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Grant A, Giacomantonio R, Lackie K, MacKenzie A, Jeffers E, Kontak J, Marshall EG, Philpott S, Sheppard-LeMoine D, Lappin E, Bruce A, Mireault A, Beck D, Cormier L, Martin-Misener R. Identifying strategies to support implementation of interprofessional primary care teams in Nova Scotia: Results of a survey and knowledge sharing event. BMC PRIMARY CARE 2024; 25:162. [PMID: 38730368 PMCID: PMC11083844 DOI: 10.1186/s12875-024-02399-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/23/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Interprofessional primary care teams (IPCTs) work together to enhance care. Despite evidence on the benefits of IPCTs, implementation remains challenging. This research aims to 1) identify and prioritize barriers and enablers, and 2) co-develop team-level strategies to support IPCT implementation in Nova Scotia, Canada. METHODS Healthcare providers and staff of IPCTs were invited to complete an online survey to identify barriers and enablers, and the degree to which each item impacted the functioning of their team. Top ranked items were identified using the sum of frequency x impact for each response. A virtual knowledge sharing event was held to identify strategies to address local barriers and enablers that impact team functioning. RESULTS IPCT members (n = 117), with a mix of clinic roles and experience, completed the survey. The top three enablers identified were access to technological tools to support their role, standardized processes for using the technological tools, and having a team manager to coordinate collaboration. The top three barriers were limited opportunity for daily team communication, lack of conflict resolution strategies, and lack of capacity building opportunities. IPCT members, administrators, and patients attended the knowledge sharing event (n = 33). Five strategies were identified including: 1) balancing patient needs and provider scope of practice, 2) holding regular and accessible meetings, 3) supporting team development opportunities, 4) supporting professional development, and 5) supporting involvement in non-clinical activities. INTERPRETATION This research contextualized evidence to further understand local perspectives and experiences of barriers and enablers to the implementation of IPCTs. The knowledge exchange event identified actionable strategies that IPCTs and healthcare administrators can tailor to support teams and care for patients.
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Affiliation(s)
- Amy Grant
- Maritime SPOR SUPPORT Unit, Nova Scotia Health, Nova Scotia, Canada
| | | | - Kelly Lackie
- School of Nursing, Dalhousie University, Nova Scotia, Canada
| | - Adrian MacKenzie
- Maritime SPOR SUPPORT Unit, Nova Scotia Health, Nova Scotia, Canada
- Research, Innovation and Discovery, Nova Scotia Health, Nova Scotia, Canada
- WHO/PAHO Collaborating Centre On Health Workforce Planning & Research, Dalhousie University, Nova Scotia, Canada
- Department of Health and Wellness, Government of Nova Scotia, Nova Scotia, Canada
| | | | - Julia Kontak
- Maritime SPOR SUPPORT Unit, Nova Scotia Health, Nova Scotia, Canada
| | | | - Susan Philpott
- Department of Health and Wellness, Government of Nova Scotia, Nova Scotia, Canada
| | - Debbie Sheppard-LeMoine
- Department of Nursing, St. Francis Xavier University, Nova Scotia, Canada
- Faculty of Nursing, University of Windsor, Ontario, Canada
| | - Elizabeth Lappin
- Maritime SPOR SUPPORT Unit, Nova Scotia Health, Nova Scotia, Canada
| | - Alice Bruce
- Maritime SPOR SUPPORT Unit, Nova Scotia Health, Nova Scotia, Canada
| | - Amy Mireault
- Maritime SPOR SUPPORT Unit, Nova Scotia Health, Nova Scotia, Canada
| | - Deanna Beck
- Primary Health Care and Chronic Disease Management Network, Nova Scotia Health, Nova Scotia, Canada
| | - Lindsay Cormier
- Primary Health Care and Chronic Disease Management Network, Nova Scotia Health, Nova Scotia, Canada
| | - Ruth Martin-Misener
- School of Nursing, Faculty of Health, Dalhousie University, PO Box 15000, 5869 University Avenue, Halifax, NS, B3H 4R2, Canada.
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Keddy AC, Packer TL, Audulv Å, Sutherland L, Sampalli T, Edwards L, Kephart G. The Team Assessment of Self-Management Support (TASMS): A new approach to uncovering how teams support people with chronic conditions. Healthc Manage Forum 2021; 34:43-48. [PMID: 32729329 DOI: 10.1177/0840470420942262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Canadian and other healthcare systems are adopting primary care models founded on multidisciplinary, team-based care. This paper describes the development and use of a new tool, the Team Assessment of Self-Management Support (TASMS), designed to understand and improve the self-management support teams provide to patients with chronic conditions. Team Assessment of Self-Management Support captures the time providers spend supporting seven different types of self-management support (process strategies, resources strategies, disease controlling strategies, activities strategies, internal strategies, social interactions strategies, and healthy behaviours strategies), their referral patterns and perceived gaps in care. Four unique features make TASMS user-friendly: it is patient-centred, it uses provider-level data to create a team profile, it has the ability to be tailored to needs (diagnosis and visit type), and visual presentation of results are quickly and intuitively understood by both providers and planners. Currently being used by providers and planners in Nova Scotia, scaling up will allow more widespread use.
