Improving outcomes in adults with diabetes through an interprofessional collaborative practice program

A scoping review of interprofessional education in healthcare: evaluating competency development, educational outcomes and challenges

BACKGROUND

Interprofessional education (IPE) is essential in healthcare to enhance collaboration, communication and teamwork among health professions education students. This review aimed to map out the core competencies health professions education students develop during IPE and identify the positive and negative educational outcomes.

METHODS

A comprehensive search strategy was developed and reported in accordance with the PRISMA ScR guidelines. The search was conducted across five electronic databases (Medline, Scopus, Web of Science, PsycINFO and EBSCO) for peer-reviewed articles published in English within the last 20 years. Data was extracted and core competencies were categorised into four defined areas-roles and responsibilities; interprofessional communication; values for interprofessional practice; teams and teamwork. The frequency of occurrence of each core competency, along with the positive and negative outcomes of IPE were analysed. Mixed methods analysis was used to integrate both qualitative and quantitative data.

RESULTS

Team and teamwork emerged as the most frequently attained core competency in IPE. The positive impacts of IPE include significant improvements in role clarity, communication skills, and teamwork dynamics. However, negative impacts were also noted, such as logistical challenges and interpersonal issues like power dynamics and communication barriers, which impeded the personal professional growth and professional interactional skill-related benefits of IPE. Additionally, some participants reported feeling overwhelmed by the extra workload required for IPE activities.

CONCLUSION

IPE is a valuable component of health professions education, significantly contributing to the development of core competencies necessary for interprofessional collaborative practice. Addressing the challenges and implementing best practices can further enhance the effectiveness of IPE programs, ultimately improving healthcare outcomes. The implications for practice, training of healthcare students and future research are discussed.

Observations of teamworking in a multidisciplinary diabetic foot clinic: Bridging roles of podiatry and technology

Diabetic foot ulcer (DFU) is arguably the gravest complication of type 2 diabetes with high disease burden and mortality. Its complexity as a chronic disease with acute presentation necessitates rapid access to a multidisciplinary team (MDT), typically comprising vascular surgeons, endocrinologists and podiatrists. We conducted a focused ethnography of 55 (82.5 h) observations, 10 interviews with patients and several opportunistic in-situ conversations with patients and members of the care team at the multidisciplinary foot clinic of a tertiary public hospital in Singapore. In the clinic, the patient sat in the centre of the treatment room to be attended to by various members of the MDT who entered and exited the room singly, then collectively, to diagnose and recommend treatments. This led us to adopt a dramaturgical model as our theoretical framework to explore the movements and interactions composing what can be recognised as teamworking. The clinicians' teamworking could be organized into front-stage planned activities of history-taking and diagnosing and treating the foot wound; front-stage ad hoc activities of clinical deliberating and recommending; back-stage planned activities consisting of discussions on workups, interventions and appointments and coordinating these for performing teamwork in the front-stage; back-stage ad hoc activities such as interprofessional discussions away from the patient and outside the clinic; and off-stage activities in the patient's lifeworld pertaining to patients' everyday decisions and concerns. The protracted treatment work of the podiatrist places her in a bridging position between the patient and the medical members of the MDT that could plug knowledge gaps, and enrich clinical explanations and decision-making. Technology enabled backstage interaction and sustained teamwork outside the clinic even when decision-makers among the medical team members were not physically present. The occurrences from the patient's lifeworld pose an essential influence that can inform teamworking in the clinic. We discuss implications for practice.

Federally Qualified Health Centers as a Model to Improve Vision Health: A Systematic Review

Importance

Disparities in eye health are associated with lower-income and minoritized populations, many of whom seek care at federally qualified health centers (FQHCs).

Objective

To examine the literature addressing vision and eye health care provided at FQHCs, identify barriers to providing care at FQHCs, and highlight recommendations on how FQHCs can decrease disparities in eye health.

Evidence Review

A systematic review of Embase, SCOPUS, and PubMed was performed, and articles regarding eye and vision health at FQHCs within the US published between January 1, 1965, and July 14, 2023, were included. This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Structured data and case studies were extracted and collated using an a priori method to reduce bias.

Findings

The systematic review yielded 423 unique articles, with 43 meeting inclusion criteria. Only 18.3% to 29% of FQHCs reported on-site vision services with the remainder relying on external referrals to vision specialists. Primary eye conditions evaluated included diabetic retinopathy (26 studies), general eye health (11 studies), and glaucoma (6 studies). Telehealth vision initiatives were an important method to expand access (18 studies). Other topics included economic analysis (5 studies) and policy suggestions (3 studies) to increase vision services at FQHCs. Systemic barriers to accessing care at FQHCs were the lack of eye clinicians available to provide services, the cost of resources, and limited reimbursement to implement screening programs. Patient barriers to accessing care included financial constraints for specialist care, limited awareness of the importance of eye examinations, and difficulty navigating the insurance system.

Conclusions and Relevance

Findings of this systematic review suggest that FQHCs are well positioned to increase vision services and thus improve vision health equity, serving populations who are at a higher risk for vision disorders. Results find systemic and patient-level barriers to vision health that may need to be addressed. Policy leaders could leverage existing gaps for purposeful advocacy, set standards and metrics for vision health at FQHCs, promote novel models of care, and encourage collaboration of eye clinicians with partnering FQHCs.

