An Overview of Reviews on Interprofessional Collaboration in Primary Care: Barriers and Facilitators

Case managers within general practices in 11 Western countries: repeat cross-sectional studies

BACKGROUND

In the context of an ageing population and increasing health needs, primary care reform is needed and several new models have emerged, including the introduction of case managers in general practitioner practices.

AIM

To describe the frequency of case managers in general practices in eleven Western countries between 2012 and 2019 and to investigate the characteristics of general practitioners and their practices associated with case manager frequency.

METHODS

A secondary analysis of the Commonwealth Fund International Health Policy Surveys of Primary Care Physicians, which were international cross-sectional studies conducted in 2012, 2015 and 2019. Random samples of general practitioners were selected in 11 Western countries (2012: n = 9776; 2015: n = 12,049; 2019: n = 13,200). The use of case managers in general practitioner practices was determined with the question "Does your practice use personnel, such as nurses or case managers, to monitor and manage care for patients with chronic conditions that need regular follow-up care?", with possible answers "Yes, within the practice", "Yes, outside the practice", "Yes, both within and outside the practice" or "No". Other variables characterising general practitioners and their practices were considered. Mixed-effects logistic regression was performed.

RESULTS

The frequency of case managers within general practitioner practices varied greatly by country, with an overall trend towards an increase from 2012 to 2019. In the multivariate analysis, more case managers were found in practices located in small towns (odds ratio [OR] 1.4; 95% confidence interval [CI] 1.2-1.7) and in rural areas (OR 1.9; 95% CI 1.5-2.4) compared to cities. The frequency of case managers was higher in larger practices, as shown in comparisons of practices in the second, third and fourth quartile of full-time equivalent employee counts compared to those in the first quartile (Q2: OR 1.7, 95% CI 1.4-1.9; Q3: OR 2.1, 95% CI 1.6-2.9; Q4: OR 3.8, 95% CI 3.0-4.9). There was no significant difference in frequency with respect to the age and sex of the general practitioners.

CONCLUSION

The use of case managers in general practitioner practices is a promising approach, but its practice varies greatly. This practice has been developing in Western countries and is tending to increase. The implementation of case managers seems to be associated with certain characteristics linked to general practitioner practices (practice location, practice size), whereas it does not seem to depend on the personal characteristics of general practitioners, such as age or sex.

Patient and Provider Attitudes and Preferences Regarding Early Palliative Care Delivery for Patients with Advanced Gastrointestinal Cancers: A Prospective Survey

Early integrated palliative care (EIPC) for patients with advanced cancers requires the involvement of family doctors (FDs) and oncologists. We compared attitudes between patients and their providers regarding the delivery of EIPC. Patients with newly diagnosed incurable gastrointestinal (GI) cancer at a tertiary cancer centre in Ontario, Canada, were surveyed using a study-specific instrument regarding the importance of and preferences for accessing support across eight domains of palliative care. Physicians within the circle of care completed a parallel survey for each patient. The concordance between patient and physician responses was analyzed. A total of 66 patients were surveyed (median age 69, 35% female). All had an oncologist, 12% had a specialist palliative care provider (SPC), and 97% had an FD, but only 41% listed the FD as part of the care team. In total, 95 providers responded (oncologist = 68, FD = 21, SPC = 6; response rate 92%; 1-3 physician responses per patient). Disease management and physical concerns were most important to patients. Patients preferred to access care in these domains from oncologists or SPCs. For all other domains, most patients attributed primary responsibility to self or family rather than any healthcare provider. Thus, concordance was poor between patient and physician responses. Across most domains of palliative care, we found low agreement between cancer patients and their physicians regarding responsibilities for care, with FDs appearing to have limited involvement at this stage.

