Document

Report
University of Missouri-Kansas City
The Importance of Cultivating Community
Engagement in the Development of
Interprofessional Clinical Practice Teams
Objectives:
1. Discuss the pre-grant writing steps needed
to develop IPCP teams in community clinics.
2. Discuss the essential recommended steps
to develop effective pre-clinical training for
faculty, students and clinic providers.
3. Discuss outcomes from the project to date
related to team identity and team trainings.
Project Team:
Susan Kimble, DNP, RN, ANP-BC, MSN
Project Director
Steven C. Stoner, PharmD, BCPP
School of Pharmacy Lead
Michael D. McCunniff, DDS, MS
School of Dentistry Lead
Margaret Brommelsiek, PhD
Director of IPE
Heather J. Gotham, PhD
Project Evaluator
Jeremy Kirchoff, MD
Hope Family Care Center
Sudeep Ross, MD
SURHC Medical Director
Martha Lofgreen, MSN
School of Nursing Faculty
Renee Endicott, DNP
School of Nursing Clinical Faculty
School of Pharmacy Faculty Preceptors:
Andrew Bzowyckyj, PharmD; Maqual Graham, PharmD; Cameron
Lindsey, PharmD, BC-ADM, CDE, BCACP; Valerie Ruehter, PharmD,
BCPP; Mark T. Sawkin, PharmD, AAHIVP; Stephanie Schauner,
PharmD, BCPS
Background:
• Community engagement and team building
• Essential to develop trust, allies, relationships
to improve health outcomes, address
challenges
• Interprofessional Collaborative Practice (IPCP)
• Extending classroom IPE experiences at two
primary care urban community clinics (Community
based and Federally funded health center)
Background:
•
•
•
•
Advanced practice nursing
Pharm D
Dental students
Clinic Providers (MD and NP)
• Students gain advanced knowledge and skills
caring for vulnerable and medically
underserved patients
Background:
• Collaboration with two urban clinics
•
Multiple meetings to discuss and pre-plan project
• Larger organization (FQHC) undergoing leadership
changes
• Providers MDs and NPs
• Smaller private organization seeking to expand
access to care beyond one primary care physician
• Relationship building prior to application for funding
Methods:
•
Utilizing recommendations from Principles of Community
Engagement (NIH, 2011)
•
Project’s faculty team met with leaders from both clinics
•
Develop innovative opportunities for incorporating IPCP teams
•
Project intent focused on student interprofessional education
(IPE)
•
Evidence of need for IPE training including the clinical staff
Methods:
• Create an executive oversight committee
• Ensure project success and communication
• Pre-rotation team training
• Student participants and providers
• Four IPE competencies:
• roles/ responsibilities
• values/ethics
• interprofessional communication
• teams/teamwork
• emphasis on working with vulnerable
populations
Methods:
• Evaluation tools utilized:
• Student surveys (pre/post rotations)
• Student and provider focus groups
• Patient satisfaction surveys
• Student reflective journaling on clinical
experiences
• Clinical case study presentations by student
groups
• Clinical huddles to determine patient care
Methods:
•
Readiness for Interprofessional Learning Scale – preclinical
•
Interprofessional Collaboration Scale – post-clinical
•
Attitudes Toward Health Care Teams Scale – pre/post
•
Team Skills Scale – pre/post
•
Cultural Competence Assessment – pre/post
•
Focus groups - post
Results:
• Outcomes included team informed care
decisions
• Students gained new perspectives regarding
vulnerable patient populations
• Improved team communication skills
Results:
• Students realized each profession serves as a
change agent
• Instilled confidence in challenging situations
• Overcoming preconceived assumptions
• Establish open and honest communication
• Integral to team identify and socialization
• Impacted both health delivery and desired patient
outcomes
Preliminary results: After 6 semester rotations:
• 16 NP students
• 56 Pharmacy students
• 16 Dental students
• 56 females, 32 males
• 84.5% White, 8.3% Black, 10.7% Asian, 4.8%
American Indian
• 28 years old (mean, 22-49 range)
• 4.10 days (mean, 0-37 range) on rotation
Results – patients seen – Clinic 1
Small, young community-based health center:
•
NP students, Pharmacy students, Dental students
•
451 patients seen (67% female; 0 - 65+ yrs)
2
1
Race/Ethnicity
5
White
26
Black
Hispanic
66
Asian
Other
Most Frequent Diagnoses
26 – Essential Hypertension
24 – General medical exam
20 – Health supervision infant/child
16 – Diabetes Mellitus
11 – General Symptoms
10 – Other Disorders, Joint
10 – Other Disorder, Back
10 – Abdominal/pelvic symptoms
Results – patients seen – Clinic 2
Large, urban federally-qualified healthcare center:
•
NP students, Pharmacy students
•
790 patients seen (66% female; 0 - 65+ yrs)
Race/Ethnicity
26
6
White
13
Black
Hispanic
10
45
Asian
Other
Most Frequent Diagnoses
75 – Health supervision infant/child
64 -- Vaccination
54 – General medical exam
53 – Essential Hypertension
32 – Normal pregnancy
25 – Special investigation/exam
20 – Secondary Diabetes Mellitus
20 – Disorders of lipoid metabolism
Discussion:
• Students gained new perspectives regarding caring
for vulnerable patient populations
• Increased interactions across professions (nursing,
dentistry, pharmacy and medicine) with patient
populations illustrating the importance of working
within IPCP teams
• Students felt better prepared to become a future
leaders in the healthcare arena
Discussion:
• Students made informed care decisions regarding
vulnerable patient populations
• Students reported an increase in cultural
competency across several areas:
attitudes
experiences
behaviors
Student Feedback
Conducted focus groups after each rotation:
• “I mean, even just stepping outside from us, we have learned so much from
each other. I just think it can only be beneficial to everybody so…”
• “I would say the more students that have the opportunity to do it, the more
learning will take place because I learn every single time I’m with the pharmacy
students. So it would be nice to be available to more students.”
