social. Utilizou-se como método o modelo evolucionista de Rodgers. Como resultados, a revisão não sistemática de literatura identificou que o apoio social é um fenômeno de interesse internacional, sendo a China responsável pela maior produção científica (31,81%), as publicações são majoritariamente do ano 2022 (63,63%) e a principal área de concentração foi a Medicina (34,09%). Foram identificados como antecedentes: eventos estressores, depressão, doenças crônicas, presença de HIV, vulnerabilidade, idoso, gestação e puerpério; como atributos: assistência física, financeira, espiritual, emocional e social, ações solidárias e/ou voluntárias, subjetivo, percebido, estrutural, funcional, redes ou grupos de apoio, afeto, formal, informal, mídia social; e como consequentes: resultados positivos em saúde. Verificou-se que suporte social é utilizado como sinônimo para apoio social e não foi evidenciada evolução do conceito na linha temporal. O conceito foi aplicado a um caso fictício de alta hospitalar. Conclui-se que apoio social é um fenômeno amplo, de interesse internacional e multiprofissional. A estratégia de análise de conceito mostrou-se fundamental para extração de elementos que possibilitou a elaboração da definição para apoio social, contribuindo para a compreensão do fenômeno e fornecendo suporte científico para o desenvolvimento de teorias de médio alcance no domínio da Enfermagem.
Background:
Chronic obstructive pulmonary disease (COPD) is considered a multisystem disease, in which comorbidities feature prominently. COPD guidelines recommend holistic assessment and management of relevant comorbid diseases but there is limited information as to how this is best achieved. This pilot study aimed to explore the views of stakeholders, including patients and the healthcare team, on the feasibility, acceptability and barriers to a collaborative, multidisciplinary team-based care intervention ('TEAMcare') to improve health outcomes in COPD patients, within the context of a local hospital outpatient clinic.
Methods:
A mixed methods study design was used. A COPD care algorithm was developed based on the Australasian guidelines, COPDX. COPD participants were consecutively recruited from an outer metropolitan hospital's respiratory clinic. Participants attended for follow up visits at 5 and 10 months to ascertain clinical status, algorithm compliance and to review and revise management recommendations. The intervention was conducted using existing resources, involving collaboration with general practice and the publicly-funded local chronic disease management programme (Medicare Local). Stakeholders provided qualitative feedback about the intervention in terms of feasibility, acceptability and barriers via structured and semi-structured interviews. All interviews were recorded, transcribed verbatim and analysed using qualitative thematic analysis to identify key concepts and themes.
Results:
The study protocol was abandoned prematurely due to clear lack of feasibility. Of 12 participants, 4 withdrew and none completed pulmonary rehabilitation (PR). The main reasons for non-participation or study withdrawal related to reluctance to attend PR (6 of 16) and the burden of increased appointments (4 of 16). PR conflicted with employment hours, which presented problems for some participants. Similarly, themes that emerged from qualitative data indicate healthcare provider perception of deficiencies in funding (for infrastructure and staffing). Health literacy, motivation, organisation and functional impairment were issues for patients.
Conclusions:
Available data from this small pilot provided valuable insights to inform future design and implementation strategies. Delivering structured team-based care to COPD patients presents challenges. In addition to enhancing health resources for engaging COPD patients, a focus on health literacy and improving health service access, including colocalisation and access outside business hours, may be required.
Trial registration:
ACTRN12616000342415 ; 16/03/2016.
Falls are the leading cause of accidental deaths in older adults and are a growing public health concern. The American Geriatrics Society (AGS) and British Geriatrics Society (BGS) published guidelines for falls screening and risk reduction, yet few primary care providers report following any guidelines for falls prevention. This article describes a project that engaged an interprofessional teaching team to support interprofessional clinical teams to reduce fall risk in older adults by implementing the AGS/BGS guidelines. Twenty-five interprofessional clinical teams with representatives from medicine, nursing, pharmacy, and social work were recruited from ambulatory, long-term care, hospital, and home health settings for a structured intervention: a 4-hour training workshop plus coaching for implementation for 1 year. The workshop focused on evidence-based strategies to decrease the risk of falls, including screening for falls; assessing gait, balance, orthostatic blood pressure, and other medical conditions; exercise including tai chi; vitamin D supplementation; medication review and reduction; and environmental assessment. Quantitative and qualitative data were collected using chart reviews, coaching plans and field notes, and postintervention structured interviews of participants. Site visits and coaching field notes confirmed uptake of the strategies. Chart reviews showed significant improvement in adoption of all falls prevention strategies except vitamin D supplementation. Long-term care facilities were more likely to address environmental concerns and add tai chi classes, and ambulatory settings were more likely to initiate falls screening. The intervention demonstrated that interprofessional practice change to target falls prevention can be incorporated into primary care and long-term care settings.
Background:
Medication reviews are recognized services to increase quality of therapy and reduce medication risks. The selection of eligible patients with potential to receive a major benefit is based on assumptions rather than on factual data. Acceptance of interprofessional collaboration is crucial to increase the quality of medication therapy.
Objective:
The research question was to identify and prioritize eligible patients for a medication review and to provide evidence-based criteria for patient selection. Acceptance of the prescribing general practitioner to implement pharmaceutical recommendations was measured and factors influencing physicians' acceptance were explored to obtain an impression on the extent of collaboration in medication review in an ambulatory care setting.
Methods:
Based on data of a cluster-randomized controlled study (WestGem-study), the correlation between patient parameters and the individual performance in a medication review was calculated in a multiple logistic regression model. Physician's acceptance of the suggested intervention was assessed using feedback forms. Influential factors were analyzed.
Results:
The number of drugs in use (p = 0.001), discrepancies between prescribed and used medicines (p = 0.014), the baseline Medication Appropriateness Index score (p<0.001) and the duration of the intervention (p = 0.006) could be identified as influential factors for a major benefit from a medication review, whereas morbidity (p>0.05) and a low kidney function (p>0.05) do not predetermine the outcome. Longitudinal patient care with repeated reviews showed higher interprofessional acceptance and superior patient benefit. A total of 54.9% of the recommendations in a medication review on drug therapy were accepted for implementation.
Conclusions:
The number of drugs in use and medication reconciliation could be a first rational step in patient selection for a medication review. Most elderly, multimorbid patients with polymedication experience a similar chance of receiving a benefit from a medication review. Longitudinal patient care should be preferred over confined medication reviews. The acceptance of medication reviews by physicians supports further implementation into health care systems.
Trial registration:
ISRCTN ISRCTN41595373.
Background:
Specialised diabetes teams, specifically certified nurse and dietitian diabetes educator teams, are being integrated part-time into primary care to provide better care and support for Canadians living with diabetes. This practice model is being implemented throughout Canada in an effort to increase patient access to diabetes education, self-management training, and support. Interprofessional collaboration can have positive effects on both health processes and patient health outcomes, but few studies have explored how health professionals are introduced to and transition into this kind of interprofessional work.
Method:
Data from 18 interviews with diabetes educators, 16 primary care physicians, 23 educators' reflective journals, and 10 quarterly debriefing sessions were coded and analysed using a directed content analysis approach, facilitated by NVIVO software.
Results:
Four major themes emerged related to challenges faced, strategies adopted, and benefits observed during this transition into interprofessional collaboration between diabetes educators and primary care physicians: (a) negotiating space, place, and role; (b) fostering working relationships; (c) performing collectively; and (d) enhancing knowledge exchange.
Conclusions:
Our findings provide insight into how healthcare professionals who have not traditionally worked together in primary care are collaborating to integrate health services essential for diabetes management. Based on the experiences and personal reflections of participants, establishing new ways of working requires negotiating space and place to practice, role clarification, and frequent and effective modes of formal and informal communication to nurture the development of trust and mutual respect, which are vital to success.
Background
A majority of patients prefer to die at home. Specialist palliative care aims to improve quality of life. Hospice assist at home is a Dutch model of general/specialised palliative care within primary care, collaboratively built by general practitioners and a hospice.
Aim
The aims of this study are to explore whether hospice assist at home service enables patients at hometo express end-of-life preferences and die in their preferred location. In addition, this study provides insight into symptomburden, stability and early referral.