Collaboration between general practitioners and health visitors about children of concern in Denmark: a qualitative study

Primary health care services are responsible for preventive measures to optimize child development in the first years of life. In Denmark, these services are shared between general practitioners and municipality health visitors. National guidelines mandate collaboration between these professionals but in reality, they work in parallel. We aimed to explore how professionals experience collaboration and communication regarding children with professional concern about their wellbeing. Seventeen semi-structured interviews were conducted with general practitioners, and health visitors. Both professions considered closer collaboration to be important in meeting children's needs. Barriers to collaboration and communication included differing legal obligations, Information Technology-systems (IT), lack of financial incentives, lack of mutual professional acknowledgment and respect, and absence of routines for sharing knowledge. The traditional division of responsibilities between physicians and nurses in which all professionals involved in preventive child health care are acculturated seems to impede collaboration based on unequal professional status. IT infrastructure needs to support information sharing and structures to support informal meetings between professionals are warranted to support more collaborative practice.

Rethinking organizational culture in intersectoral coordination: the perspective of boundary work

PURPOSE

The purpose of this paper is to rethink the concept of organizational culture as something that emerges bottom-up by using the sociological concepts of boundary object and boundary work as an analytical lens and to show how this approach can help understand and facilitate intersectoral coordination.

DESIGN/METHODOLOGY/APPROACH

We used observations and qualitative interviews to develop "deep" knowledge about processes of intersectoral coordination. The study draws on a conceptual framework of "boundary work" and "boundary objects" to show how a bottom-up perspective on organizational culture can produce better understanding of and pave the way for intersectoral coordination. We use a case of health professionals engaged in two Danish intersectoral programs developing and providing health promotion services for women with gestational diabetes mellitus (GDM).

FINDINGS

The study showed how boundary work revolves around negotiations on how to define, understand and act on the diagnosis of GDM. This diagnosis has the characteristics of a "boundary object", being more loosely structured in general terms, but strongly structured in local settings. Boundary objects help connect different professionals and facilitate coordination. The analysis showed how the introduction of time and the concept of "lifelong health promotion" helped to transgress existing organizational and professional boundaries.

RESEARCH LIMITATIONS/IMPLICATIONS

The findings contribute to the literature on organizational culture and intersectoral coordination. We highlight the benefits of a practice-oriented, bottom-up perspective for a better understanding of how shared meaning is produced in cross professional coordination and collaboration. While the theoretical implications will be general applicable when studying organizational culture, the implications for practice are sensitive to context and the processes we have described as the outcomes of boundary work are generated from cases that were most likely to provide deep insight into our research topic.

PRACTICAL IMPLICATIONS

For practice this can build bridges between organizational and professional boundaries.

ORIGINALITY/VALUE

The findings contribute to the literature on organizational culture and intersectoral coordination. We highlight the benefits of a practice-oriented, bottom-up perspective for a better understanding of how shared meaning is produced in cross professional coordination. This may build bridges between organizational and professional boundaries in practice settings.

Case report: Early use of whole exome sequencing unveils HNRNPU-related neurodevelopmental disorder and answers additional clinical questions through reanalysis

This case report chronicles the diagnostic odyssey and resolution of a 27-year-old female with a complex neurodevelopmental disorder (NDD) using Whole Exome Sequencing (WES). The patient presented to a precision medicine clinic with multiple diagnoses including intellectual disability, autism spectrum disorder (ASD), obsessive-compulsive disorder (OCD), tics, seizures, and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Although this patient previously had chromosomal microarray and several single-gene tests, the underlying cause of this patient's symptoms remained elusive. WES revealed a pathogenic missense mutation in the HNRNPU gene, associated with HNRNPU-related neurodevelopmental disorder (HNRNPU-NDD) and developmental and epileptic encephalopathy-54 (DEE54, OMIM: # 617391). Following this diagnoses, other treating clinicians identified additional indications for genetic testing, however, as the WES data was readily available, the clinical team was able to re-analyze the WES data to address their inquiries without requiring additional tests. This emphasizes the pivotal role of WES in expediting diagnoses, reducing costs, and providing ongoing clinical utility throughout a patient's life. Accessible WES data in primary care settings can enhance patient care by informing future genetic inquiries, enhancing coordination of care, and facilitating precision medicine interventions, thereby mitigating the burden on families and the healthcare system.