Impact on diabetes outcomes and team skills of integrating dietetic services into interprofessional education and teamwork in primary care

ObjectivesDiabetes is a complex disease requiring daily self-management of diet and activity, yet many patients do not receive recommended self-management education, medical nutrition therapy, or team-based care that includes registered dietitian nutritionists (RDNs). Such service deficits contribute to challenges in meeting combined diabetes care goals. We evaluated the impact of adding RDN-supervised dietetic interns to an established primary care interprofessional education/teamwork model on patients' clinical outcomes and health professions students' team skills.MethodsElectronic health records were retrospectively analyzed to evaluate the impact of interprofessional care teams including dietetic practitioners on patient outcomes and compare these changes to outcomes achieved with the previous model without such participation. Pre-test/post-test surveys were used to evaluate health professions students' self-reported changes in team skills.ResultsPatient outcomes for glycemic control, systolic blood pressure, triglycerides, and depression improved significantly, and emergency department visits decreased by 79% after interprofessional care. Average hemoglobin A1c levels decreased from 11.6% to 8.3% (p < .001), an additional 1.1% reduction over previous results, following incorporation of dietetic practitioners. Students reported increased team skills after interprofessional care participation.DiscussionHealth professions and dietetic program faculty should collaborate to develop interprofessional best practice primary care models for patients with diabetes.

Exploring the "led" in health professional student-led experiences: a scoping review

To support a complex health system, students are expected to be competent leaders as well as competent clinicians. Intentional student leadership development is needed in health professional education programs. Student-led experiences such as student-run clinics and interprofessional training wards, are practice-based learning opportunities where learners provide leadership to clinical services and/or address a gap in the system. Given the absence of leadership definitions and concepts, this scoping review explored how student leadership is conceptualized and developed in student-led experiences. The review was conducted in accordance with best practices in scoping review methodology within the scope of relevant practice-based student-led experiences for health professional students. The research team screened 4659 abstracts, identified 315 articles for full-text review and selected 75 articles for data extraction and analysis. A thematic analysis produced themes related to leadership concepts/theories/models, objectives, facilitation/supervision, assessment and evaluation of curriculum. While responding to system gaps within health professional care, student-led experiences need to align explicit leadership theory/concepts/models with curricular objectives, pedagogy, and assessments to support health professional education. To support future student-led experiences, authors mapped five leadership student role profiles that were associated with student-led models and could be constructively aligned with theory and concepts. In addition to leveraging a student workforce to address system needs, student-led experiences must also be a force for learning through a reciprocal model of leadership and service to develop future health professionals and leaders.

An evaluation of the psychometric properties of the Australian Collaborative Practice Assessment Tool

OBJECTIVES

This study aimed to validate the Collaborative Practice Assessment Tool (CPAT) in the Australian setting and provide a quality instrument in terms of psychometric properties that can be used to measure interprofessional outcomes for both healthcare practitioners and students. The outcomes evaluated include the capacity to work in an interprofessional team, good interprofessional communication skills, leadership skills, ensuring clear division of tasks and roles in a team, effective conflict management, and being actively involved with patients and their families/communities in care.

METHODS

The COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) taxonomy and standards were used as guides for evaluating the psychometric properties of the Australian CPAT, which include evaluations regarding instrument development requirements of sample target and size, content validity, internal structure (structural validity, internal consistency reliability and measurement invariance), and hypotheses testing. CPAT Australia was developed through two stages involving pilot studies and a validation study, both of which included healthcare practitioners and students as participants. A pilot study examined content validity regarding item relevance, item comprehensibility, and instrument comprehensiveness. The validation study was carried out to assess the internal structure of CPAT Australia for aspects of structural validity, internal consistency reliabilities, and configural, metric and scalar measurement invariance. The structural validity was explored using the following three steps: exploratory, confirmatory, and multi-group factor analysis. Construct validity was evaluated to confirm direct and indirect paths of assumptions based on a previously validated model. Data collected between August 2021 and May 2022.

RESULTS

The content validity evaluation confirmed that all items were relevant, understandable and comprehensive for measuring interprofessional collaborative care in Australia. Three hundred ninety-nine participants contributed to the validation study (n=152 practitioners; n=247 students). The original instrument model of 8-Factor 56-Item was improved in the Australian CPAT. Two items, Item 27 (Physicians assume the ultimate responsibility) and Item 49 (Final decision rest with the physician), were consistently rejected and therefore discarded. The internal structure of the 7-Factor 54-Item solution was confirmed as a suitable model with fit indices meeting COSMIN standards for a good model in practitioner and student cohorts. Configural, metric and scalar invariances were confirmed, indicating the invariance of the instruments when used for the practitioner and student cohorts. The construct validity evaluation indicated that 81.3% of direct and indirect assumptions were accepted, fulfilling the COSMIN requirement of >75% of proposed assumptions being accepted.

CONCLUSION

The Australian CPAT with a 7-factor 54-item solution was confirmed as a quality measure for assessing interprofessional education and collaborative practice for both healthcare practitioners and students in Australia with robust psychometric properties.

Describing the evidence linking interprofessional education interventions to improving the delivery of safe and effective patient care: a scoping review

Empirical evidence indicates that collaborative interprofessional practice leads to positive health outcomes. Further, there is an abundance of evidence examining student and/or faculty perceptions of learning or satisfaction about the interprofessional education (IPE) learning experience. However, there is a dearth of research linking IPE interventions to patient outcomes. The objective of this scoping review was to describe and summarize the evidence linking IPE interventions to the delivery of effective patient care. A three-step search strategy was utilized for this review with articles that met the following criteria: publications dated 2015-2020 using qualitative, quantitative or mixed methods; the inclusion of healthcare professionals, students, or practitioners who had experienced IPE or training that included at least two collaborators within coursework or other professional education; and at least one of ten Centers for Medicare & Medicaid Services quality measures (length of stay, medication errors, medical errors, patient satisfaction scores, medication adherence, patient and caregiver education, hospice usage, mortality, infection rates, and readmission rates). Overall, n=94 articles were identified, providing overwhelming evidence supporting a positive relationship between IPE interventions and several key quality health measures including length of stay, medical errors, patient satisfaction, patient or caregiver education, and mortality. Findings from this scoping review suggest a critical need for the development, implementation, and evaluation of IPE interventions to improve patient outcomes.