• “We don’t get the assessment aspect that you guys do. You know we are not
making diagnoses, we are taking diagnosis and making the treatment plan. So
having you guys say well this is what I think and putting that together I think is
beneficial. Together we all make a pretty good team. And most people realize
that.”
Student Feedback
Conducted focus groups after each rotation:
• “It would be really nice in an ideal world in the actual practice setting, like at a
family practice office, you have your providers that are seeing patients and then
you actually have a pharmacist right there. Not to dispense drugs, but as a
resource to talk about drug to drug interactions and second line and third line,
and this isn’t working according to the guidelines. It would be ideal to have a
pharmacist on staff just as a reference or a resource to the providers.”
• I was anticipating that it would be a positive experience, and it was. I mean after
I’m finished here, I would welcome the opportunity to work in an environment
like that again.”
Student Feedback
Conducted focus groups after each rotation:
• “I would say safety is the greatest asset…I mean again the more providers, more
eyes on the same case, people are going to find things that maybe one provider
might have missed.”
• “I enjoyed working with other student groups and just seeing what each person
brings to the table. I really didn’t have an understanding before, but now I do.”
• And I think too, showing that as we are working together that it’s like a
cooperative collaboration. I think that makes the patient feel more at ease. It’s
not someone’s trying to talk over someone else in the room. We are all working
together to provide our own expertise to give the patient the best well-rounded
care experience.
Student Feedback
Conducted focus groups after each rotation:
• “I think it’s really interesting because you go into it knowing that we each have
these expertise so to speak, and then, seeing how flawlessly they work together
in that environment and how the questions would flow into one another, the
counseling points back and forth, the education points back and forth. We really
do work together as a team and we’re designed that way. And it’s nice to know
that when you actually get put in that situation, it works.”
• “I honestly wish it could happen in the real world that it could be like that and
then have the dental office right here and the pharmacy right here and they get
it all in one area. It only makes sense. So seeing that and then being frustrated
with the way things are and how it is broken is, is saddening. I wish it was a
medical utopia out there.”
Results:
• Team informed care decisions
• Acquiring new perspectives regarding
vulnerable patient populations
• Improved communication through
interactions with team members
Individual
Professional
Competencies:
Complementary
Common
Competencies
IP
Collaborative
Competencies
• Opportunities to serve as change agents within
own professions
Results:
• Instilled confidence in challenging situations
• Overcoming preconceived assumptions
• Established a platform for open and honest
communication
• Integral to team socialization
• Impacted health delivery and desired outcomes
Conclusions:
• Project in final year
• Outcomes guiding IPE curriculum development
• Challenges regarding scheduling
• Smaller teams advantageous for cohesiveness
• Stay in same clinical teams-semester minimum
• Flexibility paramount
• Clinics desire to continue collaboration
Recommendations:
• Create community partnerships in advance
• Data supports importance of developing team
identity early in the process
• IPE training for all members of the team
• Executive committee leadership essential to project
success
• Work through issues of clinical schedules, staffing,
and measuring identified outcomes
• Routine feedback and communication between the
students, faculty, and clinical preceptors essential
This project was made possible through a grant from the Health
Resources and Services Administration
Nurse Education, Practice, Quality, and Retention:
Interprofessional Collaborative Practice
Questions?
[email protected]
[email protected]
[email protected]
[email protected]
References:
Heinemann, G.D., Schmitt, M.H., Farrell, M.P., & Brallier, S.A. (1999). Attitudes Toward Health
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Health Professions, 22(1), 123-42.
Hepburn, K., Tsukuda, R., & Fasser, C. (1998). Team skills scale, 1996. In Siegler, K., Hyer, T.,
Fulmer, T., & Mezey, M. (Eds.), Geriatric interdisciplinary team training. (pp. 264-5). New York:
Springer.
IOM. (2003). Unequal treatment: Confronting racial and ethnic disparities in healthcare.
Washington, DC: National Academies Press.
IOM . (2011). The future of nursing: Leading change, advancing health. Washington, DC: National
Academies Press.
Kenaszchuk, C.,Reeves, S., Nicholas, D., & Zwarenstein, M. (2010). Validity and reliability of a
multiple-group measurement scale for interprofessional collaboration. BMC Health Services
Research, 10:83.
References:
McFadyen, A.K., Webster, V.S. & MacLaren, W.M. (2006). The test-retest reliability of a revised
version of the Readiness for Interprofessional Learning Scale (RIPLS). Journal of
Interprofessional Care, 20, 633-639.
National Institutes of Health. (2011). Principles of community engagement. U.S. Department of
Health and Human Services. Government Printing Office, NIH Pub. No. 11-7782.
National Prevention Council. (2011). National prevention strategy. Washington, D.C.: Office of the
Surgeon General, US Department of Health and Human Services
Parsell, G. & Bligh, J. (1999). Readiness for Interprofessional Learning Scale: The development of
a questionnaire to assess the readiness for health care students for interprofessional learning
(RIPLS). Medical Education, 33, 95-100.
Schim, S. M., Doorenbos, A. Z., Benkert, R., & Miller, J. (2004). Development of a cultural
competence assessment instrument. Journal of Nursing Measurement, 11(1), 29-40.
U.S. Department of Health and Human Services. Healthy People 2020. Rockville, MD: Office of
Disease Prevention and Health Promotion, ODPHP Pub. No. B0132; 2010.
Wagner, E. (1998). Community practice: Learning, meaning and identity. Cambridge: Cambridge
University Press.

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