1
|
Nguyen AD, Medrano O, Syed S. A Call for Integrated Psychiatry-Psychology Collaboration on Consult-Liaison Services: Experiences of a Psychology Extern and Recommendations for Collaborative Care. Cureus 2023; 15:e43874. [PMID: 37746511 PMCID: PMC10511300 DOI: 10.7759/cureus.43874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Few institutions have integrated psychologists into consult-liaison (CL) psychiatry services caring for patients with medical conditions and comorbid serious mental illnesses (SMI). To our knowledge, no studies have explored the experiences of an integrated pre-doctoral psychologist on a CL psychiatry service and applications of collaborative care. The present study aims to 1) highlight the experiences of a psychology extern on an adult CL psychiatry service in a public academic hospital, and 2) apply a collaborative care framework to provide recommendations for implementing integrated psychiatry-psychology collaboration. A semi-structured qualitative interview was performed with the team's psychology extern to elicit practice goals and setting. As of June 2022, the psychology extern saw 76 inpatient adults over the year-long externship period. Through diverse case vignettes, we illustrate the extern's unique roles in providing psychotherapeutic interventions to enhance patients' coping skills. We further found that embedding a psychology extern within the CL psychiatry service follows the integrated model of collaborative care. We thus apply a collaborative care framework to guide CL services in using multidisciplinary teams to improve care quality for inpatient adults. Leveraging the expertise of a psychology extern in real-time collaboration with CL psychiatry teams can enhance patient-centered care and warrants broader institutional implementation. Future studies are needed to explore the efficacy of integrated psychiatry-psychology collaboration on provider perspectives and clinical outcomes.
Collapse
Affiliation(s)
- Audrey D Nguyen
- Psychiatry, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, USA
- Psychiatry, Olive View-University of California Los Angeles (UCLA) Medical Center, Los Angeles, USA
| | - Osmara Medrano
- Psychiatry, Olive View-University of California Los Angeles (UCLA) Medical Center, Los Angeles, USA
| | - Saba Syed
- Psychiatry, Olive View-University of California Los Angeles (UCLA) Medical Center, Los Angeles, USA
| |
Collapse
|
2
|
Tomaschek R, Gemperli A, Baumberger M, Debecker I, Merlo C, Scheel-Sailer A, Studer C, Essig S. Role distribution and collaboration between specialists and rural general practitioners in long-term chronic care: a qualitative study in Switzerland. Swiss Med Wkly 2022; 152:40015. [PMID: 36592398 DOI: 10.57187/smw.2022.40015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION This study explores general practitioners' (GPs') and medical specialists' perceptions of role distribution and collaboration in the care of patients with chronic conditions, exemplified by spinal cord injury. METHODS Semi-structured interviews with GPs and medical specialists caring for individuals with spinal cord injury in Switzerland. The physicians we interviewed were recruited as part of an intervention study. We used a hybrid framework of inductive and deductive coding to analyse the qualitative data. RESULTS Six GPs and six medical specialists agreed to be interviewed. GPs and specialists perceived the role of specialists similarly, namely as an expert and support role for GPs in the case of specialised questions. Specialists' expectations of GP services and what GPs provide differed. Specialists saw the GPs' role as complementary to their own responsibilities, namely as the first contact for patients and gatekeepers to specialised services. GPs saw themselves as care managers and guides with a holistic view of patients, connecting several healthcare professionals. GPs were looking for relations and recognition by getting to know specialists better. Specialists viewed collaboration as somewhat distant and focused on processes and patient pathways. Challenges in collaboration were related to unclear roles and responsibilities in patient care. CONCLUSION The expectations for role distribution and responsibilities differ among physicians. Different goals of GPs and specialists for collaboration may jeopardise shared care models. The role distribution should be aligned according to patients' holistic needs to improve collaboration and provide appropriate patient care.