Teamwork and its impact on chronic disease clinical outcomes in primary care: a systematic review and meta-analysis

OBJECTIVE

Teamwork positively affects staff performance and patient outcomes in chronic disease management. However, there is limited research on the impact of specific team components on clinical outcomes. This review aims to explore the impact of teamwork components on key clinical outcomes of chronic diseases in primary care.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

This systematic review and meta-analysis conducted searching EMBASE, PubMed, Cochrane Central Register of Controlled Trials. Studies included must have at least one teamwork component, conducted in primary care for selected chronic diseases, and report an impact of teamwork on clinical outcomes. Mean differences and 95% confidence intervals were used to determine pooled effects of intervention.

RESULTS

A total of 54 studies from 1988 to 2021 were reviewed. Shared decision-making, roles sharing, and leadership were missing in most studies. Team-based intervention showed a reduction in mean systolic blood pressure (MD = 5.88, 95% CI 3.29-8.46, P= <0.001, I2 = 95%), diastolic blood pressure (MD = 3.23, 95% CI 1.53 to 4.92, P = <0.001, I2 = 94%), and HbA1C (MD = 0.38, 95% CI 0.21 to 0.54, P = <0.001, I2 = 58%). More team components led to better SBP and DBP outcomes, while individual team components have no impact on HbA1C. Fewer studies limit analysis of cholesterol levels, hospitalizations, emergency visits and chronic obstructive pulmonary disease-related outcomes.

CONCLUSION

Team-based interventions improve outcomes for chronic diseases, but more research is needed on managing cholesterol, hospitalizations, and chronic obstructive pulmonary disease. Studies with 4-5 team components were more effective in reducing systolic blood pressure and diastolic blood pressure. Heterogeneity should be considered, and additional research is needed to optimize interventions for specific patient populations.

Exploring experiential learning within interprofessional practice education initiatives for pre-licensure healthcare students: a scoping review

BACKGROUND

Interprofessional collaborative team-based approaches to care in health service delivery has been identified as important to health care reform around the world. Many academic institutions have integrated interprofessional education (IPE) into curricula for pre-licensure students in healthcare disciplines, but few provide formal initiatives for interprofessional practice (IPP). It is recognized that experiential learning (EL) can play a significant role supporting IPP education initiatives; however, little is known of how EL is used within education for IPP in healthcare settings.

METHODS

We conducted a scoping review to map peer-reviewed literature describing IPP education initiatives involving EL for pre-licensure students in healthcare disciplines. A literature search was executed in MEDLINE, CINAHL, EMBASE, ERIC, PsycINFO, Scopus, and Social Services Abstracts. After deduplication, two independent reviewers screened titles and abstracts of 5664 records and then 252 full-text articles that yielded 100 articles for data extraction. Data was extracted using an Excel template, and results synthesized for presentation in narrative and tabular formats.

RESULTS

The 100 included articles represented 12 countries and IPP education initiatives were described in three main typologies of literature - primary research, program descriptions, and program evaluations. Forty-three articles used a theory, framework, or model for design of their initiatives with only eight specific to EL. A variety of teaching and learning strategies were employed, such as small interprofessional groups of students, team huddles, direct provision of care, and reflective activities, but few initiatives utilized a full EL cycle. A range of perspectives and outcomes were evaluated such as student learning outcomes, including competencies associated with IPP, impacts and perceptions of the IPP initiatives, and others such as client satisfaction.

CONCLUSION

Few educational frameworks specific to EL have been used to inform EL teaching and learning strategies to consolidate IPE learning and prepare students for IPP in healthcare settings. Further development and evaluation of existing EL frameworks and models would be beneficial in supporting robust IPP educational initiatives for students in healthcare disciplines. Intentional, thoughtful, and comprehensive use of EL informed by theory can contribute important advances in IPP educational approaches and the preparation of a future health care workforce.

Social and healthcare students' competence in patient-oriented care enhanced during interprofessional practice: A scoping review

AIM

This scoping review aimed to synthesise the findings of previous literature related to social and healthcare students' competence in patient-oriented care in interprofessional practice by attending multidisciplinary student teams.

BACKGROUND

Learning about patient-oriented care requires the comprehensive consideration of patients' physical, emotional, social and economic aspects to offer the best need-based care. Multidisciplinary student teams in the clinical practice may support learning patient-oriented care; however, the current knowledge is fragmented.

DESIGN

Scoping review METHODS: Data (N = 1548) were gathered from four databases, PubMed, MEDLINE, SocIndex and CINAHL, without start-date limitation until the end of December 2022. One article was found on the publisher's webpage recommendations. The selected studies (N = 15) answered the research questions and met the inclusion criteria. Quality assessment of the studies was conducted using the Joanna Briggs Institute (JBI) Quality Assessment Checklist. A thematic analysis process was used for data extraction and synthesis of results.

RESULTS

Perspectives on patient-oriented care competencies were analysed for both students and patients cared for by a multidisciplinary student team. The themes described students' profound understanding of professional roles and responsibilities in patient-oriented care, collaborative patient-oriented care skills, improved interprofessional communication and reported patient experiences.

CONCLUSIONS

Interprofessional practice versatility develops students' competence in patient-oriented care. Guaranteeing patient-oriented care requires a broad understanding of patients' comprehensive care needs, which can be addressed through multidisciplinary collaboration. Patients' experiences toward interprofessional student practice are mainly positive. Further research is needed to assess the impact of different interprofessional education methods on students' patient-oriented care competence using valid instruments and the long-term effects of students' competence in patient-oriented care.

