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Layani G, Vachon B, Duhoux A, Lussier MT, Gil J, Brault I, Vanier MC, Rodrigues I, Motulsky A, Kaczorowski J, David PM, Battaglini A. Structuring and organizing interprofessional healthcare in partnership with patients with diabetes: the INterprofessional Management and Education in Diabetes care (INMED) pathway. J Interprof Care 2023; 37:329-332. [PMID: 35403546 DOI: 10.1080/13561820.2022.2051452] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Type 2 diabetes is a complex chronic disease that requires ongoing monitoring by an interprofessional team to prevent complications. The INMED (INterprofessional Management and Education in Diabetes) care pathway was developed by our team to optimize primary care services for these patients and their families. The objective of this study is to describe the preliminary results of its adoption and implementation. The INMED care pathway is organized into four axes: (a) continuing professional education, (b) self-management support, (c) case management, and (d) ongoing evaluation of the quality of diabetes care and services. A multiple-case study is underway to document its effects on practice change using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Preliminary results on the adoption and implementation revealed some strengths: (a) regular patient follow-up by the case manager, (b) scheduling of physician appointments when required, and (c) regular screening for risk factors. Barriers were also identified: (a) lack of clear understanding of the case manager role, (b) lack of referrals to team members, and (c) lack of use of the motivational interview approach. The INMED care pathway is being adopted by primary care teams but challenges need to be overcome to improve its reach and effectiveness.
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Affiliation(s)
- Géraldine Layani
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montreal, C.P. 6128, Succ. Centre-ville, Montreal, QC, Canada.,Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et des services sociaux de Laval, Laval, Qc, Canada
| | - Brigitte Vachon
- Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et des services sociaux de Laval, Laval, Qc, Canada.,School of rehabilitation, Faculty of Medicine, Université de Montréal, CP 6128 Succursale Centre-Ville, Montreal, QC, Canada
| | - Arnaud Duhoux
- Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et des services sociaux de Laval, Laval, Qc, Canada.,Faculty of Nursing, Université de Montréal, CP 6128 Succursale Centre-Ville, Montreal, QC, Canada
| | - Marie-Thérèse Lussier
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montreal, C.P. 6128, Succ. Centre-ville, Montreal, QC, Canada.,Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et des services sociaux de Laval, Laval, Qc, Canada
| | - Julian Gil
- Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et des services sociaux de Laval, Laval, Qc, Canada
| | - Isabelle Brault
- Faculty of Nursing, Université de Montréal, CP 6128 Succursale Centre-Ville, Montreal, QC, Canada
| | - Marie-Claude Vanier
- Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et des services sociaux de Laval, Laval, Qc, Canada.,Faculty of Pharmacy, Université de Montréal, CP 6128 Succursale Centre-Ville, Montreal, QC, Canada
| | - Isabel Rodrigues
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montreal, C.P. 6128, Succ. Centre-ville, Montreal, QC, Canada.,Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et des services sociaux de Laval, Laval, Qc, Canada
| | - Aude Motulsky
- Department of Management, School of Public Health, Université de Montréal, Cp 6128 Succursale Centre-Ville, Montreal, QC, Canada
| | - Janusz Kaczorowski
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montreal, C.P. 6128, Succ. Centre-ville, Montreal, QC, Canada
| | - Pierre-Marie David
- Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et des services sociaux de Laval, Laval, Qc, Canada.,Faculty of Pharmacy, Université de Montréal, CP 6128 Succursale Centre-Ville, Montreal, QC, Canada
| | - Alex Battaglini
- Centre de recherche des pratiques cliniques et organisationnelles du Centre intégré de santé et des services sociaux de Laval, Laval, Qc, Canada
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Loyola-Sanchez A, Pelaez-Ballestas I, Crowshoe L, Lacaille D, Henderson R, Rame A, Linkert T, White T, Barnabe C. "There are still a lot of things that I need": a qualitative study exploring opportunities to improve the health services of First Nations People with arthritis seen at an on-reserve outreach rheumatology clinic. BMC Health Serv Res 2020; 20:1076. [PMID: 33239042 PMCID: PMC7687986 DOI: 10.1186/s12913-020-05909-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022] Open
Abstract
Background Arthritis is a highly prevalent disease and leading cause of disability in the Indigenous population. A novel model of care consisting of a rheumatology outreach clinic in an on-reserve primary healthcare center has provided service to an Indigenous community in Southern Alberta since 2010. Despite quality assessments suggesting this model of care improves accessibility and is effective in meeting treatment targets, substantial improvements in patient-reported outcomes have not been realized. Therefore, the objective of this study was to explore the experiences of Indigenous persons with arthritis and healthcare providers involved in this model of care to inform the development of health service improvements that enhance patient outcomes. Methods This was a narrative-based qualitative study involving a purposeful sample of 32 individuals involved in the Indigenous rheumatology model of care. In-depth interviews were conducted to elicit experiences with the existing model of care and to encourage reflections on opportunities to improve it. A two-stage analysis was conducted. The first stage aimed to produce a narrative synthesis of concepts through a dialogical method comparing people with arthritis and health providers’ narratives. The second stage involved a collective effort to synthesize concepts and propose specific recommendations to improve the quality of the current model of care. Triangulation, through participant checking and discussion among researchers, was used to increase the validity of the final recommendations. Results Ten Indigenous people with arthritis lived experience, 14 health providers and 8 administrative staff were interviewed. One main overarching theme was identified, which reflected the need to provide services that improve people’s physical and mental functioning. Further, the following specific recommendations were identified: 1) enhancing patient-provider communication, 2) improving the continuity of the healthcare service, 3) increasing community awareness about the presence and negative impact of arthritis, and 4) increasing peer connections and support among people living with arthritis. Conclusions Improving the quality of the current Indigenous rheumatology model of care requires implementing strategies that improve functioning, patient-provider communication, continuity of care, community awareness and peer support. A community-based provider who supports people while navigating health services could facilitate the implementation of these strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05909-9.