Responsible coordination of municipal health and care services for individuals with serious mental illness: a participatory qualitative study with service users and professionals

BACKGROUND

Care coordination is crucial to ensure the health of individuals with serious mental illness. The aim of this study was to describe and analyze an inclusive innovation process for coordinating municipal health and care services for individuals with serious mental illness.

METHODS

We conducted café dialogues with professionals and service users with serious mental illness. The café dialogues engaged participants in conversation and knowledge exchange about care coordination, adressing topics of efficiency, challenges, and improvement. We used a responsible innovation framework to analyze the innovation process.

RESULTS

Responsible coordination requires promoting service users' health and ensuring communication and mutual awareness between professionals. Individual-level factors supporting responsible coordination included service users knowing their assigned professionals, personalized healthcare services, and access to meaningful activities. Provider-level factors included effective coordination routines, communication, information exchange, and professional familiarity. Results reflect professionals' and service users' perspectives on efficient care coordination, existing challenges, and measures to improve care coordination.

CONCLUSION

Café dialogues are an inclusive, participatory method that can produce insights into the responsible coordination of municipal health and care services for individuals with serious mental illness. The responsible innovation framework is helpful in identifying care coordination challenges and measures for responsible coordination.

Characteristics of Multiprofessional and Client-Oriented Approach in Occupational Health Services: A Cross-Sectional Survey Among Occupational Health Professionals

Background

Multiprofessional and client-oriented approaches are considered key factors for successful occupational health services, and for impressive occupational health cooperation between a client organisation and occupational health service provider. The purpose of this study was to find out the views of occupational health physicians, occupational health nurses, occupational physiotherapists, and occupational health psychologists about multiprofessional and client-oriented working methods. These working methods describe the guidelines for good occupational health practice in Finland, also serving the framework of the present study.

Material and Methods

The survey was conducted in May and June 2022. The data consisted of answers to open-ended questions of a larger questionnaire. The data was analysed with the method of theory-related thematic analysis. Seven occupational health service providers committed to the study. Altogether 121 professionals responded to the question surveying the multiprofessional approach, and 119 professionals responded to the question of client-oriented approach.

Results

The results showed that both the multiprofessional and client-oriented approaches are closely related to each other, and the views of these approaches are in line with the good occupational health practice. Multiprofessional approach was most commonly described with the theme of sharing expertise. Respectively, the theme of smooth cooperation most commonly described the client-oriented approach. At its best, the answers showed that a multiprofessional working strategy takes into account the expertise of different professionals so that the client can be offered high-quality, accurate content and timely occupational health services.

Conclusion

The results provide up-to-date information on working strategies of occupational health services in Finland. The results can be used in further development of multiprofessional and client-oriented work in occupational health services.

Complementary Care Collaboration: A Call to Action

Collaboration among members of a client's/patient's wellness team is a key goal for effective service delivery, and yet often remains elusive. It is proposed that complementary health care practitioners are well situated to lead the way in collaboration. In this article, a framework for how practitioners in any discipline can begin to develop these professional collaborations is presented-NOTP! Network, openness, time, patience. It is a call to action.

Success factors and barriers in interprofessional collaboration between dental hygienists and dietitians in community-dwelling older people: Focus group interviews

INTRODUCTION

Poor nutritional status can impair oral health while poor oral health can influence the individual's dietary intake, which may result in malnutrition. This interaction between nutritional status and oral health in older age requires attention, coordination and collaboration between healthcare professionals. This qualitative study explores dental hygienists' and dietitians' opinions about current collaboration with the aim of identifying success factors and barriers to this interprofessional collaboration.

METHODS

Three focus group interviews were held with Dutch dental hygienists and dietitians about nutritional and oral healthcare in community-dwelling older people.

RESULTS

In total, 9 dietitians and 11 dental hygienists participated in three online focus group interviews. Dental hygienists and dietitians seldom collaborated or consulted with each other. They struggled with the professional boundaries of their field of expertise and experienced limited knowledge about the scope of practice of the other profession, resulting in conflicting information to patients about nutrition and oral health. Interprofessional education was scarce during their professional training. Organizational and network obstacles to collaborate were recognized, such as limitations in time, reimbursement and their professional network that often does not include a dietitian or dental hygienist.