Interprofessional Collaborative Practice: Management of Chronic Disease and Mental Health Issues in Primary Care

This case study describes the process of implementing and evaluating an interprofessional collaborative practice (IPCP) program for primary care and behavioral health integration focused on chronic disease management. The result was a strong IPCP program in a nurse-led federally qualified health center serving medically underserved populations. The IPCP program at the Larry Combest Community Health and Wellness Center at the Texas Tech University Health Sciences Center spanned >10 years of planning, development, and implementation, supported by demonstration, grants, and cooperative grants from the Health Resources and Services Administration. The program launched 3 projects: a patient navigation program, an IPCP program for chronic disease management, and a program for primary care and behavioral health integration. We established 3 evaluation domains to track the outcomes of the program: TeamSTEPPS education outcomes (Team Strategies and Tools to Enhance Performance and Patient Safety), process/service measures, and patient clinical and behavioral measures. TeamSTEPPS outcomes were evaluated before and after training on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Mean (SD) scores increased significantly in team structure (4.2 [0.9] vs 4.7 [0.5]; P < .001), situation monitoring (4.2 [0.8] vs 4.6 [0.5]; P = .002), and communication (4.1 [0.8] vs 4.5 [0.5]; P = .001). From 2014 to 2020, the rate of depression screening and follow-up improved from 16% to 91%, and the hypertension control rate improved from 50% to 62%. Lessons learned include recognizing partner contributions and the worth of each team member. Our program evolved with the help of networks, champions, and collaborative partners. Program outcomes show the positive impact of a team-based IPCP model on health outcomes among medically underserved populations.

Introspective Learning From Interprofessional Virtual Grand Rounds

BACKGROUND

Interprofessional collaboration in health care settings improves patient safety and outcomes, yet collaboration among health professionals requires specific competencies and skills. Providing nursing students with interprofessional learning experiences with multiple health professions is possible yet challenging.

PROBLEM

Opportunities for effective online interprofessional learning are lacking.

APPROACH

This article explores nursing students' reflections on how an interprofessional learning experience, Virtual Grand Rounds (VGRs), influenced their personal development and provided meaningful learning that they can use in their practices as professional nurses. Thematic analysis was done on the open-ended questions in students' final reflection assignment.

OUTCOMES

Analysis of student reflections identified 5 learning themes including the value of teamwork and collaboration, the importance of communication skills, professional identity, plans to engage diverse health professions, and the desire for future learning.

CONCLUSIONS

Student reflections indicate the VGR was an effective method for nursing students to experience collaboration with multiple health professions without disrupting curriculums.

Measuring Interprofessional Collaboration's Impact on Healthcare Services Using the Quadruple Aim Framework: A Protocol Paper

Despite decades of research on the impact of interprofessional collaboration (IPC), we still lack definitive proof that team-based care can lead to a tangible effect on healthcare outcomes. Without return on investment (ROI) evidence, healthcare leaders cannot justifiably throw their weight behind IPC, and the institutional push for healthcare manpower reforms crucial for facilitating IPC will remain variable and fragmentary. The lack of proof for the ROI of IPC is likely due to a lack of a unifying conceptual framework and the over-reliance on the single-method study design. To address the gaps, this paper describes a protocol which uses as a framework the Quadruple Aim which examines the ROI of IPC using four dimensions: patient outcomes, patient experience, provider well-being, and cost of care. A multimethod approach is proposed whereby patient outcomes are measured using quantitative methods, and patient experience and provider well-being are assessed using qualitative methods. Healthcare costs will be calculated using the time-driven activity-based costing methodology. The study is set in a Singapore-based national and regional center that takes care of patients with neurological issues.

Piloting a Telehealth Interprofessional Diabetes Clinic During Covid 19: Continuing patient care and student learning

Due to the COVID-19 pandemic, a team of faculty from dietetics, nursing, pharmacy, and social work converted a long-standing effective Interprofessional Team Care Clinic (IPTCC) at two outpatient health centers to a telehealth clinic during 2020 and 2021. Preliminary data suggest that this pilot telehealth clinic for patients with diabetes or prediabetes was effective in significantly lowering average hemoglobin A1C levels and increasing students' perceived interprofessional skills. This article describes the pilot telehealth interprofessional model used to educate students and provide patient care, outlines preliminary data about its effectiveness, and makes recommendations for future research and practice.

Conquering diabetes therapeutic inertia: practical tips for primary care

Diabetes is a complex condition that is largely self-managed. Decades of scientific evidence has proved that early glycemic control leads to improved microvascular and macrovascular outcomes in people with diabetes mellitus. Despite well-established management guidelines, only about half of the patients with diabetes achieve glycemic targets, and only one in five patients achieve metabolic control (blood pressure, lipid, and glucose targets), and both patients and physicians find themselves stuck in a rut called therapeutic inertia (TI). The authors present several practical strategies that can be tailored to different practice settings and facilitate reducing TI.

Scoping review to identify strategies and interventions improving interprofessional collaboration and integration in primary care

OBJECTIVE

To identify strategies and interventions used to improve interprofessional collaboration and integration (IPCI) in primary care.

DESIGN

Scoping review DATA SOURCES: Specific Medical Subject Headings terms were used, and a search strategy was developed for PubMed and afterwards adapted to Medline, Eric and Web of Science.

STUDY SELECTION

In the first stage of the selection, two researchers screened the article abstracts to select eligible papers. When decisions conflicted, three other researchers joined the decision-making process. The same strategy was used with full-text screening. Articles were included if they: (1) were in English, (2) described an intervention to improve IPCI in primary care involving at least two different healthcare disciplines, (3) originated from a high-income country, (4) were peer-reviewed and (5) were published between 2001 and 2020.

DATA EXTRACTION AND SYNTHESIS

From each paper, eligible data were extracted, and the selected papers were analysed inductively. Studying the main focus of the papers, researchers searched for common patterns in answering the research question and exposing research gaps. The identified themes were discussed and adjusted until a consensus was reached among all authors.

