Development of a Customizable Programme for Improving Interprofessional Team Meetings: An Action Research Approach

Complex primary care for multimorbid patients in the Netherlands: Interprofessional perspectives within and beyond general practice

Many consultations in general practice concern patients with multimorbidity, pressuring our healthcare systems with complex care needs. The number of people affected from multimorbidity is still increasing, as is the average number of co-occurring diseases per patient. The resulting complexity of care needs cannot be managed by health professionals from a single discipline, but requires interprofessional collaborative practice. This paper describes best practices from the Netherlands to facilitate interprofessional caretaking of patients with multimorbidity in primary care. The focus here is on collaborations within general practice and at community level.

How to promote changes in primary care? The Florentine experience of the House of Community

Primary care (PC) has a central role in promoting health and preventing diseases, even during health emergencies. The COVID-19 pandemic has shown how strengthening comprehensive primary healthcare (c-PHC) services is key to ensuring community health. The Italian government decided to support PHC by investing resources from the Next Generation EU (NextGenEu) plan in the development of local health districts (LHDs) and local PC centers called "Houses of Community (HoC)". The Florence LHD (Tuscany)-in direct collaboration with the University of Florence-has represented the experimental context in which a c-PHC-inspired organizational model has been proposed and included the HoC as the nearest access point to PC services. Through multiprofessional collaboration practices, HoCs provide continuity of care as well as health and social integration. Different levels of action must coexist to initiate, implement, and sustain this new PC model: the organizational and managerial level, the experimentation of a new model of care, and the research level, which includes universities and LHD through participatory research and action approaches. This process benefits from health professionals' (HPs) participation and continuous assessment, the care for working relationships between HPs and services, an appropriate research methodology together with a "permeable" multidisciplinary research group, and educational programs. In this context, the HoC assumes the role of a permanent laboratory of experimentation in PC, supporting the effectiveness of care and answering what the Next Gen EU plan has been foreseeing for the rethinking of Italian territorial services.

Nursing home geriatric rehabilitation care and interprofessional collaboration; a practice-based study

BACKGROUND

Frailty and multimorbidity are common among patients in geriatric rehabilitation care (GRC). Proper care of these patients involves multiple professionals which requires optimal interprofessional collaboration to provide the best possible support. Interprofessional collaboration (IPC) goes beyond multi-professional collaboration. It requires professionals to think beyond the expertise of their own discipline and work on joint outcomes in which the patient is actively involved. This study describes the development of the GRC teams of an elderly care organization towards the IPC.

METHODS

Mixed method pre-post study of 15 months. The interprofessional training program comprised team trainings, webinars, and online team sessions. Data was aggregated by administering the Extended Professional Identity Scale (EPIS) and QuickScan Interprofessional Collaboration (QS) measurements to GRC staff and by observations of the multi-professional team consultation (MPC) meetings of six GRC teams of an organization for elderly care in Drachten and Dokkum in the Netherlands. ADL independence (Barthel Index) and number of inpatient days were analyzed before and after the project.

RESULTS

Pretest healthcare professional response was 106, patients for analyses was 181; posttest response was 84, patients was 170. The EPIS shows improvement on "interprofessional belonging" (P = .001, 95%CI: 0.57-2.21), "interprofessional commitment" (P = .027, 95%CI: 0.12-1.90), and overall "interprofessional identity" (P = .013, 95%CI: 0.62 - 5.20). On the QS, all domains improved; "shared values" (P = .009, 95%CI: 0.07 - 0.47), "context" (P = .005, 95%CI: 0.08 - 0.44), "structure & organization" (P = .001, 95%CI: 0.14 - 0.56), "group dynamics & interaction" (P < .001, 95%CI: 0.18 - 0.58), and "entrepreneurship & management" (P = .039, 95%CI: 0.01 - 0.48). A qualitative analysis of the reflection responses and MPC observations indicate a shift from multi-professional to more IPC. Differences in ADL over time were not statistically significant. The mean number of inpatient days was reduced by 11.8 (P < .001, 95%CI: -17.34 - - 6.31) days.

CONCLUSIONS

Within the GRC teams, there was a shift observed to more IPC and better representation of the patient's wishes and needs. ADL independence did not change, yet we found a statistically significant decrease in the number of inpatient days. The basis for IPC was well established, however, it remains necessary that the teams continue to develop and invest in the collaboration with each other and the patient to further improve it.