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Affiliation(s)
- Adalberto Loyola-Sanchez
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Ingris Pelaez-Ballestas
- Department of Rheumatology, Hospital General de Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Lynden Crowshoe
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Diane Lacaille
- Division of Rheumatology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rita Henderson
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ana Rame
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tessa Linkert
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tyler White
- Siksika Health Services, Siksika Nation, Siksika, Alberta, Canada
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Xu Y, Li S, Zhao P, Zhao J. Using the knowledge-to-action framework with joint arthroplasty patients to improve the quality of care transition: a quasi-experimental study. J Orthop Surg Res 2020; 15:31. [PMID: 31996244 PMCID: PMC6988266 DOI: 10.1186/s13018-020-1561-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Total joint arthroplasty is a mature and effective treatment for end-stage osteoarthritis. Assisting patients in completing the transition of the perioperative period and improving their satisfaction are important aspects of quality of care. This study aimed to investigate an intervention to improve the quality of care transition for joint arthroplasty patients informed by the knowledge-to-action (KTA) framework. METHODS In this quasi-experimental study, a total of 160 patients who underwent joint arthroplasty at a tertiary hospital from September to November 2018 and January to March 2019 were selected as participants using convenience sampling. The control group received routine medical care, while the observation group received medical care based on the KTA framework. Transitional care quality was assessed by the Care Transition Measure (CTM), with follow-up 1 week after discharge. RESULTS The observation group fared significantly better than the control group on general self-care preparation and written plan dimensions, as well as the quality of care transition. There was no significant difference in doctor-patient communication or health monitoring. CONCLUSIONS The KTA framework provides a logical, valuable tool for clinical work. Using the KTA framework for joint arthroplasty patients helps to improve the quality of care transition, which is worth promoting.
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Affiliation(s)
- Yaping Xu
- Department of Orthopedics, China-Japan Friendship Hospital, Beijing, China. .,Bone Necrosis and Joint Preservation Reconstruction Center, China-Japan Friendship Hospital, Beijing, China. .,Department of Bone and Joint Surgery, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Hepingli, Chaoyang District, Beijing, 100029, China.
| | - Shuang Li
- Department of Orthopedics, China-Japan Friendship Hospital, Beijing, China.,Bone Necrosis and Joint Preservation Reconstruction Center, China-Japan Friendship Hospital, Beijing, China
| | - Peiyu Zhao
- Department of Nursing, China-Japan Friendship Hospital, Beijing, China
| | - Jing Zhao
- Department of Nursing, China-Japan Friendship Hospital, Beijing, China
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Levis-Peralta M, González MDR, Stalmeijer R, Dolmans D, de Nooijer J. Organizational Conditions That Impact the Implementation of Effective Team-Based Models for the Treatment of Diabetes for Low Income Patients-A Scoping Review. Front Endocrinol (Lausanne) 2020; 11:352. [PMID: 32760344 PMCID: PMC7375199 DOI: 10.3389/fendo.2020.00352] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 05/05/2020] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Renée Stalmeijer
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - Diana Dolmans
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - Jascha de Nooijer
- Department of Health Promotion, School of Health Professions Education, Maastricht University, Maastricht, Netherlands
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Stickland MK, Sharpe H. Respiratory Health Strategic Clinical Network: Five years of innovation in respiratory care. CMAJ 2019; 191:S30-S32. [PMID: 31801761 DOI: 10.1503/cmaj.190582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Michael K Stickland
- Respiratory Health Strategic Clinical Network (Stickland, Sharpe), Alberta Health Services; Faculty of Medicine and Dentistry (Stickland), University of Alberta, Edmonton, Alta.; Cumming School of Medicine (Sharpe), University of Calgary, Calgary, Alta.
| | - Heather Sharpe
- Respiratory Health Strategic Clinical Network (Stickland, Sharpe), Alberta Health Services; Faculty of Medicine and Dentistry (Stickland), University of Alberta, Edmonton, Alta.; Cumming School of Medicine (Sharpe), University of Calgary, Calgary, Alta
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Abstract
There is a significant gap between what is known and what is implemented by key stakeholders in practice (the evidence to practice gap). The primary purpose of knowledge translation is to address this gap, bridging evidence to clinical practice. The knowledge to action cycle is one framework for knowledge translation that integrates policy-makers throughout the research cycle. The knowledge to action cycle begins with the identification of a problem (usually a gap in care provision). After identification of the problem, knowledge creation is undertaken, depicted at the center of the cycle as a funnel. Knowledge inquiry is at the wide end of the funnel, and moving down the funnel, the primary data is synthesized into knowledge products in the form of educational materials, guidelines, decision aids, or clinical pathways. The remaining components of the knowledge to action cycle refer to the action of applying the knowledge that has been created. This includes adapting knowledge to local context, assessing barriers to knowledge use, selecting, tailoring implementing interventions, monitoring knowledge use, evaluating outcomes, and sustaining knowledge use. Each of these steps is connected by bidirectional arrows and ideally involves healthcare decision-makers and key stakeholders at each transition.
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Affiliation(s)
- Braden J Manns
- University of Calgary, 1403 - 29th Street NW, Calgary, AB, Canada, T2N 2T9,
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