RESULTS

The literature search yielded a total of 1816 papers. After removing duplicates, screening titles and abstracts, and performing full-text readings, 34 papers were incorporated in this scoping review. The identified strategies and interventions were inductively categorised under five main themes: (1) Acceptance and team readiness towards collaboration, (2) acting as a team and not as an individual; (3) communication strategies and shared decision making, (4) coordination in primary care and (5) integration of caregivers and their skills and competences.

CONCLUSIONS

We identified a mix of strategies and interventions that can function as 'building blocks', for the development of a generic intervention to improve collaboration in different types of primary care settings and organisations.

Development and implementation of interprofessional education activity among health professions students in Jordan: A pilot investigation

Implementing interprofessional education (IPE) in health professions curricula requires considerations of students' attitudes and readiness. Interventional studies that assess students' perceptions about IPE are needed. As IPE is an emerging concept in Jordan, our study aimed at exploring the attitudes of health profession students about IPE and collaborative practice before and after implementing an IPE activity. Students completed the validated Interprofessional Attitudes Scale (IPAS) before and after completing a 3-hour interprofessional activity. Students' attitudes toward IPE were compared using the subscales and total IPAS scores. A total of 41 health profession students attending the professional health programs of Doctor of Pharmacy, Medicine, Nursing, Nutrition, or Pharmacy completed IPAS before and after conducting the interprofessional activity. Students reported positive attitudes toward IPE prior to the activity. Significant increases were observed in IPAS scores from pre- (median [interquartile range: IQR] score = 4.19 [0.61]) to post-activity (median [IQR] = 4.48 [0.65]), and in its subscales (teamwork, roles and responsibilities, diversity and ethics, and community-centeredness). Students' experience with the IPE activity was positive and optimistic. The findings revealed for the first time the perception and readiness of health profession students toward IPE and collaborative practice in Jordan. This readiness can help draw a path for strategic integration of IPE in health profession curricula.

Identifying contributing factors influencing pediatric nurses' and health professionals' self-reported collaborative practice behaviors

PURPOSE

In this study, we examined the influence of interprofessional American Heart Association (AHA) resuscitation courses on pediatric health care professionals' (N = 218) self- reported collaborative practice behaviors (CPBs) and examined differences in CPBs between nursing, medicine, and respiratory therapy.

DESIGN AND METHODS

A mixed methods explanatory design was utilized with a sample of pediatric nurses, nurse practitioners, physicians, and respiratory therapists. Data were collected using the Interprofessional Collaborative Competency Attainment Survey (ICCAS) and two open-ended questions. Data analysis included: exploratory factor analysis, paired t-tests, mixed effects modeling and directed content analysis. Inferences were made across quantitative and qualitative data.

RESULTS

Statistically significant improvement in mean CPB scores was demonstrated by all professions (t (208) = -12.76; ρ < 0.001) immediately after the AHA courses. Qualitative responses indicated physicians identified roles and responsibilities (94%, n = 17) as the most important CPB. Communication was identified by nurses (78%, n = 76), nurse practitioners (100%, n = 11) and respiratory therapists (71%, n = 5) as most important.

CONCLUSIONS

Participation in an interprofessional AHA course significantly increased mean self-reported CPB scores. Changes in mean CPB scores were sustained over 6 weeks upon return to clinical practice.

PRACTICE IMPLICATIONS

Future research focused on CPBs of front-line health care professionals can provide an accurate portrayal of an interprofessional team and can inform how collaborative practice is established in everyday clinical practice.

Patient Outcomes from Student-Run Health Services: An Integrative Review

Background

Student-run clinics (SRCs) offer an innovative approach to expand healthcare access and equity and increase clinical placement opportunities for students. However, research on the health benefits and/or outcomes of such clinics is currently fragmented.

Methods

An integrative review was conducted to capture and synthesize findings across a range of study types involving varied student disciplines, student delivered intervention types, and health conditions addressed or care areas of focus. Only published and peer reviewed studies were included. Studies needed to report outcomes in a defined study group measured over time, or report SRC data with explicit comparisons to non-SRC settings. Data were analyzed using inductive content analysis to identify major themes and natural clustering of health outcomes measured.

Results

Fifty-one articles were selected for review based on the eligibility criteria. Studies were predominantly from the United States, and most (n = 34, 67%) adopted a case review methodology for measuring outcomes. Health outcomes were evaluated in relation to a range of health conditions that, for the purposes of this review, were considered to naturally cluster into eight categories: diabetes, hypertension, functional health/quality of life, depression, hospital utilization, substance use, weight, health screening/vaccinations, and others.

Conclusion

This integrative review sought to evaluate the health outcomes accrued by patients in student-run health clinics. Taken as a whole, the literature suggests positive health outcomes resulting from student-run clinics across a range of health conditions. Greater confidence in care-related findings would be achieved from future research utilizing more robust and prospective study designs.

Pilot of a community-based interprofessional "student-infused" pulmonary rehabilitation program in Saint John, New Brunswick

Background

With the increasing prevalence of chronic pulmonary conditions in New Brunswick and Canada it is necessary to consider innovative interventions to improve access to rehabilitation and supportive care for affected clients. In Fall 2018 we piloted a pulmonary rehabilitation (PR) program for persons with moderate to severe chronic obstructive pulmonary disease (COPD) to demonstrate a novel approach of bridging interprofessional education of students in health care fields with provision of care in a community setting.

Methods

An 8-week PR program was implemented and evaluated using a quasi-experimental design with pre- and post-testing to measure the effects of the program’s exercise and educational interventions on persons with COPD. Participants were assessed using the 6-Minute Walk Test (6MWT), the St. George’s Respiratory Questionnaire (SGRQ), and a custom questionnaire that rated the participants’ activities of daily living and the PR program.