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Affiliation(s)
| | | | | | | | - Tara Sampalli
- 432234Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Lynn Edwards
- 432234Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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Packer TL, Fracini A, Audulv Å, Alizadeh N, van Gaal BGI, Warner G, Kephart G. What we know about the purpose, theoretical foundation, scope and dimensionality of existing self-management measurement tools: A scoping review. PATIENT EDUCATION AND COUNSELING 2018; 101:579-595. [PMID: 29239734 DOI: 10.1016/j.pec.2017.10.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 10/10/2017] [Accepted: 10/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To identify self-report, self-management measures for adults with chronic conditions, and describe their purpose, theoretical foundation, dimensionality (multi versus uni), and scope (generic versus condition specific). METHODS A search of four databases (8479 articles) resulted in a scoping review of 28 self-management measures. RESULTS Although authors identified tools as measures of self-management, wide variation in constructs measured, purpose, and theoretical foundations existed. Subscales on 13 multidimensional tools collectively measure domains of self-management relevant to clients, however no one tool's subscales cover all domains. CONCLUSIONS Viewing self-management as a complex, multidimensional whole, demonstrated that existing measures assess different, related aspects of self-management. Activities and social roles, though important to patients, are rarely measured. Measures with capacity to quantify and distinguish aspects of self-management may promote tailored patient care. PRACTICE IMPLICATIONS In selecting tools for research or assessment, the reason for development, definitions, and theories underpinning the measure should be scrutinized. Our ability to measure self-management must be rigorously mapped to provide comprehensive and system-wide care for clients with chronic conditions. Viewing self-management as a complex whole will help practitioners to understand the patient perspective and their contribution in supporting each individual patient.
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Affiliation(s)
- Tanya L Packer
- School of Occupational Therapy, Dalhousie University, Halifax, Canada; Radboud University Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands; Faculty of Health and Social Studies, Han University of Applied Sciences, Nijmegen, The Netherlands.
| | - America Fracini
- School of Occupational Therapy, Dalhousie University, Halifax, Canada.
| | - Åsa Audulv
- Department of Nursing Science, Mid Sweden University, Sundsvall, Sweden.
| | - Neda Alizadeh
- School of Occupational Therapy, Dalhousie University, Halifax, Canada.
| | - Betsie G I van Gaal
- Radboud University Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands; Faculty of Health and Social Studies, Han University of Applied Sciences, Nijmegen, The Netherlands.
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, Canada.
| | - George Kephart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
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Meeting the needs of a complex population: a functional health- and patient-centered approach to managing multimorbidity. JOURNAL OF COMORBIDITY 2016; 6:76-84. [PMID: 29090178 PMCID: PMC5556449 DOI: 10.15256/joc.2016.6.83] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/12/2016] [Indexed: 11/16/2022]
Abstract
Individuals with multimorbidity have complex care needs along with significant impacts to their functional health and quality of life. Recent evidence-based and experience-based explorations have revealed the importance of patient perspectives and functional health management in improving care delivery and health outcomes for individuals with multimorbidity. The impact of managing multimorbidity is evident at multiple levels of healthcare – the individual, the provider, and the system. Our local experience dealing with these challenges has led to the development of a functional health model that includes patient perspectives in care delivery within the Integrated Chronic Care Service (ICCS) of the health authority in Nova Scotia. In this paper, we present a discussion of the challenges, guiding models, and service-level transformations that have been integrated into care delivery at the ICCS to meet the healthcare needs of people with multiple health conditions. We describe our redesign strategies for care team planning, treatment approach, and patient inclusion.
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Sampalli T, Desy M, Dhir M, Edwards L, Dickson R, Blackmore G. Improving wait times to care for individuals with multimorbidities and complex conditions using value stream mapping. Int J Health Policy Manag 2015; 4:459-66. [PMID: 26188810 DOI: 10.15171/ijhpm.2015.76] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/31/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Recognizing the significant impact of wait times for care for individuals with complex chronic conditions, we applied a LEAN methodology, namely - an adaptation of Value Stream Mapping (VSM) to meet the needs of people with multiple chronic conditions and to improve wait times without additional resources or funding. METHODS Over an 18-month time period, staff applied a patient-centric approach that included LEAN methodology of VSM to improve wait times to care. Our framework of evaluation was grounded in the needs and perspectives of patients and individuals waiting to receive care. Patient centric views were obtained through surveys such as Patient Assessment of Chronic Illness Care (PACIC) and process engineering based questions. In addition, LEAN methodology, VSM was added to identify non-value added processes contributing to wait times. RESULTS The care team successfully reduced wait times to 2 months in 2014 with no wait times for care anticipated in 2015. Increased patient engagement and satisfaction are also outcomes of this innovative initiative. In addition, successful transformations and implementation have resulted in resource efficiencies without increase in costs. Patients have shown significant improvements in functional health following Integrated Chronic Care Service (ICCS) intervention. The methodology will be applied to other chronic disease management areas in Capital Health and the province. CONCLUSION Wait times to care in the management of multimoribidities and other complex conditions can add a significant burden not only on the affected individuals but also on the healthcare system. In this study, a novel and modified LEAN methodology has been applied to embed the voice of the patient in care delivery processes and to reduce wait times to care in the management of complex chronic conditions.
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Affiliation(s)
- Tara Sampalli
- Integrated Chronic Care Service, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada.,Dalhousie University, Halifax, NS, Canada.,Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Michel Desy
- Performance Excellence, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Minakshi Dhir
- Integrated Chronic Care Service, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada.,Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Lynn Edwards
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Robert Dickson
- Integrated Chronic Care Service, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Gail Blackmore
- Performance Excellence, Nova Scotia Health Authority, Halifax, NS, Canada
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