Design
A retrospective cross-sectional evaluation study was performed (December 2014–March 2015), using hospice assist at home patient records and documentation. Primary outcome includes congruence between preferred and actual place of death. Secondary outcomes include symptom burden, (in)stability and early identification.
Setting/participants
Between June 2012 and December 2014, 130 hospice assist at home patients, living at home with a life expectancy <1 year, were enrolled. Hospice assist at home, a collaboration between general practitioners, district nurses, trained volunteers and a hospice team, facilitates (1) general practitioner–initiated consultation by Nurse Consultant Hospice, (2) fortnightly interdisciplinary consultations and (3) 24/7 hospice backup for patients, caregivers and professionals.
Results
A total of 130 patients (62 (48%) men; mean age, 72 years) were enrolled, of whom 107/130 (82%) died and 5 dropped out. Preferred place of death was known for 101/107 (94%) patients of whom 91% patients died at their preferred place of death.
Conclusion
Hospice assist at home service supports patients to die in their preferred place of death. Shared responsibility of proactive care in primary care collaboration enabled patients to express preferences. Hospice care should focus on local teamwork, to contribute to shared responsibilities in providing optimal palliative care.
Background:
Although a growing number of collaborative mental health care models have been developed, targeting specific populations, few studies have utilized such interventions among homeless populations. This quasi-experimental study compared the outcomes of two shelter-based collaborative mental health care models for men experiencing homelessness and mental illness: (1) an integrated multidisciplinary collaborative care (IMCC) model and (2) a less resource intensive shifted outpatient collaborative care (SOCC) model.
Methods:
In total 142 participants, 70 from IMCC and 72 from SOCC were enrolled and followed for 12 months. Outcome measures included community functioning, residential stability, and health service use. Multivariate regression models were used to compare study arms with respect to change in community functioning, residential stability, and health service use outcomes over time and to identify baseline demographic, clinical or homelessness variables associated with observed changes in these domains.
Results:
We observed improvements in both programs over time on measures of community functioning, residential stability, hospitalizations, emergency department visits and community physician visits, with no significant differences between groups over time on these outcome measures.
Conclusions:
Our findings suggest that shelter-based collaborative mental health care models may be effective for individuals experiencing homelessness and mental illness. Future studies should seek to confirm these findings and examine the cost effectiveness of collaborative care models for this population.
Our objective was to identify and examine studies of collaboration in relation to the use of health information technologies (HIT) in the biomedical informatics field.
We conducted a systematic literature review of articles through PubMed searches as well as reviewing a variety of individual journals and proceedings. Our search period was from 1990-2015. We identified 98 articles that met our inclusion criteria. We excluded articles that were not published in English, did not deal with technology, and did not focus primarily on individuals collaborating.
We categorized the studies by technology type, user groups, study location, methodology, processes related to collaboration, and desired outcomes. We identified three major processes: workflow, communication, and information exchange and two outcomes: maintaining awareness and establishing common ground. Researchers most frequently studied collaboration within hospitals using qualitative methods.
Based on our findings, we present the "collaboration space model", which is a model to help researchers study collaboration and technology in healthcare. We also discuss issues related to collaboration and future research directions.
While collaboration is being increasingly recognized in the biomedical informatics community as essential to healthcare delivery, collaboration is often implicitly discussed or intertwined with other similar concepts. In order to evaluate how HIT affects collaboration and how we can build HIT to effectively support collaboration, we need more studies that explicitly focus on collaborative issues.
Copyright © 2015. Published by Elsevier Inc.
Background
Interprofessional consultation contributes to symptom control for home-based palliative care patients and improves advance care planning. Distance and travel time, however, complicate the integration of primary care and specialist palliative care. Expert online audiovisual teleconsultations could be a method for integrating palliative care services.
Aim
This study aims to describe (1) whether and how teleconsultation supports the integration of primary care, specialist palliative care, and patient perspectives and services and (2) how patients and (in)formal caregivers experience collaboration in a teleconsultation approach.
Design
This work consists of a qualitative study that utilizes long-term direct observations and in-depth interviews.
Setting/participants
A total of 18 home-based palliative care patients (16 with cancer, 2 with chronic obstructive pulmonary disease; age range 24–85 years old), 12 hospital-based specialist palliative care team clinicians, and 17 primary care physicians.
Results
Analysis showed that the introduction of specialist palliative care team-patient teleconsultation led to collaboration between primary care physicians and specialist palliative care team clinicians in all 18 cases. In 17/18 cases, interprofessional contact was restricted to backstage work after teleconsultation. In one deviant case, both the patient and the professionals were simultaneously connected through teleconsultation. Two themes characterized integrated palliative care at home as a consequence of teleconsultation: (1) professionals defining responsibility and (2) building interprofessional rapport.
Conclusion
Specialist palliative care team teleconsultation with home-based patients leads to collaboration between primary care physicians and hospital-based palliative care specialists. Due to cultural reasons, most collaboration was of a multidisciplinary character, strongly relying on organized backstage work. Interdisciplinary teleconsultations with real-time contact between patient and both professionals were less common but stimulated patient-centered care dialogues.
While integrated health care system has been proved an effective way to help improving patient health and system efficiency, the exact behaviour model and motivation approach are not so clear in poor rural areas where health human resources and continuous service provision are urgently needed. To gather solid evidence, we initiated a comprehensive intervention project in Qianjiang District, southwest part of rural China in 2012. And after one-year's pilot, we developed an intervention package of team service, comprehensive pathway and prospective- and performance-based payment system.
To testify the potential influence of payment interventions, we use clustered randomised controlled trial, 60 clusters are grouped into two treatment groups and one control group to compare the time and group differences. Difference-in-differences model and structural equation modelling will be used to analyse the intervention effects and pathway. The outcomes are: quality of care, disease burden, supplier cooperative behaviour and patient utilisation behaviour and system efficiency. Repeated multivariate variance analysis will be used to statistically examine the outcome differences.
This is the first trial of its kind to prove the effects and efficiency of integrated care. Though we adopted randomised controlled trial to gather the highest rank of evidence, still the fully randomisation was hard to realise in health policy reform experiment. To compensate, the designer should take efforts on control for the potential confounders as much as possible. With this trial, we assume the effects will come from: (1) improvement on the quality of life through risk factors control and lifestyles change on patient's behaviours; (2) improvement on quality of care through continuous care and coordinated supplier behaviours; (3) improvement on the system efficiency through active interaction between suppliers and patients.
The integrated care system needs collaborative work from different levels of caregivers. So it is extremely important to consider the supplier cooperative behaviour. In this trial, we introduced payment system to help the delivery system integration through providing financial incentives to motivate people to play their roles. Also, the multidisciplinary team, the multi-institutional pathway and system global budget and pay-for-performance payment system could afford as a solution.
To enhance the quality of diabetes care in the Netherlands, so-called care groups with three to 250 general practitioners emerged to organise and coordinate diabetes care. This introduced a new quality management level in addition to the quality management of separate general practices. We hypothesised that this new level of quality management might be associated with the aggregate performance indicators on the patient level. Therefore, we aimed to explore the association between quality management at the care group level and its aggregate performance indicators.
A cross-sectional study.
All Dutch care groups (n=97).
23 care groups provided aggregate register-based performance indicators of all their practices as well as data on quality management measured with a questionnaire filled out by 1 or 2 of their quality managers.
The association between quality management, overall and in 6 domains ('organisation of care', 'multidisciplinary teamwork', 'patient centredness', 'performance management', 'quality improvement policy' and 'management strategies') on the one hand and 3 process indicators (the percentages of patients with at least 1 measurement of glycated haemoglobin, lipid profile and systolic blood pressure), and 3 intermediate outcome indicators (the percentages of patients with glycated haemoglobin below 53 mmol/mol (7%); low-density lipoprotein cholesterol below 2.5 mmol/L; and systolic blood pressure below 140 mm Hg) by weighted univariable linear regression.
The domain 'management strategies' was significantly associated with the percentage of patients with a glycated haemoglobin <53 mmol/mol (β 0.28 (0.09; 0.46) p=0.01) after correction for multiple testing. The other domains as well as overall quality management were not associated with aggregate process or outcome indicators.