Results

Seven participants completed our PR program. Following the intervention, participants’ self-reported health demonstrated a statistically significant improvement. Even though changes on the 6MWT and SGRQ were not shown to be statistically significant, there was evidence of clinically meaningful improvements in those measures. On average, participants walked 25 m further postintervention and showed clinically meaningful improvements on the SGRQ.

Conclusions

This pilot project demonstrated that a community-based PR program with active involvement of students from multiple health care programs can have positive outcomes for clients with COPD. It also illustrated how educational programs can provide an innovative means for increasing access to rehabilitation and supportive care for clients in the community.

Effect of Daily Multidisciplinary Team Reflection in Ambulatory Care: A Qualitative Analysis

Purpose

Participants and Methods

Results

Conclusion

Sustainability of an IPCP program within a federally qualified health center including interprofessional student team placements

In an effort to improve teamwork and collaborative care at a Federally Qualified Health Center (FQHC), the Midwest Interprofessional Practice, Education, and Research Center (MIPERC) collaborated on the implementation of an interprofessional collaborative practice (IPCP) program that included placement of multidisciplinary student teams. The MIPERC IPCP program supported staff, preceptor and student teams through interprofessional education and structured interprofessional activities for students, including daily huddles, interprofessional student team visits, and nurse triage phone calls. Results from the project's first year were previously reported (Nagelkerk et al., 2017b). Ongoing effects of IPCP on staff morale, IPE knowledge and practice efficiency were measured. Study tools included demographic forms, pre/post module knowledge tests, focus groups and program evaluations. The mean number of clinic patient visits per hour per medical provider was calculated to evaluate practice efficiency. Students (n = 26) and staff (n = 30) demonstrated improvement (p ≤.05) in knowledge test scores for Patient Safety, Team Dynamics and Tips for Behavioral Changes. Providers increased the number of patients seen per hour. Program evaluations and focus group data from providers, staff, and students indicated IPCP programs can be sustainable with ongoing intentional team care strategies.

How are nurse educators prepared to teach interprofessional practice?

BACKGROUND

When healthcare professionals collaborate and communicate well, patients have better health outcomes. Nursing students need to learn interprofessional team skills before they graduate to succeed. Nurse educators are responsible for preparing students to function in interprofessional teams. However, many nursing programs, especially ones with fewer resources, struggle to teach interprofessional collaboration. Experts agree that the first step in implementing interprofessional education is to provide educators with faculty development. Despite this, little is known about if and how nurse educators are prepared to teach interprofessional concepts.

OBJECTIVES

The purpose of this study was to explore nurse educator experiences regarding their preparation to teach interprofessional education and to explore how their preparation influenced their teaching.

DESIGN

A qualitative multiple case study approach was used to gather information regarding nurse educators' preparation to teach interprofessional education. Data were gathered from interviews and educational documents.

SETTINGS

This study involved three different undergraduate RN programs located in the Western United States.

PARTICIPANTS

Data was gathered from three educators from each of the three different undergraduate nursing programs, for a total of nine participants.

METHODS

Interview transcripts and educational documents were thematically analyzed using the Interprofessional Education Collaborative's core competencies as a framework.

RESULTS

None of the educators had participated in any type of formal faculty development to prepare them to teach interprofessional collaboration. Most had an incomplete understanding of interprofessional collaborative practice. Few were aware of the resources available to help them incorporate interprofessional collaboration into their curriculum. Although there were isolated instances where participants taught students communication or teamwork concepts, none of the programs explored had any formal interprofessional education in their curricula.

CONCLUSIONS

This study's findings support the need for faculty development if leaders expect nursing educators to teach interprofessional collaboration to students.

Assessment of Interprofessional Collaborative Practices and Outcomes in Adults With Diabetes and Hypertension in Primary Care: A Systematic Review and Meta-analysis

Importance

Interprofessional collaborative practice (ICP), the collaboration of health workers from different professional backgrounds with patients, families, caregivers, and communities, is central to optimal primary care. However, limited evidence exists regarding its association with patient outcomes.

Objective

To examine the association of ICP with hemoglobin A1C (HbA1c), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels among adults receiving primary care.

Data Sources

A literature search of English language journals (January 2013-2018; updated through March 2020) was conducted using MEDLINE; Embase; Ovid IPA; Cochrane Central Register of Controlled Trials: Issue 2 of 12, February 2018; NHS Economic Evaluation Database: Issue 2 of 4, April 2015; Clarivate Analytics WOS Science Citation Index Expanded (1990-2018); EBSCOhost CINAHL Plus With Full Text (1937-2018); Elsevier Scopus; FirstSearch OAIster; AHRQ PCMH Citations Collection; ClinicalTrials.gov; and HSRProj.

Study Selection

Studies needed to evaluate the association of ICP (≥3 professions) with HbA1c, SBP, or DBP levels in adults with diabetes and/or hypertension receiving primary care. A dual review was performed for screening and selection.

Data Extraction and Synthesis

This systematic review and meta-analysis followed the PRISMA guideline for data abstractions and Cochrane Collaboration recommendations for bias assessment. Two dual review teams conducted independent data extraction with consensus. Data were pooled using a random-effects model for meta-analyses and forest plots constructed to report standardized mean differences (SMDs). For high heterogeneity (I2), data were stratified by baseline level and by study design.

Main Outcomes and Measures

The primary outcomes included HbA1c, SBP, and DBP levels as determined before data collection.

Results

A total of 3543 titles or abstracts were screened; 170 abstracts or full texts were reviewed. Of 50 articles in the systematic review, 39 (15 randomized clinical trials [RCTs], 24 non-RCTs) were included in the meta-analyses of HbA1c (n = 34), SBP (n = 25), and DBP (n = 24). The sample size ranged from 40 to 20 524, and mean age ranged from 51 to 70 years, with 0% to 100% participants being male. Varied ICP features were reported. The SMD varied by baseline HbA1c, although all SMDs significantly favored ICP (HbA1c <8, SMD = -0.13; P < .001; HbA1c ≥8  to < 9, SMD = -0.24; P = .007; and HbA1c ≥9, SMD = -0.60; P < .001). The SMD for SBP and DBP were -0.31 (95% CI, -0.46 to -0.17); P < .001 and -0.28 (95% CI, -0.42 to -0.14); P < .001, respectively, with effect sizes not associated with baseline levels. Overall I2 was greater than 80% for all outcomes.

