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? 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