This first exploratory study on quality management showed weak or no associations between quality management of diabetes care groups and their performance. It remains uncertain whether this second layer on quality management adds to better quality of care.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Background:
Integrative health care (IHC) combines therapies and providers from complementary and conventional health care. Previous studies on IHC have shown power relations between providers but few studies have explored how the interaction develops over time. The objective of this study was to explore the development of IHC collaboration and interaction among participating providers during a series of consensus case conferences for managing patients with back and neck pain.
Methods:
This qualitative study was conducted within a pragmatic randomized controlled clinical trial in primary care. Patients' treatment plans were developed based on IHC provider consensus conferences (n = 26) of which 15 (5 of the first, 5 in the middle, and 5 of the last in the clinical trial) were selected for analysis. Findings were derived by means of discourse analysis, focusing on the participants' use of subject positions during the conferences.
Findings:
The IHC team in this study gradually formed a group identity, moving their subject positions from individual treating subjects to members of a team and were able to make consensus-based decisions about patients' individual treatment plans. In the discourse, the IHC team identified collaborative shortcomings and problematized the provision of IHC. They were able to capitalize on the synergies in their collaboration and developed a shared vision of IHC provision.
Conclusions:
The process of IHC collaboration involved the gradual formation of an IHC team identity, which facilitated interdisciplinary, non-hierarchical consensus-based decision-making in the team. The discourse further suggests that a reform of some legal and organizational health sector barriers might be needed to realize sustainable implementation of IHC services in Sweden.
Background
Patients with comorbid depression and physical health problems have poorer outcomes compared with those with single long term conditions (LTCs), or multiple LTCs without depression. Primary care has traditionally struggled to provide integrated care for this group. Collaborative care can reduce depression in people with LTCs but evidence is largely based on trials conducted in the United States that adopted separate treat to target protocols for physical and mental health. Little is known about whether collaborative care that integrates depression care within the management of LTCs is implementable in UK primary care, and acceptable to patients and health care professionals.
Methods
Nested interview study within the COINCIDE trial of collaborative care for patients with depression and diabetes/CHD (ISRCTN80309252). The study was conducted in primary care practices in North West England. Professionals delivering the interventions (nurses, GPs and psychological well-being practitioners) and patients in the intervention arm were invited to participate in semi-structured qualitative interviews.
Results
Based on combined thematic analysis of 59 transcripts, we identified two major themes: 1) Integration: patients and professionals valued collaborative ways of working because it enhanced co-ordination of mental and physical health care and provided a sense that patients’ health was being more holistically managed. 2) Division: patients and professionals articulated a preference for therapeutic and spatial separation between mental and physical health. Patients especially valued a separate space outside of their LTC clinic to discuss their emotional health problems.
Conclusion
The COINCIDE care model, that sought to integrate depression care within the context of LTC management, achieved service level integration but not therapeutic integration. Patients preferred a protected space to discuss mental health issues, and professionals maintained barriers around physical and mental health expertise. Findings therefore suggest that in the context of mental-physical multimorbidity, collaborative care can facilitate access to depression care in ways that overcome stigma and enhance the confidence of multidisciplinary health teams to work together. However, such care models need to be flexible and patient centred to accommodate the needs of patients for whom their depression may be independent of their LTC.
RÉSUMÉ
De plus en plus, les équipes interprofessionnelles sont chargées de fournir la prestation de services de soins de santé intégrés. Cependant, les équipes efficaces ne sont pas le fruit du hasard, mais nécessitent une planification minutieuse et une attention soutenue au processus de développer l’équipe. Basée sur une étude de cas portant sur des entretiens, l’observation participante, et une enquête, nous avons identifié les attributs clés pour le travail interprofessionnel efficace (TIE) dans le cadre de soins primaires à domicile (SPD). Reconnaissant l’importance d’un modèle théorique qui reflète la nature multi-dimensionnelle de la recherche sur l’efficacité de l’équipe, nous avons utilisé le modèle de l’efficacité de l’équipe integrée pour analyser nos résultats. Ces résultats indiquaient qu’une vision commune, des objectifs communs, le respect et la confiance entre les membres de l’équipe—ainsi que la communication continue, la direction efficace et des mécanismes de résolution des conflits—sont essentiels pour le développement d’une equipe de TIE qui fonctionne très bien. L’ambiguité et l’incertitude qui entoure le cadre de la prestation de services (à domicile), ainsi que la négociation des relations extérieures dans le domaine SPD, nécessitent la recherche plus approfondie.
Introduction: Return to work (RTW) of employees on sick leave for common mental disorders may require a multidisciplinary approach. This article aims to assess time to RTW after a psychiatric consultation providing treatment advice to the occupational physician (OP) for employees on sick leave for common mental disorders in the occupational health (OH) setting, compared to care as usual (CAU). Methods: Cluster randomized clinical trial evaluating patients of 12 OPs receiving consultation by a psychiatrist, compared to CAU delivered by 12 OPs in the control group. 60 patients suffering from common mental disorders and >= six weeks sicklisted were included. Follow up three and six months after inclusion. Primary outcome measure was time to RTW. Intention-to-treat multilevel analysis and a survival analysis were performed to evaluate time to RTW in both groups. Results: In CAU, referral was the main intervention. Both groups improved in terms of symptom severity and quality of life, but time to RTW was significantly shorter in the psychiatric consultation group. At three months follow up, 58% of the psychiatric consultation group had full RTW versus 44% of the control group, a significant finding (P = 0.0093). Survival analysis showed 68 days earlier RTW after intervention in the psychiatric consultation group (P = 0.078) compared to CAU. Conclusion: Psychiatric consultation for employees on sick leave in the OH setting improves time to RTW in patients with common mental disorders as compared to CAU. In further research, focus should be on early intervention in patients with common mental disorders on short sick leave duration. Psychiatric consultation might be particularly promising for improvement of RTW in those patients.
Rigorous comprehensive evaluations of primary healthcare (PHC) quality improvement (QI) initiatives are lacking. This article describes the evaluation of the Quality Improvement & Innovation Partnership Learning Collaborative (QIIP-LC), an Ontario-wide PHC QI program targeting type 2 diabetes management, colorectal cancer (CRC) screening, access to care, and team functioning.Methods
This article highlights the primary outcome results of an external retrospective, multi-measure, mixed-method evaluation of the QIIP-LC, including: 1) matched-control pre-post chart audit of diabetes management (A1c/foot exams) and rate of CRC screening; 2) post-only advanced access survey (third-next available appointment); and 3) post-only semi-structured interviews (team functioning).ResultsChart audit data was collected from 34 consenting physicians per group (of which 88% provided access data). Between-group differences were not statistically significant (A1c [p = 0.10]; foot exams [p = 0.45]; CRC screening [p = 0.77]; advanced access [p = 0.22]). Qualitative interview (n = 42) themes highlighted the success of the program in helping build interdisciplinary team functioning and capacity.Conclusion
The rigorous design and methodology of the QIIP-LC evaluation utilizing a control group is one of the most significant efforts thus far to demonstrate the impact of a QI program in PHC, with improvements over time in both QIIP and control groups offering a likely explanation for the lack of statistically significant primary outcomes. Team functioning was a key success, with team-based chronic care highlighted as pivotal for improved health outcomes. Policy makers should strive to endorse QI programs with proven success through rigorous evaluation to ensure evidence-based healthcare policy and funding.
METHODS: Using a mixed-methods approach, the focus was on fidelity (quality of implementation), dose delivered (completeness), dose received (exposure and satisfaction), reach (participation rate), recruitment, and context. Twenty-four general practices participated, of which 13 implemented the home visitation programme and 11 delivered usual care to older people. Data collection consisted of semi-structured interviews with practice nurses (PNs), general practitioners (GPs), and older people; feedback meetings with PNs; structured registration forms filled-out by PNs; and narrative descriptions of the recruitment procedures and registration of inclusion and drop-outs by members of the research team.
Objective To investigate the long term effectiveness of integrated disease management delivered in primary care on quality of life in patients with chronic obstructive pulmonary disease (COPD) compared with usual care.
Design 24 month, multicentre, pragmatic cluster randomised controlled trial
Setting 40 general practices in the western part of the Netherlands
Participants Patients with COPD according to GOLD (Global Initiative for COPD) criteria. Exclusion criteria were terminal illness, cognitive impairment, alcohol or drug misuse, and inability to fill in Dutch questionnaires. Practices were included if they were willing to create a multidisciplinary COPD team.