CONCLUSION

Dental hygienists and dietitians do not collaborate or consult each other about (mal)nutrition or oral health in community-dwelling older people. To establish interprofessional collaboration, they need to gain knowledge and skills about nutrition and oral health to effectively recognize problems in nutritional status and oral health. Interprofessional education for healthcare professionals is needed to stimulate interprofessional collaboration to improve care for older people.

The Effect of Interprofessional Education on Student Readiness for Collaborative Practice

BACKGROUND

Health care reform promotes interprofessional patient-centric health care models associated with improved population health outcomes. Interprofessional education (IPE) programs are necessary to cultivate collaborative care, yet little evidence exists to support IPE pedagogy within nursing and other health science academia.

METHOD

This quasiexperimental study examined differences in pre- and posttest Readiness for Interprofessional Learning Scale (RIPLS) scores following an IPE intervention. The IPE intervention consisted of a video presentation and a debriefing session after a simulated interprofessional collaborative patient care conference that introduced baccalaureate nursing and health science students to the roles and responsibilities of clinicians in team-based primary care. Pre- and postintervention RIPLS scores were analyzed.

RESULTS

Pre- and postintervention RIPLS scores increased across all subscales, with distinct variation between nursing and health science student subscales.

CONCLUSION

This IPE intervention had positive effects on students' readiness for interprofessional learning. Additional research is warranted to support health science pedagogy. [J Nurs Educ. 2024;63(5):304-311.].

Postresidency Practice Setting and Clinical Care Features According to 3 Versus 4 Years of Training in Family Medicine: A Length of Training Pilot Study

BACKGROUND AND OBJECTIVES

Factors associated with physician practice choice include residency location, training experiences, and financial incentives. How length of training affects practice setting and clinical care features postgraduation is unknown.

METHODS

In this Length of Training Pilot (LoTP) study, we surveyed 366 graduates of 3-year (3YR) and 434 graduates of 4-year (4YR) programs 1 year after completion of training between 2013 and 2021. Variables assessed included reasons for practice setting choice, practice type, location, practice and community size, specialty mix, and clinical care delivery features (eg, integrated behavioral health, risk stratified care management). We compared different length of training models using χ2 or Fisher's exact tests for categorical variables and independent samples, and t test (unequal variances) for continuous variables.

RESULTS

Response rates ranged from 50% to 88% for 3YR graduates and 68% to 95% for 4YR graduates. Scope of practice was a predominant reason for graduates choosing their eventual practice, and salary was a less likely reason for those completing 4 years versus 3 years of training (scope, 72% vs 55%, P=.001; salary, 15% vs 22%, P=.028). Community size, practice size, practice type, specialty mix, and practice in a federally designated underserved site did not differ between the two groups. We found no differences in patient-centered medical home features when comparing the practices of 3YR to 4YR graduates.

CONCLUSIONS

Training length did not affect practice setting or practice features for graduates of LoTP programs. Future LoTP analyses will examine how length of training affects scope of practice and clinical preparedness, which may elucidate other elements associated with practice choice.

Promotion of Physical Activity by Québec Primary Care Physicians: What Has Changed in the Last Decade?

OBJECTIVE

This study aimed to assess the changes in the frequency of physical activity (PA) counseling and in the predictors of primary care PA promotion in Québec primary care physicians (PCPs) between 2010 and 2020.

METHODS

In 2010, we conducted a survey among Québec PCPs. Questions included: frequency of promoting PA to patients, perceived barriers, needs to improve PA promotion practice, frequency of PCPs' PA practice, and sociodemographic information. In 2020, we took over the 2010 questionnaire to document the evolution of the PA promotion practice.