Conclusions and Relevance

This systematic review and meta-analysis found that ICP was associated with reductions in HbA1c regardless of baseline levels as well as with reduced SBP and DBP. However, the greatest reductions were found with HbA1c levels of 9 or higher. The implementation of ICP in primary care may be associated with improvements in patient outcomes in diabetes and hypertension.

Developing interprofessional collaborative practice competencies in rural primary health care teams

BACKGROUND

Leaders from a university, Area Health Education Center, and primary care centers (PCCs) collaborated to integrate Interprofessional Collaborative Practice (IPCP) in PCCs.

PURPOSE

Describe the facilitators and barriers of IPCP implementation in rural clinics and the impact on decision-making and safety culture.

METHODS

The implementation team used engagement strategies to support the development of IPCP. PCC team participants completed surveys measuring collaboration and satisfaction with care decisions and safety culture. Qualitative data were analyzed to describe facilitators and barriers to IPCP.

FINDINGS

Significant improvement (p < .035) in the Global Amount of Collaboration made over time. Barriers to IPCP included high turnover, hierarchical culture, lack of role clarity, competing time demands, limited readiness for change, and physical space limitations. Facilitators included structured huddles, alignment of IPCP with organizational goals, and academic-practice partnership.

DISCUSSION

Partnering with academic-practice partnerships may facilitate collaboration and team learning as PCCs incorporate IPCP into practice.

Organizational Conditions That Impact the Implementation of Effective Team-Based Models for the Treatment of Diabetes for Low Income Patients-A Scoping Review

Background: Team-based care models (TBC) have demonstrated effectiveness to improve health outcomes for vulnerable diabetes patients but have proven difficult to implement in low income settings. Organizational conditions have been identified as influential on the implementation of TBC. This scoping review aims to answer the question: What is known from the scientific literature about how organizational conditions enable or inhibit TBC for diabetic patients in primary care settings, particularly settings that serve low-income patients? Methods: A scoping review study design was selected to identify key concepts and research gaps in the literature related to the impact of organizational conditions on TBC. Twenty-six articles were finally selected and included in this review. This scoping review was carried out following a directed content analysis approach. Results: While it is assumed that trained health professionals from diverse disciplines working in a common setting will sort it out and work as a team, co-location, and health professions education alone do not improve patient outcomes for diabetic patients. Health system, organization, and/or team level factors affect the way in which members of a care team, including patients and caregivers, collaborate to improve health outcomes. Organizational factors span across seven categories: governance and policies, structure and process, workplace culture, resources, team skills and knowledge, financial implications, and technology. These organizational factors are cited throughout the literature as important to TBC, however, research on the organizational conditions that enable and inhibit TBC for diabetic patients is extremely limited. Dispersed organizational factors are cited throughout the literature, but only one study specifically assesses the effect of organizational factors on TBC. Thematic analysis was used to categorize organizational factors in the literature about TBC and diabetes and a framework for analysis and definitions for key terms is presented. Conclusions: The review identified significant gaps in the literature relating to the study of organizational conditions that enable or inhibit TBC for low-income patients with diabetes. Efforts need to be carried out to establish unifying terminology and frameworks across the field to help explain the relationship between organizational conditions and TBC for diabetes. Gaps in the literature include research be based on organizational theories, research carried out in low-income settings and low and middle income countries, research explaining the difference between the organizational conditions that impact the implementation of TBC vs. maintaining or sustaining TBC and the interaction between organizational factors at the micro, meso and macro level and their impact on TBC. Few studies include information on patient outcomes, and fewer include information on low income settings. Further research is necessary on the impact of organizational conditions on TBC and diabetic patient outcomes.

Effect of student-led health interventions on patient outcomes for those with cardiovascular disease or cardiovascular disease risk factors: a systematic review

Background

As the need for health care services rise, alternative service delivery models such as student-led health interventions become attractive alternatives to alleviate the burden on healthcare. Predominantly, student-led health interventions were free clinics servicing socially disadvantaged communities in the USA. A 2015 systematic review identified that students value these student-run clinics and reported skill and knowledge attainment from participating. Previous research has reported on patient satisfaction outcomes, but less frequently about the clinical outcomes patients accrue from these student-delivered services. As cardiovascular disease is the leading cause of death worldwide, this review aimed to explore the effectiveness of student-led health interventions through examining their impact on objective clinical outcomes, using the case of patients at risk of, or with, cardiovascular disease.

Methods

A systematic literature search was conducted in eight electronic databases to identify student-led health interventions conducted on adults with a cardiovascular disease risk factor or established cardiovascular disease, and a clinical outcome of interest. Through double-blinded screening and data extraction, sixteen studies were identified for synthesis.

Results

The majority of student-led health interventions for patients at risk of cardiovascular disease demonstrated a positive impact on patient health. Statistically significant changes amongst patients at risk of cardiovascular disease appeared to be associated with student-led individualised intervention or group-based interventions amongst patients with diabetes or those who are overweight or obese. The evidence was of moderate quality, as included studies lacked a control group for comparison and detail to enable the intervention to be replicated.

Conclusions

Future research applying a student-led health intervention through a randomised control trial, with rigorous reporting of both student and patient interventions and outcomes, are required to further understand the effectiveness of this alternative service delivery model.