Collapse
Affiliation(s)
- Rebecca Tomaschek
- Center for Primary and Community Care, University of Lucerne, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Armin Gemperli
- Center for Primary and Community Care, University of Lucerne, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
| | | | | | - Christoph Merlo
- Center for Primary and Community Care, University of Lucerne, Switzerland
| | - Anke Scheel-Sailer
- Department of Health Sciences and Medicine, University of Lucerne, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Christian Studer
- Center for Primary and Community Care, University of Lucerne, Switzerland
| | - Stefan Essig
- Center for Primary and Community Care, University of Lucerne, Switzerland
| |
Collapse
|
3
|
Sirimsi MM, De Loof H, Van den Broeck K, De Vliegher K, Pype P, Remmen R, Van Bogaert P. Scoping review to identify strategies and interventions improving interprofessional collaboration and integration in primary care. BMJ Open 2022; 12:e062111. [PMID: 36302577 PMCID: PMC9621161 DOI: 10.1136/bmjopen-2022-062111] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Muhammed Mustafa Sirimsi
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Centre of Research and Innovations in Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Hans De Loof
- Laboratory of Physiopharmacology, Faculty of pharmaceutic sciences, University of Antwerp, Antwerp, Belgium
| | - Kris Van den Broeck
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Peter Pype
- Center for family medicine, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Ghent, Belgium
| | - Roy Remmen
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Peter Van Bogaert
- Centre for research and innovation in care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
4
|
van de Mortel T, Billett S, Armit L, Frommolt V, Mitchell C, Mitchell M, Shaw J, Grealish L. Developing intersubjectivity and teamwork skills through learning circles on clinical placement: A mixed methods study. Nurse Educ Pract 2021; 56:103214. [PMID: 34592490 DOI: 10.1016/j.nepr.2021.103214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/31/2021] [Accepted: 09/19/2021] [Indexed: 11/25/2022]
Abstract
AIM To determine the efficacy of learning circles on developing intersubjectivity and teamwork skills and determine barriers to and facilitators of, learning circles as a learning tool. BACKGROUND Teamwork skills are vital for safe, effective nursing care and are dependent on individual team members' shared understandings or intersubjectivity. Work-based learning circles offer a potential pedagogic strategy to promote teamwork. METHODS In work-based learning circles conducted in 2018, students drew a concept map based on a clinical case and discussed an element of it with the group. Using a convergent parallel mixed methods design, a cross-sectional survey of students using a student clinical experience questionnaire and a qualitative descriptive approach for interviews with clinical facilitators was conducted. RESULTS Overall, 128 Bachelor of Nursing students (88.9% response) completed the survey and five facilitators (50%) attended group interviews. Students agreed that core teamwork skills were developed during their placement and clinical facilitators reported (1) student engagement in the learning circle processes; (2) learning much about students' abilities; and (3) developing subtle teaching skills to enhance discussion. Sharing experiences from different wards and clinical experiences was a platform for developing intersubjectivity. CONCLUSIONS To promote intra-professional teamwork skills, conducting learning circles with students from different disciplines may further enhance intersubjectivity and is an area for further research.