RESULTS

The proportion of PCPs discussing PA with their patients significantly increased (P < .05) in 2020 for the following health conditions: depression, low back pain, chronic obstructive pulmonary disease, and cancer; it declined (P < .05) for overweight patients, those with metabolic syndrome, and in primary prevention. Collaboration with PA professionals was the major need identified, and it increased in 2020. PCPs' own practice of PA was a predictor of PA promotion in 2010 (odds ratio = 6.679; P < .001) and in 2020 (odds ratio = 6.679; P < .001). In both 2010 and in 2020, older or more experienced PCPs were more likely to discuss PA with their patients without diagnosed diseases than younger ones or those with less experience.

CONCLUSIONS

Over the last 10 years, there has been a significant increase in PCPs promoting PA in Québec; however, it has been mainly oriented toward secondary prevention. It is concerning that PA counseling in primary prevention has declined, notably among younger PCPs. The stronger claim for closer collaboration with kinesiologists suggests that PCPs are in favor of an interprofessional strategy, namely collaboration with PA specialists.

The process of nurses' role negotiation in general practice: A grounded theory study

AIM

To explain the process by which nurses' roles are negotiated in general practice.

BACKGROUND

Primary care nurses do important work within a social model of health to meet the needs of the populations they serve. Latterly, in the face of increased demand and workforce shortages, they are also taking on more medical responsibilities through task-shifting. Despite the increased complexity of their professional role, little is known about the processes by which it is negotiated.

DESIGN

Constructivist grounded theory.

METHODS

Semi-structured interviews were conducted with 22 participants from 17 New Zealand general practices between December 2020 and January 2022. Due to COVID-19, 11 interviews were via Zoom™. Concurrent data generation and analysis, using the constant comparative method and common grounded theory methods, identified the participants' main concern and led to the construction of a substantive explanatory theory around a core category.

RESULTS

The substantive explanatory theory of creating place proposes that the negotiation of nurse roles within New Zealand general practice is a three-stage process involving occupying space, positioning to do differently and leveraging opportunity. Nurses and others act and interact in these stages, in accordance with their conceptualizations of need-responsive nursing practice, towards the outcome defining place. Defining place conceptualizes an accommodation between the values beliefs and expectations of individuals and pre-existing organizational norms, in which individual and group-normative concepts of need-responsive nursing practice are themselves developed.

CONCLUSION

The theory of creating place provides new insights into the process of nurses' role negotiation in general practice. Findings support strategies to enable nurses, employers and health system managers to better negotiate professional roles to meet the needs of the populations they serve, while making optimum use of nursing skills and competencies.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Findings can inform nurses to better negotiate the complexities of the primary care environment, balancing systemic exigencies with the health needs of populations.

IMPACT

What Problem Did the Study Address? In the face of health inequity, general practice nurses in New Zealand, as elsewhere, are key to meeting complex primary health needs. There is an evidence gap regarding the processes by which nurses' roles are negotiated within provider organizations. A deeper understanding of such processes may enable better use of nursing skills to address unmet health need. What Were the Main Findings? Nurses' roles in New Zealand general practice are determined through goal-driven negotiation in accordance with individual concepts of need-responsive nursing practice. Individuals progress from occupying workspaces defined by the care-philosophies of others to defining workplaces that incorporate their own professional beliefs, values and expectations. Negotiation is conditional upon access to role models, scheduled dialogue with mentors and decision-makers, and support for safe practice. Strong clinical and organizational governance and individuals' own positive personal self-efficacy are enablers of effective negotiation. Where and on Whom Will the Research Have Impact? The theory of Creating Space can inform organizational and individual efforts to advance the roles of general practice nurses to meet the health needs of their communities. General practice organizations can provide safe, supported environments for effective negotiation; primary care leaders can promote strong governance and develop individuals' sense of self-efficacy by involving them in key decisions. Nurses themselves can use the theory as a framework to support critical reflection on how to engage in active negotiation of their professional roles.

REPORTING METHOD

The authors adhered to relevant EQUATOR guidelines using the COREQ reporting method.