Developing and validating utility parameters to establish patient-reported outcome-based perioperative symptom management in patients undergoing prostatectomy: a multicentre, prospective, observational cohort study protocol

INTRODUCTION

Symptom monitoring and alerting based on patient-reported outcomes have proven valuable in a postoperative setting. However, the parameters of the implemented patient-centred symptom management system for patients with prostate cancer (PC) remain unclear. This study aims to develop a perioperative symptom scale (PSS) to monitor symptoms, determine the appropriate timing for symptom assessment and establish intervention criteria for physicians.

METHODS AND ANALYSIS

We will prospectively recruit 387 patients undergoing PC surgery in 3 hospitals. The Chinese version of the MD Anderson Symptom Inventory (MDASI) will be used for longitudinal symptom data collection, presurgery and 1, 2, 3, 5, 7, 14, 21, 28, 42 and 90 days post surgery. A PSS will be generated when symptoms change significantly over time. A linear mixed model will be used to determine appropriate follow-up time points. The functional status determined by MDASI interference can then be used to establish alarm thresholds.

ETHICS AND DISSEMINATION

This study was approved by the Lishui Municipal Central Hospital Ethics Committee on 13 April 2022 (No. LSMCHEC-2022-54) and the Ethics Committee of Huzhou Central Hospital on 5 July 2023 (No. HZCHEC-202306017-01), the Ethics Committee of the First Affiliated Hospital of Huzhou Normal College on 20 June 2023 (No. HZYYEC-2023KYLL055). The latest protocol used in this study was V.2.0, dated on 25 February 2023. Before publication in a peer-reviewed journal, our findings will be presented and discussed at relevant medical conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2200059110.

Accidental allergic reactions to food in adolescents and adults: An overview of the factors involved and implications for prevention

Accidental allergic reactions to food are one of the major problems in adult patients diagnosed with food allergy. Such reactions occur frequently, are often severe and are associated with higher medical and non-medical costs. The aim of this Perspective is to provide insight into the different factors involved in the occurrence of accidental allergic reactions and to present an overview of practical implications for effective preventive measures. Several factors affect the occurrence of accidental reactions. These factors are related to the patient, health care, or food. The most important patient-related factors are age, social barriers to disclosing their allergy and non-adherence to the elimination diet. With regards to healthcare, the degree to which clinical practice is tailored to the individual patient is an important factor. The major food-related factor is the absence of adequate precautionary allergen labeling (PAL) guidelines. Since many factors are involved in accidental allergic reactions, different preventive strategies are needed. It is highly recommended that health care be tailored to the individual patient, with regard to education about the elimination diet, support on behavioral and psychosocial aspects, usage of shared decision-making and taking into account health literacy. In addition, it is crucial that steps are taken to improve policies and guidelines for PAL.

The effect of interprofessional simulation practice on collaborative learning: A randomized controlled trial

This study examined the effect of simulation on readiness for collaborative practice and learning using a randomized-controlled trial design that used the same education protocol with interprofessional and uniprofessional groups. The sample consisted of 43 students from four different majors. The students were assessed with the Readiness for Interprofessional Learning Scale, and a care plan measurement instrument. The interprofessional group showed a small increase (0.1 ± 0.43; p = .02) in readiness for teamwork and collaboration; the uniprofessional group showed a smaller increase for teamwork and collaboration (0.04 ± 0.31; p = .04) and for patient-centred care (0.0 ± 0.35; p = .01). The enriching work of interprofessional learning was evident within the care plan activity, suggesting that interprofessional simulation is an effective learning method for interprofessional education.

Participation of inpatients in multidisciplinary team meetings: An explorative study of mental healthcare workers' perception

AIM

To explore the perception of mental healthcare workers about participation of inpatients during multidisciplinary team meetings (MTMs) and to determine which demographic and contextual factors are associated with this perception.

METHODS

A cross-sectional multicentre study in 17 psychiatric hospitals with 701 mental healthcare workers was performed between 29 April and 19 May 2019. For measuring the perception of the mental healthcare workers, the Patient Participation during Multidisciplinary Team meetings Questionnaire was used.

RESULTS

93 % of the mental healthcare workers indicate that they are willing to allow patients to participate in a MTM. Most mental healthcare workers prefer an active role for the patient when participating in a MTM (93 %) and a collaborative role for the patient when making decisions in a MTM (75 %). Level of education, discipline, experience with patient participation in MTMs, working in a team where patient participation is applied, and recent training on patient participation, are associated with the mental healthcare worker's perception on patient participation in MTMs.

CONCLUSION

Mental healthcare workers report a great willingness to involve inpatients in MTMs. However, social workers, nurses, and pedagogues feel less competent and are less positive about the effects of patient participation in MTMs. Mental healthcare workers with recent training in patient participation and experience in patient participation in MTMs feel more competent and believe more often that the patient should fulfil a more autonomous role when participating in a MTM. These results can be used to understand and improve patient participation in MTMs in mental healthcare.