Collapse
Affiliation(s)
| | - Stephen Billett
- Mt Gravatt Campus, Griffith University, 176 Messines Ridge Road, Mount Gravatt, QLD 4122, Australia
| | - Lyn Armit
- Gold Coast Health, 1 Hospital Blvd, Southport Q 4215, Australia
| | - Valda Frommolt
- Logan Campus, Griffith University, 68 University Dr, Meadowbrook, QLD 4131, Australia
| | - Creina Mitchell
- Gold Coast Campus, Griffith University, Southport, QLD 4215, Australia
| | - Marion Mitchell
- Nathan Campus, Griffith University, 170 Kessels Road, Nathan, QLD 4111, Australia
| | - Julie Shaw
- CQUniversity Brisbane Campus, Level 20, 160 Ann St, Brisbane, QLD 4000, Australia
| | - Laurie Grealish
- Gold Coast Campus, Griffith University, Southport, QLD 4215, Australia; Gold Coast Health, 1 Hospital Blvd, Southport Q 4215, Australia
| |
Collapse
|
5
|
Donnelly C, Ashcroft R, Bobbette N, Mills C, Mofina A, Tran T, Vader K, Williams A, Gill S, Miller J. Interprofessional primary care during COVID-19: a survey of the provider perspective. BMC FAMILY PRACTICE 2021; 22:31. [PMID: 33535973 PMCID: PMC7857097 DOI: 10.1186/s12875-020-01366-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Interprofessional primary care (IPC) teams provide comprehensive and coordinated care and are ideally equipped to support those populations most at risk of adverse health outcomes during the COVID-19 pandemic, including older adults, and patients with chronic physical and mental health conditions. There has been little focus on the experiences of healthcare teams and no studies have examined IPC practice during the early phase of the COVID-19 pandemic. The objective of the study was to describe the state of interprofessional health provider practice within IPC teams during the COVID-19 pandemic. METHODS Observational cross-sectional design. A web-based survey was deployed to IPC providers working in team-based primary care clinics in the province of Ontario, Canada. The survey included 26 close-ended and six open-ended questions. Close-ended questions were analyzed using descriptive statistics. Content analysis was used to analyze the open-ended questions. RESULTS 445 surveys were included in the final analysis. Service delivery shifted from in-person care (77% pre-COVID-19) to telephone (76.5% during the COVID-19 pandemic). Less than half of the respondents (40%) reported receiving any training for virtual delivery. Wait times to access team members were reported to have decreased. There has also been a shift in what IPC providers report as the most commonly seen conditions, with increases in visits related to mental health concerns, acute infections (including COVID-19), social isolation, and resource navigation. Respondents also reported a reduction in healthcare provision for multiple chronic conditions including diabetes, cardiovascular disease, and chronic pain. CONCLUSIONS IPC teams are rapidly shifting their practice to supporting their patients during the pandemic. A surge in mental health issues has been seen and is expected to continue to increase in response to COVID-19. Understanding early experiences can help plan for future pandemic waves.
Collapse
Affiliation(s)
- Catherine Donnelly
- Queen's University, 31 George Street, Kingston, Ontario, K7L 3N6, Canada.
| | - Rachelle Ashcroft
- University of Toronto, 246 Bloor Street, Toronto, Ontario, M5S 1V4, Canada
| | - Nicole Bobbette
- Centre for Addiction and Mental Health, 1001 Queen St. West, Toronto, Ontario, M6J 1H4, Canada
| | - Christine Mills
- Queen's University, 31 George Street, Kingston, Ontario, K7L 3N6, Canada
| | - Amanda Mofina
- Queen's University, 31 George Street, Kingston, Ontario, K7L 3N6, Canada
| | - Todd Tran
- Queen's University, 31 George Street, Kingston, Ontario, K7L 3N6, Canada
| | - Kyle Vader
- Queen's University, 31 George Street, Kingston, Ontario, K7L 3N6, Canada
| | - Ashley Williams
- Queen's University, 31 George Street, Kingston, Ontario, K7L 3N6, Canada
| | - Sandeep Gill
- Association of Family Health Teams of Ontario, 400 University Avenue, Suite 2100, Toronto, Ontario, M5G 1S5, Canada
| | - Jordan Miller
- Queen's University, 31 George Street, Kingston, Ontario, K7L 3N6, Canada
| |
Collapse
|
6
|
King C, Edlington T, Williams B. Avoiding Difficult Conversations in the Australian Health Sector. SAGE Open Nurs 2020; 6:2377960820941978. [PMID: 33415297 PMCID: PMC7774411 DOI: 10.1177/2377960820941978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 06/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background Health professionals avoiding difficult conversations with each other can lead to serious negative consequences for patients. Clinical supervisors are in the unique position of interacting both with students as well as colleagues and peers. This study explores the avoidance of difficult conversations from the perspective of clinical supervisors in order to better understand why health professionals avoid difficult conversations. Objective This study aimed to identify the reasons why difficult conversations are avoided between health-care professionals and to gain deeper insight into the phenomenon of avoiding difficult conversations in general. Methods Convergent interviewing was used with 20 clinical supervisors to explore the following question: Why do you think that people in your workplace avoid difficult conversations? Results Major reasons for avoiding difficult conversations included the fear of negative consequences, a general distaste for confrontation, and a lack of confidence in their skills to have such conversations. Additional factors included individual qualities such as personality type and communication style, available time, size of the workplace, and a range of perceived cultural barriers standing in the way of having difficult conversations. Conclusion There is a need to encourage clinical supervisors and other health professionals to embrace difficult conversations to reduce adverse events and enhance patient outcomes. This requires additional training and educational opportunities to enhance knowledge, skills, and confidence to plan and engage in difficult conversations. Some types of difficult conversations require more skills than others.