Intervention General practitioners, practice nurses, and specialised physiotherapists in the intervention group received a two day training course on incorporating integrated disease management in practice, including early recognition of exacerbations and self management, smoking cessation, physiotherapeutic reactivation, optimal diagnosis, and drug adherence. Additionally, the course served as a network platform and collaborating healthcare providers designed an individual practice plan to integrate integrated disease management into daily practice. The control group continued usual care (based on international guidelines).
Main outcome measures The primary outcome was difference in health status at 12 months, measured by the Clinical COPD Questionnaire (CCQ); quality of life, Medical Research Council dyspnoea, exacerbation related outcomes, self management, physical activity, and level of integrated care (PACIC) were also assessed as secondary outcomes.
Results Of a total of 1086 patients from 40 clusters, 20 practices (554 patients) were randomly assigned to the intervention group and 20 clusters (532 patients) to the usual care group. No difference was seen between groups in the CCQ at 12 months (mean difference –0.01, 95% confidence interval –0.10 to 0.08; P=0.8). After 12 months, no differences were seen in secondary outcomes between groups, except for the PACIC domain “follow-up/coordination” (indicating improved integration of care) and proportion of physically active patients. Exacerbation rates as well as number of days in hospital did not differ between groups. After 24 months, no differences were seen in outcomes, except for the PACIC follow-up/coordination domain.
Conclusion In this pragmatic study, an integrated disease management approach delivered in primary care showed no additional benefit compared with usual care, except improved level of integrated care and a self reported higher degree of daily activities. The contradictory findings to earlier positive studies could be explained by differences between interventions (provider versus patient targeted), selective reporting of positive trials, or little room for improvement in the already well developed Dutch healthcare system.
Trial registration Netherlands Trial Register NTR2268.
Background:
Most persons with dementia live at home and are treated in the primary care. However, the ambulatory health care system in Germany contains a lot of "interface problems" and is not optimized for the future challenges. Innovative concepts like regional networks in dementia care exist on a project level and need to be tested for efficacy to encourage implementation. The goal of the study is the scientific evaluation of an already existing regional dementia network.
Methods:
Prospective randomized controlled trial of 235 community-living elderly with dementia and their family caregivers of network treatment (n=117) compared to usual care (n=118) in a predominantly rural region. The allocation to intervention or control group was based on network membership of their General Practitioner. Intervention patients received diagnostic evaluation and subsequent treatment according to network guidelines. Main outcome measures were the early contact with a neurologic or psychiatric specialist and dementia-specific medication as well as quality of life of the patients, and as secondary outcomes caregiver burden and caregiver health-related quality of life.
Results:
Network patients were more likely to receive antidementive drugs (50.5 % vs. 35.8 %; p=0.035) and had more often contact to a neurologist (18.6 % vs. 2.8 %; p<0.001). No group differences were found on patient's quality of life nor overall effects or treatment by time effects. Intervention caregivers reported no significant improvements in health related quality of life measured by SF-36 and EQ-5D.
Conclusion:
The management of dementia patients in an interdisciplinary regional network solelyprovides measurable advantages with respect to the provision of dementia-specific medication and utilization of medical treatment i.e. referral rates to specialists. Further evaluation research is needed to identify relevant mechanismsof collaborative processes with respect to their impact on patient and caregiver related outcomes.
Background:
Working and learning go hand in hand during interprofessional collaborative practice. Patients' nursing records are designed to record patient care and health status. It is not known whether these records are also used to keep track of interprofessional contacts or interprofessional learning between team members. This study explored the usefulness of patients' nursing records in optimising interprofessional workplace learning for general practitioners.
Methods:
We utilized a descriptive retrospective chart review. All palliative home care teams of the Dutch speaking part of Belgium were involved. Throughout the year 2010, a representative sample of patient charts was selected. Characteristics of encounters between general practitioners and palliative care nurses were extracted from the charts.
Results:
Detailed accounts of interprofessional contacts were found in the charts. Palliative care nurses recorded number and type of contacts, topics discussed during contacts and general practitioner's learning activities.
Discussion:
Palliative care nurses are sensitive and open towards the general practitioners' learning needs. Patients' nursing records provide useful information for interprofessional team discussions on workplace learning. Healthcare professionals should be trained to respond to each other's learning needs.
INTRODUCTION: Hyperglycemia is one of the most frequent metabolic complications in hospitalized patients. Increased risk of infection following hyperglycemia has been reported in hospitalized patients and infections may also cause insulin resistance which complicates the control of blood glucose level. In this study the impact of the clinical pharmacist interventions on the glycemic control in patients admitted to infectious diseases ward has been evaluated. METHODOLOGY: We conducted a prospective, pre-post interventional study among patients with hyperglycemia. The clinical pharmacist-led multidisciplinary team managed the glycemic profile of patients according to an established insulin protocol commonly used in internal wards. Clinical pharmacists reviewed patients' medical charts for proper insulin administration, evaluated nurses' technique for insulin injection and blood glucose measurement, and educated patients about symptoms of hypoglycemia and the importance of adherence to different aspects of their glycemic management. RESULTS: The percentage of controlled random blood sugar increased from 13.8% in the pre-intervention to 22.3% in the post-intervention group (p value < 0.01). On the other hand, the percentage of controlled fasting blood sugars in the post-intervention group was non-significantly higher than in the pre-intervention group. CONCLUSION: Pharmacists and additional health care providers from other departments such as nursing and dietary departments need to be devoted to glycemic control service. Collaborative practice agreement between physicians is necessary to promote this service and help to increase the use of such services in different settings for diabetes control.
Hyperglycemia is one of the most frequent metabolic complications in hospitalized patients. Increased risk of infection following hyperglycemia has been reported in hospitalized patients and infections may also cause insulin resistance which complicates the control of blood glucose level. In this study the impact of the clinical pharmacist interventions on the glycemic control in patients admitted to infectious diseases ward has been evaluated.
We conducted a prospective, pre-post interventional study among patients with hyperglycemia. The clinical pharmacist-led multidisciplinary team managed the glycemic profile of patients according to an established insulin protocol commonly used in internal wards. Clinical pharmacists reviewed patients' medical charts for proper insulin administration, evaluated nurses' technique for insulin injection and blood glucose measurement, and educated patients about symptoms of hypoglycemia and the importance of adherence to different aspects of their glycemic management.
The percentage of controlled random blood sugar increased from 13.8% in the pre-intervention to 22.3% in the post-intervention group (p value < 0.01). On the other hand, the percentage of controlled fasting blood sugars in the post-intervention group was non-significantly higher than in the pre-intervention group.
Pharmacists and additional health care providers from other departments such as nursing and dietary departments need to be devoted to glycemic control service. Collaborative practice agreement between physicians is necessary to promote this service and help to increase the use of such services in different settings for diabetes control.
Pharmacists have developed innovative practices in various settings as singular providers or as members of multidisciplinary or interdisciplinary teams. Examples include pharmacists practicing in heart failure, hypertension, or hyperlipidemia clinics. There is a paucity of literature describing pharmacists in interdisciplinary memory clinics and specifically pharmacists practicing in interdisciplinary, primary care-based memory clinics. New practice models should be disseminated to guide others in the development of similar models given the complexity of this population. Patients with dementia are more difficult to manage because of cognitive impairment, behavioral and psychological symptoms, the common presence of multiple comorbidities, and related polypharmacy and caregiver issues. These challenges require expertise in neurodegenerative disorders and geriatrics. The purpose of this article is to describe the role of clinical pharmacists providing care to patients with cognitive complaints in a primary care-based, interdisciplinary memory clinic, with a focus on how the pharmacist practices and is integrated in this collaborative care setting. Patients are assessed using an interdisciplinary approach, with team consensus for assessment and planning of care. Pharmacists' activities include assessment of (1) appropriateness of medications based on frailty, (2) medications that can impair cognition and/or function, (3) medication adherence and management skills, and (4) vascular risk factor control. Pharmacists provide education regarding medications and diseases, ensure appropriate transitions in care, and conduct home visits. Pharmacist participation in this clinic represents a novel opportunity to advance pharmacy practice in primary care, interdisciplinary models. Work is ongoing to describe outcomes attributable to pharmacist participation in this clinic.