Scoping review to identify strategies and interventions improving interprofessional collaboration and integration in primary care

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.

Impetus of US hospital leaders to invest in patient-reported outcome measures (PROMs): a qualitative study

OBJECTIVES

Though hospital leaders across the USA have invested significant resources in collection of patient-reported outcome measures (PROMs), there are very limited data on the impetus for hospital leadership to establish PROM programmes. In this qualitative study, we identify the drivers and motivators of PROM collection among hospital leaders in the USA.

DESIGN

Exploratory qualitative study.

SETTING

Thirty-seven hospital leaders representing seven different institutions with successful PROMs programs across twenty US states.

METHODS

Semistructured interviews conducted with hospital leaders. Transcripts were analysed using thematic analysis.

RESULTS

Leaders strongly believe that collecting PROMs is the 'right thing to do' and that the culture of the institution plays an important role in enabling PROMs. The study participants often believe that their institutions deliver superior care and that PROMs can be used to demonstrate the value of their services to payors and patients. Direct financial incentives are relatively weak motivators for collection of PROMs. Most hospital leaders have reservations about using PROMs in their current state as a meaningful performance metric.

CONCLUSION

These findings suggest that hospital leaders feel a strong moral imperative to collect PROMs, which is also supported by the culture of their institution. Although PROMs are used in negotiations with payors, direct financial return on investment is not a strong driver for the collection of PROMs. Understanding why leaders of major healthcare institutions invest in PROMs is critical to understanding the role that PROMs play in the US healthcare system.

Consensus about GP interprofessional competencies: A nominal group study

BACKGROUND

Since the requirements for collaboration in primary care increase, effective interprofessional teamwork between general practitioners (GPs) and other primary care professionals is crucial. The need for more training in interprofessional collaborative competencies is widely recognised. However, existing competency frameworks do not sufficiently specify interprofessional collaboration to guide interprofessional competency development.

AIM

Consensus among GPs and other primary care professionals on interprofessional competencies that GP and GP-trainees should learn.

DESIGN & SETTING

Qualitative consensus study among Dutch GPs and other primary care professionals, all with expertise in primary care interprofessional collaborative practice.

METHOD

Three nominal group sessions were held, each resulting in its own group consensus on GP interprofessional collaborative competencies. The researchers conducted a content analysis to merge and thematise the prioritised competencies into one list. Participants prioritised this list of competencies. A pre-set cut-off point was applied to determine the overall consensus on core GP interprofessional competencies.

RESULTS

Eighteen professionals from nine different disciplines participated. The content analysis resulted in 31 unique competencies of which fourteen competencies were prioritised in the final ranking into three main themes: 1. Professional identity development and role definition by the GP. (three competencies); 2. Developing and executing shared care plans for individual patients (6); 3. Setting up and maintaining interprofessional collaborative partnerships.(5) CONCLUSION: An interprofessional group of experts reached consensus on 14 competencies within 3 themes. This framework provides a steppingstone for GPs to focus on their development regarding interprofessional collaboration.

Using an Activity Tracker in Healthcare: Experiences of Healthcare Professionals and Patients

Despite the increased use of activity trackers, little is known about how they can be used in healthcare settings. This study aimed to support healthcare professionals and patients with embedding an activity tracker in the daily clinical practice of a specialized mental healthcare center and gaining knowledge about the implementation process. An action research design was used to let healthcare professionals and patients learn about how and when they can use an activity tracker. Data collection was performed in the specialized center with audio recordings of conversations during therapy, reflection sessions with the therapists, and semi-structured interviews with the patients. Analyses were performed by directed content analyses. Twenty-eight conversations during therapy, four reflection sessions, and eleven interviews were recorded. Both healthcare professionals and patients were positive about the use of activity trackers and experienced it as an added value. Therapists formulated exclusion criteria for patients, a flowchart on when to use the activity tracker, defined goals, and guidance on how to discuss (the data of) the activity tracker. The action research approach was helpful to allow therapists to learn and reflect with each other and embed the activity trackers into their clinical practice at a specialized mental healthcare center.