Interprofessional Collaborative Practice Model to Advance Population Health

The purpose of this paper is to describe the development, implementation, and lessons learned associated with an interprofessional collaborative practice (IPCP) care delivery model initiated at the University of Alabama at Birmingham (UAB). The model emphasizes transitional care coordination in chronic disease management for underserved and vulnerable populations. The model operates within a clinic environment with care providers from a variety of disciplines who integrate individual case management and actualize leadership taken by the appropriate discipline based on the needs of each patient. Two clinics will be discussed - Providing Access to Healthcare (PATH) and Heart Failure Transitional Care Services for Adults (HRTSA) - both of which leverage the resources of an existing academic-practice partnership between the UAB School of Nursing and UAB Hospital (UABH) and Health System. Clinic target patient populations are uninsured adults with diabetes (PATH Clinic) and uninsured or underinsured adults with heart failure (HRTSA Clinic) who are discharged from UABH with no source for ongoing care. The model uses a nurse-led, team-based approach that involves multiple professions working together to provide care for high-need, high-cost patients. Clinics use 4 simultaneous bundles of care that include evidence-based treatment guidelines, transitional care coordination activities, patient activation strategies, and behavioral health integration. Engaged patients indicate very high levels of satisfaction with care and improved physical and mental health outcomes resulting in significant cost savings for the health system. Finally, IPCP team members report joy in their work within the clinics.

The state of the science of interprofessional collaborative practice: A scoping review of the patient health-related outcomes based literature published between 2010 and 2018

INTRODUCTION

If interprofessional collaborative practice is to be an important component of healthcare reform, then an evidentiary base connecting interprofessional education to interprofessional practice with significantly improved health and healthcare outcomes is an unconditional necessity. This study is a scoping review of the current peer reviewed literature linking interprofessional collaborative care and interprofessional collaborative practice to clearly identified healthcare and/or patient health-related outcomes. The research question for this review was: What does the evidence from the past decade reveal about the impact of Interprofessional collaborative practice on patient-related outcomes in the US healthcare system?

MATERIALS AND METHODS

A modified preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach was followed.

RESULTS

Of an initial 375 articles retrieved 20 met review criteria. The most common professions represented in the studies reviewed were physicians, pharmacists and nurses. Primary care was the most common care delivery setting and measures related to chronic disease the most commonly measured outcomes. No study identified negative impacts of interprofessional collaborative practice. Eight outcome categories emerged from a content analysis of the findings of the reviewed studies.

CONCLUSIONS

The results suggest a need for more research on the measurable impact of interprofessional collaborative practice and/or care on patient health-related outcomes to further document its benefits and to explore the models, systems and nature of collaborations that best improve population health, increase patient satisfaction, and reduce cost of care.

Scoping Pharmacy Students' Learning Outcomes: Where Do We Stand?

Background: The professional abilities of graduate pharmacists have been associated with pharmacy undergraduates’ educational settings and features. This study aimed to perform a scoping review on how students’ learning outcomes are achieved, including learning assessment strategies, focusing on current pharmacy practice education. Methods: Relevant keywords, e.g., “pharmacy practice”, “(students or undergraduates)” and “outcomes” were browsed in Public/Publisher MEDLINE, Scientific Electronic Library Online, Directory of Open Access Journals, and other relevant databases for recently published sources (2018 and 2017). Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria were followed to assure the scoping quality. All types of students’ learning outcomes were addressed for indexed publications in English, Portuguese or Spanish. Reviews, descriptive studies and commentaries were excluded. Study data are presented in tables comprising objectives, methods, number of participants and main research findings. Results: Overall, 100 studies were identified and 22 were selected. The selected studies were distributed into seven main topics: real practices (n = 9); active-learning strategies (n = 5); comparisons between different teaching pedagogies (n = 3); pharmacy curriculum (n = 2); and other evaluations (n = 3). Conclusions: Studies on pharmacy students’ learning outcomes are limited. Pharmacy undergraduates’ performance was dependent on the learning strategies and extension of syllabus implementation.

Instrument Refinement for Measuring Self-Efficacy for Competence in Interprofessional Collaborative Practice: Development and Psychometric Analysis of IPECC-SET 27 and IPECC-SET 9

Assessing competence in interprofessional collaborative practice (ICP) among health professions students is a high priority. This cross-sectional study built on the authors' prior work that led to the development of the 38-item Interprofessional Education Collaborative Competency Self Efficacy Tool (IPECC-SET), an instrument to evaluate health professions students' self-efficacy in interprofessional collaborative competency, and addressed two primary questions. First, could a unidimensional scale based on the IPEC competencies and assessing perceived self-efficacy for competence in ICP and be constructed? Second, could a shorter version of that instrument still meet criteria for unidimensionality and retain the ability to separate students in distinct levels of perceived self-efficacy for competence in ICP? Study participants were two cohorts of students from 11 health professions programs participating in an institutional interprofessional immersion event in 2015 and 2016. Statistical stepwise analyses were conducted using a Rasch rating scale model. The original 38 IPECC-SET items did not meet the criteria to generate a valid unidimensional measure of self-efficacy for competence in ICP, but could be condensed into a 27-item scale that met all set criteria for unidimensionality, with an explained variance of 61.2% and a separation index of 3.02. A shorter, 9-item scale demonstrated a separation index of 2.21. The nine items included also demonstrated a relatively equivalent range (54.93-45.65) as compared to the 27-item scale (57.26-46.16). Findings confirm empirically the conceptual suggestion from our earlier work that the four dimensions in the original IPEC competencies contribute to a shared underlying construct: perceived competence in interprofessional collaboration. Given the emphasis on ICP, psychometrically sound instruments are needed to evaluate the effectiveness of educational efforts to promote competency for ICP. Based on the findings from this study, both the IPECC-SET 27 and IPECC-SET 9 can be used to measure perceived self-efficacy for competence in ICP.