This paper describes the use of general practitioner (GP) services and achievement of guideline targets by 285 adults with type 2 diabetes in urban and regional areas of Victoria, Australia. Anthropometric and biomedical measures and responses to a self-administered questionnaire were collected. Findings indicate that almost all participants had visited a GP and had had their hypoglycated haemoglobin (HbA1c) measured in the past 6 months; less than one-third had visited a practice nurse. Fifty per cent achieved a HbA1c target of ≤7.0%; 40%, a total cholesterol ≤4.00mmol/L; 39%, BP Systolic ≤130mmHg; 51%, BP Diastolic ≤80mmHg; 15%, body mass index ≤25kg/m2; and 34% reported a moderately intense level of physical activity, that is, ≥30min, 5 days a week. However, 39% of individuals achieved at least two targets and 18% achieved at least three of these guideline targets. Regional participants were more likely to report having a management plan and having visited a practice nurse, but they were less likely to have visited other health professionals. Therefore, a more sustained effort that also includes collaborative care approaches is required to improve the management of diabetes in Australia.
Type 1 diabetes is one of the most frequent long-term endocrine childhood disorders and the Swedish National Diabetes Register for children states that adolescents (12-18 years) constitute the most vulnerable patient group in terms of metabolic control. The aim of this study was to examine how a multidisciplinary team functions when caring for adolescents with type 1 diabetes.
Qualitative interviews were performed with 17 health professionals at a Paediatric Diabetes Care Unit in a Swedish university hospital. The interviews were analysed to gain insight into a multidisciplinary care team's experiences of various organizational processes and circumstances related to the provision of person-centred paediatric diabetes care.
Building long-term relationships with adolescents, the establishment of a multidisciplinary care team and ensuring adequate documentation are vital for the delivery of person-centred care (PCC). Furthermore, a PCC process and/or practice requires more than the mere expression of person-centred values. The contribution of this study is that it highlights the necessity of facilitating and safeguarding the organization of PCC, for which three processes are central: 1. Facilitating long-term relationships with adolescents and their families; 2. Facilitating multi-professional teamwork; and 3. Ensuring adequate documentation.
Three processes emerged as important for the functioning of the multidisciplinary team when caring for adolescents with type 1 diabetes: building a long-term relationship, integrating knowledge by means of multidisciplinary team work and ensuring adequate documentation. This study demonstrates the importance of clearly defining and making use of the specific role of each team member in the paediatric diabetes care unit (PDCU). Team members should receive training in PCC and a PCC approach should form the foundation of all diabetes care. Every adolescent suffering from type 1 diabetes should be offered individual treatment and support according to her/his needs. However, more research is required to determine how a PCC approach can be integrated into adolescent diabetes care, and especially how PCC education programmes for team members should be implemented.
Numerous intensive research projects to assess the effects of stepped collaborative care (SCC) for depressed patients have been reported in primary care, yet it is unclear how SCC is sustained in usual care.
To assess how SCC for depression is actually being used and how it performs in usual primary care by studying medical data that are routinely collected in family practice, outside the research setting.
Retrospective before and after comparison of electronic medical records (EMR) regarding the implementation of an SCC depression programme in a large primary care organization from 2003 to 2012. Depression care parameters included prevalences, minimal interventions, Beck Depression Inventory-2 (BDI-2), antidepressants, referrals to psychologists and psychiatrists and primary health care consumption.
After programme implementation, differentiation between levels of depression severity increased, more patients were treated with minimal interventions and more patients were monitored with BDI-2. These effects occurred in both nonseverely and severely depressed patients, although they were larger for patients registered as nonseverely depressed. Antidepressant prescription rates and referral rates seemed not to have been influenced by the SCC programme. Health care consumption of the depressed patients increased significantly.
The depression care parameters changed to a different extent and at a different pace than after previous implementation initiatives. Future research should identify whether SCC uptake in primary care is best enhanced by intensive external guidance or by making care providers themselves responsible for the implementation. Analyses of EMR can be valuable in monitoring the implementation effects, especially after research projects are completed.
Objective
Demonstrate the feasibility of implementing a collaborative care program for poorly-controlled type 2 diabetes and complex behavioral health disorders in an urban academically-affiliated safety net primary care clinic.
Methods
This retrospective cohort study evaluates multidisciplinary team care approach to diabetes in a safety net clinic, and included 634 primary care clinic patients with hemoglobin A1c (HbA1c) > 9%. HbA1c, blood pressure, and depression severity were assessed at the initial visit and at the end of treatment, and compared to those of patients who were not referred to the team.
Results
The 151 patients referred to the program between March 2013 and November 2014 had a higher initial mean HbA1c: 10.6% vs. 9.4%, and were more likely to have depression (p = 0.006), anxiety (p = 0.04), and bipolar disorder (p = 0.03), compared to the 483 patients who were not referred. During the 18-month study period, there was a mean decrease in HbA1c of 0.9 (10.6 to 9.4) among those referred to the team, compared to a mean decrease of 0.2 (9.4 to 9.2) among those not referred. This was a significantly greater percent change in HbA1c (p = 0.008).
Conclusion
The integration of behavioral healthcare into chronic care management of patients with diabetes is a promising strategy to improve outcomes among the high risk population in safety net settings.
GRACE targets home-based, geriatrics team management, primary care collaboration, and protocols for common conditions. GRACE can improve outcomes and reduce acute-care utilization. We aimed to characterize medication-related GRACE recommendations. Medical record review of Indiana University Health Physicians GRACE patients (June 2012 to September 2013), with six months' follow-up was conducted. Demographics, clinical characteristics, and recommendations were summarized. Mean age (N = 156) was 82 years; 71% were women, 24% black, and 34% living alone, with a mean of 12 medications. Medication management was activated in 99%. Implementation occurred in 96% of 924 recommendations, including reviewing medication lists (N = 153) and purposes (N = 109) with patients, and providing medication lists to providers (N = 119). GRACE recommended and implemented medication-related interventions, facilitating medication reconciliation, education, communication, and coordination of care. Medication management, a key GRACE component, may contribute to reducing hospitalization rates.
Three thousand nine hundred thirty-one veterans aged 75 and older receive primary care (PC) in two large practices of the Department of Veterans Affairs (VA) Boston Healthcare System. Cognitive and functional disabilities are endemic in this group, creating needs that predictably exceed available or appropriate resources. To address this problem, Geriatrics in Primary Care (GPC) embeds geriatric services directly into primary care. An on-site consulting geriatrician and geriatric nurse care manager work directly with PC colleagues in medicine, nursing, social work, pharmacy, and mental health within the VA medical home. This design delivers interdisciplinary geriatric care within PC that emphasizes comprehensive evaluations, care management, planned transitions, informed resource use, and a shift in care focus from multiple subspecialties to PC. Four hundred thirty-five veterans enrolled during the project's 4-year course. Complex, fragmented care was evident in a series of 50 individuals (aged 82 ± 7) enrolled during Months 1 to 6. The year before, these individuals made 372 medical or surgical subspecialty clinic visits (7.4 ± 9.8); 34% attended five or more subspecialty clinics, 48% had dementia, and 18% lacked family caregivers. During the first year after enrollment the mean number of subspecialty clinic visits declined significantly (4.7 ± 5.0, P = .01), whereas the number of PC-based visits remained stable (3.1 ± 1.5 and 3.3 ± 1.5, respectively, P = .50). Telephone contact by GPC (2.3 ± 2.0) and collaboration with PC clinicians replaced routine follow-up geriatric care. GPC facilitated planned transitions to rehabilitation centers (n = 5), home hospice (n = 2), dementia units (n = 3), and home care (n = 37). GPC provides efficient, comprehensive geriatric care and case management while preserving established relationships between patients and the PC team. Preliminary results suggest "care defragmentation," as reflected by a significant reduction in subspecialty clinic use. Model simplicity and flexibility facilitated ready implementation.
Objectives:
African American and Hispanic elderly are at elevated risk of both depression and cardiovascular disease, relative to non-Hispanic whites. Effective interventions are therefore needed to address depressive symptoms and to reduce these disparities. BRIGHTEN Heart was a behavioral randomized controlled trial to test the efficacy of a virtual team intervention in reducing depressive symptoms in minority elderly as measured by the 9-item Patient Health Questionnaire (PHQ9).