Collapse
Affiliation(s)
- Christine King
- Department of Paramedicine, Monash University, Clayton, Victoria, Australia
| | - Tanya Edlington
- The Conversation Clinic Pty Ltd, Melbourne, Victoria, Australia
| | - Brett Williams
- Department of Paramedicine, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
7
|
Solimeo SL, Steffen MJA, Gardner EE, Adjognon O, Shin MH, Moye J, Sullivan JL. Using the PACT Resources Framework to Understand the Needs of Geriatric Primary Care Teams. J Am Geriatr Soc 2020; 68:2006-2014. [PMID: 32379919 DOI: 10.1111/jgs.16498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/20/2020] [Accepted: 04/03/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify the perceived organizational resources required by healthcare workers to deliver geriatric primary care in a geriatric patient aligned care team (GeriPACT). DESIGN Cross-sectional observational study using deductive analyses of qualitative interviews conducted with GeriPACT team members. SETTING GeriPACTs practicing at eight geographically dispersed Department of Veterans Affairs (VA) healthcare systems. PARTICIPANTS GeriPACT clinicians, nurses, clerical associates, clinical pharmacists, and social workers (n = 67). MEASUREMENTS Semistructured qualitative interviews conducted in person, transcribed, and then analyzed using the PACT Resources Framework. RESULTS Using the PACT Resources Framework, we identified facility-, clinic-, and team-level resources critical for GeriPACT implementation. Resources within each level reflect how the needs of older adults with complex comorbidity intersect with general population primary care medical home practice. GeriPACT implementation is facilitated by attention to patient characteristics such as cognitive impairment, ambulatory limitations, or social support services in staffing and resourcing teams. CONCLUSION Models of geriatric primary care such as GeriPACT must be implemented with an eye toward the most effective use of our most limited resource-trained geriatricians. In contrast to much of the literature on medical home teams serving a general adult population, interviews with GeriPACT members emphasize how patient needs inform all aspects of practice design including universal accessibility, near real-time response to patient needs, and ongoing interdisciplinary care coordination. Examination of GeriPACT implementation resources through the lens of traditional primary care teams illustrates the importance of tailoring primary care design to the needs of older adults with complex comorbidity.
Collapse
Affiliation(s)
- Samantha L Solimeo
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA.,Primary Care Analytics Team-Iowa City, Iowa City VA Health Care System, Iowa City, Iowa, USA.,Veterans Rural Health Resource Center- Iowa City, Iowa City VA Health Care System, Washington, DC, USA.,University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Melissa J A Steffen
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA.,Primary Care Analytics Team-Iowa City, Iowa City VA Health Care System, Iowa City, Iowa, USA.,Veterans Rural Health Resource Center- Iowa City, Iowa City VA Health Care System, Washington, DC, USA
| | - Ellen E Gardner
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Omonyêlé Adjognon
- Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare, Boston, Massachusetts, USA
| | - Marlena H Shin
- Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare, Boston, Massachusetts, USA
| | - Jennifer Moye
- Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare, Boston, Massachusetts, USA.,New England Geriatric Research Education and Clinical Center (GRECC), Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer L Sullivan
- Center for Healthcare Organization and Implementation Research (CHOIR) VA Boston Healthcare, Boston, Massachusetts, USA.,Boston University, Boston, Massachusetts, USA
| |
Collapse
|