Framework for interprofessional case conferences - empirically sound and competence-oriented communication concept for interprofessional teaching

Aims/objectives: Interprofessional case conferences support future team-based approaches to healthcare, and inevitably require targeted communication between the various participants. However, the success of communication during a case conference must be learnt explicitly. The subject of conversation is often the only outcome of the case conference that is discussed in plenary or small groups. Communication processes are hardly taken into account. However, integrating process orientation and making communication relevant to goal achievement is mandatory in order to teach in a competence-oriented fashion in this area. The aim of this article is to present an empirically sound framework for teaching case conferences, with the help of which conversation processes can be practiced, evaluated and analysed in interprofessional case conferences. Methodology: With the aid of literature analysis, insights from empirical conversation research and the International Classification of Functioning and Health (ICF), we have developed an empirically and theoretically sound framework for interprofessional case conferences. This is intended to support the training of communication skills and to serve as a basis for assessing them. Results: In practice, it has been shown that embedding case conferences in higher education curricula is feasible and effective for a group size of 200 students. The framework has proven itself in verbal training while aligning itself with concepts of sharing for the negotiation of leadership, goals and decisions. In addition, it could also be used as a theoretical construct for the "interprofessional objective structured clinical examination" (iOSCE) at graduation from the module "Interprofessional Case Conference" at the Hochschule für Gesundheit. Conclusion: The topics of interprofessional practice (IPP) and communication are now the subject of curricula in the health professions, both nationally and internationally. In addition, various competence settings are available that can support didactic orientation. However, the authors believe that there are no concrete imperatives for competence-oriented implementation in teaching and examination. In the area of communication teaching, one can integrate empirically sound concepts instead of induction into degree course for the health professions, in order to provide a basis for the further development of communicative competence in this field.

Unknown makes unloved-A case study on improving integrated health and social care in the Netherlands using a participatory approach

Many initiatives integrating health and social care have been implemented in order to provide adequate care and support to older people living at home. Further development of existing initiatives requires iterative processes of developing, implementing and evaluating improvements to current practice. This case study provides insight into the process of improving an existing integrated care initiative in the Netherlands. Using a participatory approach, researchers and local stakeholders collaborated to develop and implement activities to further improve collaboration between health and social care professionals. Improvement activities included interprofessional meetings focussing on reflection and mutual learning and workplace visits. Researchers evaluated the improvement process, using data triangulation of multiple qualitative and quantitative data sources. According to participating professionals, the improvement activities improved their communication and collaboration by establishing mutual understanding and trust. Enabling factors included the safe and informal setting in which the meetings took place and the personal relationships they developed during the project. Different organisational cultures and interests and a lack of ownership and accountability among managers hindered the improvement process, whereas issues such as staff shortages, time constraints and privacy regulations made it difficult to implement improvements on a larger scale. Still, the participatory approach encouraged the development of partnerships and shared goals on the level of both managers and professionals. This case study highlights that improving communication between professionals is an important first step in improving integrated care. In addition, it shows that a participatory approach, in which improvements are co-created and tailored to local priorities and needs, can help in the development of shared goals and trust between stakeholders with different perspectives. However, stakeholders' willingness and ability to participate in such an improvement process is challenged by many factors.

Suitability of a Programme for Improving Interprofessional Primary Care Team Meetings

INTRODUCTION

Primary care is increasingly being confronted with complex health care demands stemming from both biomedical and psychosocial problems of people with chronic diseases. Interprofessional collaboration is needed to enhance person-centredness and coordinate care provision in an efficient manner, which should eventually result in high-quality and integrated care. In primary care, collaboration often occurs through periodic interprofessional team (IPT) meetings. We have developed a multifaceted programme (including a reflection framework, training activities and a toolbox) to enhance team functioning in terms of improved person-centredness and efficiency of meetings. The aim of this study was to evaluate the perceived suitability and potential impact of this programme. Eventually, findings of this evaluation should contribute to understanding the suitability of the programme and optimizing its design.

METHODS

A prospective process evaluation was conducted, using a mixed-methods approach. Six primary care IPTs participated. Data collection included observations of team meetings, semi-structured interviews with team chairpersons, a focus group meeting, and a questionnaire for all team members. Qualitative data were analysed using directed content analysis and quantitative data using descriptive statistics.

RESULTS

The results show that, on the whole, the programme was appreciated. Most progress was perceived regarding structure and organization. Chairs perceived increased awareness of person-centredness and team processes. They perceived the training activities as useful and instructive, and valued peer feedback and on-the-job coaching as the most effective strategies. Findings from the questionnaire showed a tendency in the desired direction for all variables.

CONCLUSION

To conclude, the programme can be considered as a suitable approach for improving team functioning. However, enhancing person-centredness requires additional training/practice and on-the-job coaching. Lastly, the programme should be context-specific, flexible in use, and preferably delivered and mediated by an external facilitator at the workplace.