Study design:
250 African American and Hispanic adults, age ≥60 years, with comorbid depression and overweight/obesity were randomized. Participants randomized to the Intervention condition received a social work evaluation, team-based electronic consultation, case management, and psychotherapy over a 12 month period. Control participants were enrolled in a membership program that provided health classes and other services to support chronic disease self-management. Blinded research assistants completed assessments at baseline, and 6 and 12 months postrandomization.
Results:
The study population was characterized by low socioeconomic status, with 81.4% having a household income of less than $20,000. Although median depression scores were in the mild range, 25% of participants had scores showing moderate to severe depression at baseline. 75% of participants had four or more chronic conditions. Significant demographic and clinical differences were observed between the African American and Hispanic populations.
Conclusions:
BRIGHTEN Heart was designed to rigorously test the efficacy of a multi-level intervention to reduce comorbid depressive symptoms and cardiovascular risk in minority elderly. Investigators successfully recruited a cohort well suited to testing the study hypothesis.
Purpose:
To evaluate the effectiveness of a pharmacist-physician collaborative practice model (PPCPM) to improve long-term blood pressure (BP) control rates in a primarily African-American underserved urban population.
Practice innovation:
Volunteer physicians established initial diagnoses, whereas pharmacists provided most (more than 70%) of the medication management. During each scheduled visit, the pharmacist reconciled the medication list, completed a clinical interview, conducted a focused physical examination, developed and implemented a treatment plan, and provided documentation in a shared medical record.
Evaluation:
A retrospective chart review was performed to collect data for a longitudinal cohort of patients managed by the PPCPM from 2010-2013.
Results:
Of 385 patients with at least two pharmacist visits during 2009, 172 patients received continuous care over the study period. At baseline, the mean age of the cohort was 51.3 years, 62% were female, and 76% were African-American. Approximately 65% were obese (body mass index 30 kg/m(2) or higher), and 39% were cigarette smokers. Mean baseline BP was 156/98 mm Hg, with only 17% of the cohort at their BP goal of lower than 140/90 mm Hg. The BP control rate improved to 66% during the first year and persisted throughout the study period, with 68% of patients at goal in 2013 (p<0.05 compared with baseline).
Conclusion:
The PPCPM BP control rate ranks in the 90th percentile of National Committee for Quality Assurance benchmarks and was superior even to the 2013 reported mean for commercial insurers. The PPCPM effectively improved hypertension control in an uninsured, primarily African-American, urban population despite significant health barriers. Key elements of this asynchronous care model included access to a common medical record, optimization of distinct interprofessional roles, frequent follow-up with evaluation, and collaborative practice agreement with sufficient scope of practice to implement medication changes at the time of the visit.
Background and purpose:
Changes in our nation's health care delivery system, shifting patient demographics, and availability of new health insurance programs have resulted in exploration of new practice models of health care delivery. Chronic diseases require coordinated care efforts over decades of a patient's life. Oral health professionals will be part of that care.
Methods:
The practice model for this article was developed in the context of an academic medical center that promotes oral health care professionals as health care providers through interprofessional education. The combined experiences of the authors, including a diabetes predictive model for oral health settings, the efficacy and effectiveness of human immunodeficiency virus screening in a dental setting, the feasibility of using a decision support tool for tobacco cessation, and the effectiveness of integrating oral health education with comprehensive health services for people living with human immunodeficiency virus, have contributed to this concept.
Conclusions:
Prevention is increasingly recognized as a cost-effective means of reducing chronic disease burdens. To be effective, health promotion activities that encourage healthy living and early detection need to occur in a variety of health care settings. Oral health professionals represent an underutilized group of health care providers that can contribute to improved health of populations living with chronic diseases by broadening their scope of practice to include primary health screenings and tailored health promotion activities.
Objective To evaluate the impact of an integrated child health system.
Design Mixed methods service evaluation.
Setting and patients Children, young people and their families registered in Child Health General Practitioner (GP) Hubs where groups of GP practices come together to form ‘hubs’.
Interventions Hospital paediatricians and GPs participating in joint clinics and multidisciplinary team (MDT) meetings in GP practices, a component of an ‘Inside-Out’ change known as ‘Connecting Care For Children (CC4C)’.
Main outcome measures Cases seen in clinic or discussed at MDT meetings and their follow-up needs. Hospital Episode data: outpatient and inpatient activity and A&E attendance. Patient-reported experience measures and professionals’ feedback.
Results In one hub, 39% of new patient hospital appointments were avoided altogether and a further 42% of appointments were shifted from hospital to GP practice. In addition, there was a 19% decrease in sub-specialty referrals, a 17% reduction in admissions and a 22% decrease in A&E attenders. Smaller hubs running at lower capacity in early stages of implementation had less impact on hospital activity. Patients preferred appointments at the GP practice, gained increased confidence in taking their child to the GP and all respondents said they would recommend the service to family and friends. Professionals valued the improvement in knowledge and learning and, most significantly, the development of trust and collaboration.
Conclusions Child Health GP Hubs increase the connections between secondary and primary care, reduce secondary care usage and receive high patient satisfaction ratings while providing learning for professionals.
Objective: The successful management of somatoform disorders in primary care is often limited due to low diagnostic accuracy, delayed referral to psychotherapy, and unstructured overuse of health care. This study aimed to investigate the feasibility of establishing a collaborative stepped health care network for somatoform disorders, and its impact on the diagnostic process and treatment recommendations in primary care.
Method: The Network for Somatoform and Functional Disorders (Sofu-Net) was established to connect 41 primary care physicians (PCP), 35 psychotherapists, and 8 mental health clinics. To evaluate Sofu-Net, primary care patients at high risk of having a somatoform disorder were identified using the Patient Health Questionnaire, and were assessed in detail at the patient and PCP level. Discussion of psychosocial distress in the consultations, diagnostic detection rates and treatment recommendations were compared before and 12 months after establishing the network.
Results: Out of the pre- (n=1645) and 12-months-post Sofu-Net patient samples (n=1756), 267 (16.2%) and
269 (15.3%) high-risk patientswere identified. Fromthese, 156 and 123 patientswere interviewed and information was assessed fromtheir PCP. Twelve months after Sofu-Net establishment, high-risk patients more frequently discussed psychosocial distress with their PCP (63.3% vs. 79.2%, p < .001). PCPs prescribed more antidepressants (3.8% vs. 25.2%, p < .001) and less benzodiazepines (21.8% vs. 6.5%, p < .001). Sofu-Net did not affect PCP's diagnostic detection rates or recommendation to initiate psychotherapy.
Conclusion: The study results indicate feasibility of an interdisciplinary network for somatoformdisorders. Collaborative care networks for somatoform disorders have the potential to improve doctor–patient-communication and prescription behavior.
Background:
Care of the elderly with diabetes is more complicated than that for other age groups. The elderly and/or those with multiple comorbidities are often excluded from randomized controlled trials of treatments for diabetes. The heterogeneity of health status of the elderly also increases the difficulty in diabetes care; therefore, diabetes care for the elderly should be individualized. Motivated patients educated about diabetes benefit the most from collaborating with a multidisciplinary patient-care team. A pharmacist is an important team member by serving as an educator, coach, healthcare manager, and pharmaceutical care provider.
Objective:
To evaluate the effects of pharmaceutical care on glycemic control of ambulatory elderly patients with type 2 diabetes.
Setting:
A 421-bed district hospital in Nantou City, Taiwan.
Method:
We conducted a randomized controlled clinical trial involving 100 patients with type 2 diabetes with poor glycemic control (HbA1c levels of ≥9.0 %) aged ≥65 years over 6 months. Participants were randomly assigned to a standard-care (control, n = 50) or pharmaceutical-care (intervention, n = 50) group. Pharmaceutical care was provided by a certified diabetes-educator pharmacist who identified and resolved drug-related problems and established a procedure for consultations pertaining to medication. The Mann–Whitney test was used to evaluate nonparametric quantitative data. Statistical significance was defined as P < 0.05.
Main outcome measure:
The change in the mean HbA1c level from the baseline to the next level within 6 months after recruiting.
Results:
Nonparametric data (Mann–Whitney test) showed that the mean HbA1c level significantly decreased (0.83 %) after 6 months for the intervention group compared with an increase of 0.43 % for the control group (P ≤ 0.001). Medical expenses between groups did not significantly differ (−624.06 vs. −418.7, P = 0.767). There was no significant difference in hospitalization rates between groups.
Conclusion:
The pharmacist intervention program provided pharmaceutical services that improved long-term, safe control of blood sugar levels for ambulatory elderly patients with diabetes and did not increase medical expenses.
Aim To describe the symptoms and functional changes in patients with high levels of somatization who were referred to an outpatient, multidisciplinary, shared mental healthcare (SMHC) service that primarily offered cognitive behavioural therapy. Second, we wished to compare the levels of somatization in this outpatient clinical sample with previously published community norms.
Somatization is common in primary care, and it can lead to significant impairment, disproportionate resource use, and poses a challenge for management.
All the patients (18+ years, n=508) who attended three or more treatment sessions in SMHC primary care over a seven-year period were eligible for inclusion to this pre-post study. Self-report measures included the Patient Health Questionnaire's somatic symptom severity scale (PHQ-15) and the World Health Organization Disability Assessment Schedule (WHODAS II). Normative comparisons were used to assess the degree of symptoms and functional changes. Findings Clinically significant levels of somatization before treatment were common (n=138, 27.2%) and were associated with a significant reduction in somatic symptom severity (41.3% reduction; P<0.001) and disability (44% reduction; P<0.001) after treatment. Patients' levels of somatic symptom severity and disability approached but did not quite reach the community sample norms following treatment. Multidisciplinary short-term SMHC was associated with significant improvement in patient symptoms and disability, and shows promise as an effective treatment for patients with high levels of somatization. Including a control group would allow more confidence regarding the conclusions about the effectiveness of SMHC for patients impaired by somatization.
Understanding the impact interprofessional teamwork has on patient outcomes is of great interest to health care providers, educators, and administrators. This article describes one clinical team, Women's Health Specialists, and their implementation of an interprofessional health intervention
course: "Mindfulness and Well-being: The Mature Woman" (MW: MW) to support mature women's health needs in midlife (age 40–70 years) and empower patient involvement in self-care. The provider team works to understand how their interprofessional education and collaborative practice (IPECP)
interventions focused on supporting midlife women are associated with improved quality and clinical outcomes. This case study describes the work of the Women's Health Specialists clinic in partnership with the National Center for Interprofessional Education and Collaborative Practice to study
the impact an interprofessional team has on the health needs of women in midlife. This article summarizes the project structure, processes, outputs, and outcomes. Data collection, analysis, strategy, and next steps for future midlife women's projects are also discussed.
The implementation of telemedicine often introduces major organizational changes in the affected healthcare sector. The objective of this study was to examine the organizational changes through the perception of the healthcare professionals regarding the implementation of a telemedical intervention. We posed the following research question: What are the key organizational factors in the implementation of telemedicine in wound care?
In connection with a randomized controlled trial of telemedical intervention for patients with diabetic foot ulcers in the region of Southern Denmark, we conducted an organizational analysis. The trial was designed as a multidisciplinary assessment of outcomes using the Model of ASsessment of Telemedicine (MAST). We conducted eight semi-structured interviews including individual interviews with leaders, and an IT specialist as well as focus group interviews with the clinical staff. A qualitative data analysis of the interviews was performed in order to analyze the healthcare professionals and leaders perception of the organizational changes caused by the implementation of the intervention.
The telemedical setup enhanced confidence among collaborators and improved the wound care skills of the visiting nurses from the municipality. The effect was related to the direct communication between visiting nurses and specialist doctors. Focus on the training of the visiting nurses was highlighted as a key factor in the success to securing implementation. Concerns regarding lack of multidisciplinary wound care teams, patient responsibility and lack of patient interaction with the physician were raised. Furthermore, the need for clinical guidelines in future implementation was underlined.
Several influential factors were demonstrated in the analysis including visiting nurses wound care training, focus on management, economy, periods with absence from work and clinical care. However, the technology used here could provide an additional option to offer patients after an individual assessment of their health condition.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Within the current Australian health system is the understanding of a need to change from the predominate biomedical model to incorporate a comprehensive primary health care
centred approach, embracing the social contexts of health and wellbeing. Recent research
investigated the benefits of the primary health care philosophy and strategies in relation to the Rainbows programme which addresses grief and loss in primary school aged students in Western Australia. A multidisciplinary collaboration between the Western Australian Departments of Health and Education enabled community school health nurse coordinators to train teacher facilitators in the implementation of Rainbows, enabling support for students and their parents.
The role of the outreach diabetes case manager in New Brunswick, Canada, was first developed in the Moncton Area of Horizon Health Network in response to a physician-identified gap between patients' diagnoses of diabetes and their attendance at the local diabetes education centre. This model of collaborative interprofessional practice increases support for primary care providers and people living with diabetes in that they are being provided the services of certified diabetes educators who can address knowledge gaps with respect to evidence-based guidelines and best practice, promote advancement of diabetes and chronic-disease management therapies and support adherence to treatment plans and self-management practices. This report chronicles a review of the implementation, expansion and evaluation of the outreach diabetes case manager model in the province of New Brunswick, Canada, along with the rationale for development of the role for registered nurses in other jurisdictions.
Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.
To enhance the universal coverage of quality diabetes care and overcome disparities in care among different care-provider levels by changing the diabetes care system in Changhua, Taiwan.
The Changhua Diabetes Shared Care program's second stage commenced in 2004. Two levels of diabetes care were proposed to facilitate physician participation via advocating the more attainable goals of diabetes care. The empowerment processes were differentiated into hospital-level and primary-care-clinic-level. The community multidisciplinary care teams took the scale of the practices into consideration, and several measures were applied to ameliorate the shared care network. The implementation support team from the health authority initiated in-person, one-on-one contacts with physicians to tailor collaboration activities to the individual primary care settings. The program's performance (2004-2012) was evaluated according to the RE-AIM model's five dimensions.
There was substantial improvement in diabetes care quality across all dimensions and the proportion of attaining all goals significantly grew.
The program achieved its primary goal of enhancing the universal coverage of quality diabetes care and overcoming disparities among different levels of care providers.
Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Background:
The literature on the use of telemedicine for children with developmental disabilities (DD) is limited and mostly describes telemedicine being used to link patients with distant subspecialty multidisciplinary care. Parents generally have reported satisfaction with such care and have perceived it to be equally effective as in-person care. Here we report on the use of school-based asynchronous telemedicine to connect children with DD with primary care providers.
Materials and methods:
We developed Tele-Health-Kids, a school-based program using asynchronous telemedicine to connect children with DD with their primary care physician for the care of minor illnesses. We surveyed parents at enrollment and after the child's first telemedicine visit to assess satisfaction. We describe 4 cases that illustrate benefits, particularly for children with DD and challenging behaviors, suggesting that asynchronous telemedicine may actually be superior to traditional in-office visits in some circumstances.
Results:
Most parents expressed a high level of satisfaction with the program. Benefits identified include decreased stress to the child and the parents as well as increasing the likelihood of a successful medical examination due to greater cooperation by the child. Visits using asynchronous or "store and forward" telemedicine technology may be superior in some situations by allowing the visit to be performed at a pace that can be adjusted to the needs of the child with DD.
Conclusions:
More research in the use of asynchronous telemedicine for children and youth with DD, particularly for children with DD and challenging behaviors, is needed.
Objectives:
Health care system fragmentation is a pervasive problem. Research has not delineated concrete behavioral strategies to guide providers to communicate with personnel in other organizations to coordinate care. We addressed this gap within a particular context: home-based providers delivering depression care management (DCM) to older adults requiring coordination with primary care personnel. Our objective was to pilot test a communication protocol ('BRIDGE - BRinging Inter-Disciplinary Guidelines to Elders') in conjunction with DCM.
Method:
In an open pilot trial (N = 7), home-based providers delivered DCM to participants. Following the BRIDGE protocol, home-based providers made scripted telephone calls and sent structured progress reports to personnel in participants' primary care practices with concise information and requests for assistance. Home-based providers documented visits with participants, contacts to and responses from primary care personnel. A research interviewer assessed participant outcomes [Symptom Checklist-20 (depressive symptoms), World Health Organization Disability Assessment Schedule-12, satisfaction] at baseline, three months, and six months.
Results:
Over 12 months, home-based providers made 2.4 telephone calls and sent 6.3 faxes to other personnel, on average per participant. Primary care personnel responded to 18 of 22 requests (81.8%; 2 requests dropped, 2 ongoing), with at least one response per participant. Participants' depressive symptoms and disability improved significantly at both post-tests with large effect sizes (d ranged 0.73-2.3). Participants were satisfied.
Conclusion:
Using BRIDGE, home-based providers expended a small amount of effort to communicate with primary care personnel, who responded to almost all requests. Larger scale research is needed to confirm findings and potentially extend BRIDGE to other client problems, professions, and service sectors.
Aims
The primary aim of this study was to evaluate the impact of pharmaceutical care interventions on glycemic control and other health-related clinical outcomes in patients with type 2 diabetes patients in Jordan.
Methods
A randomized controlled clinical trial was conducted on 106 patients with uncontrolled type 2 diabetes seeking care in the diabetes clinics at Jordan University Hospital. Patients were randomly allocated into control and intervention group. The intervention group patients received pharmaceutical care interventions developed by the clinical pharmacist in collaboration with the physician while the control group patients received usual care without clinical pharmacist's input. Fasting blood glucose and HbA1c were measured at the baseline, at three months, and six months intervals for both intervention and control groups.
Results
After the six months follow-up, mean of HbA1c and FBS of the patients in the intervention group decreased significantly compared to the control group patients (P < 0.05). Also, the results indicated that mean scores of patients’ knowledge about medications, knowledge about diabetes and adherence to medications and diabetes self-care activities of the patients in the intervention group increased significantly compared to the control group (P < 0.05).
Conclusions
This study demonstrated an improvement in HbA1c, FBS, and lipid profile, in addition to self-reported medication adherence, diabetes knowledge, and diabetes self-care activities in patients with type 2 diabetes who received pharmaceutical care interventions. The results suggest the benefits of integrating clinical pharmacist services in multidisciplinary healthcare team and diabetes management in Jordan.
Objective:
To improve key indicators of diabetes care by expanding a proven community-based model of care throughout high-risk areas in the United States.
Design:
Observational, multisite, pre-post comparison study.
Setting:
Federally qualified health centers, free clinics, employer worksites, community pharmacies, departments of health, physician offices, and other care facilities in 25 communities in 17 states from June 2011 through January 2013.
Participants:
1,836 patients disproportionately affected by diabetes representing diverse ethnicities, insurance statuses, and social and economic backgrounds.
Intervention:
Pharmacists were integrated into local, interdisciplinary diabetes care teams and provided customized diabetes education and medication consultations to patients.
Main outcome measures:
Clinical measures included glycosylated hemoglobin (A1C), body mass index, systolic and diastolic blood pressures, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, and total cholesterol. Process measures included smoking status, eye examination status, foot examination status, and influenza vaccine status.
Results:
Pharmacist patient care services for those underserved or disproportionately affected by diabetes resulted in a statistically significant and clinically relevant decrease in mean A1C levels (-0.8%). Other outcome indicators were below target levels at baseline and decreased significantly but not by clinically relevant amounts (LDL-C, -7.1 mg/dL; triglycerides, -23.7 mg/dL, and total cholesterol, -8.8 mg/dL). The mean increase in HDL-C (+0.6 mg/dL) was not statistically significant or clinically relevant. Among evaluable patients who were not at target for process measures at baseline, 51.7% of 453 patients received eye examinations, 72.0% of 271 patients received foot examinations, 41.7% of 307 patients received influenza vaccinations, and 9.3% patients of 270 quit smoking during the project. Of the communities involved in the study, 92% intend to sustain pharmacists' services.
Conclusion:
Project
Impact:
Diabetes results show significant improvement in patients' clinical outcomes and demonstrate that all patients, even those with tremendous barriers to appropriate diabetes care, benefit from patient-centered, interdisciplinary health care teams that include pharmacists.
RÉSUMÉ
La mise en oeuvre en l’Ontario de 15 cliniques interprofessionnelles des troubles de la mémoire à base de soins primaires représente un modèle unique de gestion de cas en équipe, visant à accroître la capacité de traitement de la démence au niveau des soins primaires. Chaque clinique a suivi les patients; dans un sous-ensemble des cliniques, des graphiques ont été vérifiés par les gériatres, les membres de la clinique ont été interrogés, et les patients, les soignants et les médecins traitants ont rempli des questionnaires de satisfaction. Dans toutes les cliniques, 582 patients ont été évalués, et 8,9 pour cent ont été adressés à un spécialiste. Les patients et les soignants étaient très satisfaits des soins reçus, de même que les médecins traitants de la famille, qui ont déclaré une augmentation de la capacité à gérer la démence. La vérification des dossiers des gériatres a révélé un niveau élevé d'accord avec le diagnostic et la gestion. Cette étude a démontré l'acceptabilité, la faisabilité et l'efficacité préliminaire du modèle de clinique des troubles de la mémoire de soins primaires. Dirigée par les médecins de famille spécialement formés, il a fourni un accès en temps opportun à la haute qualité des soins de la démence collaboratives, affectant recours aux services de santé par une utilisation plus efficace des maigres ressources spécialisées en gériatrie.
The majority of diabetes care in Canada is provided within the primary healthcare setting. It is delivered in a variety of models ranging from the physician working in a solo fee-for-service practice to an interprofessional team setting with specialist collaboration. To augment diabetes-related health services, the Ontario government has provided substantial funding to support community diabetes education programs. These models and initiatives are improving diabetes outcomes, and continued evolution of these programs can provide even greater outcomes. The St. Joseph's Primary Care Diabetes Support Program (SJHC PCDSP) is an innovative model that incorporates multidisciplinary allied health professionals together with physician support to provide care for more than 3000 patients in London, Ontario, Canada. It embodies the Canadian Diabetes Association (CDA)'s Organizations of Care recommendations to combine patient education and self-management with active medical support at each clinic encounter, all while embodying the tenets of primary care. A brief review of primary healthcare reform is provided to explain how the SJHC PCDSP combines features of current models in a unique format so as to deliver exceptional patient care. By providing a detailed description of the services delivered at the SJHC PCDSP, it is hoped that both specialists and primary care providers consider using and adapting approaches to diabetes management based on this innovative model to optimize their practices.
Over the last years hospital information systems became more integrated. Hospital information systems with the wide variety of systems are highly suitable to use process mining for knowledge discovery and optimization of processes. Applying process mining in hospital information systems is a modern and recommendable approach in health care. But process mining techniques can only provide a high result quality if the structure of data is known and if the structure of the event logs are maintained appropriately. This paper describes process mining, hospital information systems and shows where the challenges are if the two areas are combined.
Child maltreatment is a leading cause of pediatric morbidity and mortality, described as one of the greatest threats facing the health, welfare, and social well-being of children in the United States (). Despite mandatory reporting laws, the poignant reality is that this public health problem is significantly underrecognized and underreported by heath care providers. The purpose of this project was to implement a series of strategies in a pediatric emergency department to identify children who are at risk of maltreatment and initiate interventions to ensure their safety and protection before a devastating outcome occurs. The results of this project support the implementation of nursing education, a screening program for risk of child maltreatment, and collaboration with interdisciplinary stakeholders to achieve best practice in emergency medicine.
This article describes a pilot model to increase palliative care (PC) knowledge and collaboration among providers and to systematically identify chronic multimorbid home care patients who would benefit from focused discussion of potential PC needs. Thirty health care providers from a home-based primary care team attended interdisciplinary trainings. The Palliative Performance Scale (PPS) tool was used to trigger discussions of potential palliative needs at team rounds for patients who scored below a cutoff point on the tool. Palliative Performance Scale implementation added little burden on nurses and triggered a discussion in 51 flagged patients. The tool successfully identified 75% of patients who died or were discharged. Screening was systematic and consistent and resulted in targeted discussions about PC needs without generating additional burden on our PC consult service. This model shows promise for enhancing collaborative patient care and access to PC.