PATIENT OR PUBLIC CONTRIBUTION

Researchers and participants currently working in general practice were involved in the development of this study. By the process of theoretical sampling and constant comparison, participants' comments helped to shape the study design. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: An understanding of the processes by which health professionals negotiate their roles is important to support them to meet the challenges of increased complexity across all health sectors globally.

Enhancing interprofessional teamwork between youth care professionals using an electronic health record; a mixed methods intervention study

We aimed to investigate whether using a shared electronic patient record (EPR-Youth) strengthened interprofessional teamwork among professionals in youth care and child healthcare. Using a mixed-methods design, we compared two partly overlapping samples of professionals, who completed questionnaires before the introduction of EPR-Youth (n = 117) and 24 months thereafter (n = 127). Five components of interprofessional teamwork (interdependence, newly created professional activities, flexibility, collective ownership of goals, and reflection on processes) were assessed for this study. Midway through the study period, focus groups were held with 12 professionals to examine how EPR-Youth contributed to interprofessional teamwork. Professionals reported significantly more flexibility after the introduction of EPR-Youth than before. Professionals scored slightly -but not significantly- more positively on the other components of teamwork. Focus group participants reported that using EPR-Youth strengthened their sense of interdependence and collective ownership of goals, and contributed to newly created professional activities. At baseline, levels of interprofessional teamwork differed between organizations. Focus group participants confirmed these differences and attributed them to differences in facilitation of interprofessional teamwork. Our findings suggest that using EPR-Youth can foster interprofessional teamwork. Organizational differences underline that implementing an EPR alone is inadequate: shared definitions of teamwork and organizational facilities are needed to strengthen interprofessional teamwork.

The mobilisation of professional identity: A scoping and lexical review

Interprofessional care obliges different healthcare professions to share decision-making and sometimes, practices. Given established hierarchies, it can be difficult to promote interprofessional care, partly because of the need to reshape professional identities. Despite interest in effective interprofessional care, there is limited research on how professional identity can be mobilised to promote it. A scoping review as well as lexical review of academic publications was conducted to address this void. After searching seven academic databases and screening the identified publications, 22 publications met the inclusion criteria. They collectively reported on 22 interventions, most of which were used in healthcare. The scoping review suggested there is some evidence that professional identities can be mobilised. Yet, of the 22 interventions, only ten explicitly targeted professional identity. The most common intervention was a training or development program, followed by workplace redesign. The need for internal motivation to mobilise professional identity was reported as was the impact of external drivers, like extending the scope of practice. Extending these findings, the lexical review demonstrated that, among the 22 publications, the relationship between professional identity and mobilisation did not feature prominently within the discourse. Furthermore, it seems that geography matters-that is, while all the publications spoke of professional identity, they differed by region on how they did this. Given these findings, concentrated scholarship is needed on the relationship between professional identity and interprofessional care, lest interprofessional care programs have limited, sustained effect. Implications for scholars and practitioners are explicated.

Psychosocial factors contributing to value creation in value-based healthcare: a scoping review

Background

Healthcare systems constantly evolve to improve care quality and resource utilization. One way is implementing Value-Based Healthcare (VBHC) an economic approach. This scoping review aims to identify and describe the literature on VBHC, particularly its psychosocial aspects, to uncover research gaps.

Method

The review followed the PRISMA guidelines for Scoping Reviews. We took the following 14 steps: (a) defining the research question; (b) identifying relevant studies; (c) selecting studies; (d) 15 mapping data; (e) collecting, synthesizing and reporting results. A detailed Boolean search was conducted from January 2021 to August 31, 2021, across APA PsycINFO and PubMed databases using keywords such as "Value-Based Healthcare" and "psychosocial perspective." Initially, three reviewers screened 70 e-records independently, assessing titles, abstracts, and full-text against the inclusion criteria. Discrepancies regarding the evaluation of the articles were resolved through consensus sessions between the reviewers.

Results

The final review included 14 relevant e-records in English from peer-reviewed sources, focusing on quantitative and qualitative research. From the analysis, four areas emerged: (1) Value chains in Healthcare; (2) Styles, activities, and practices of value co-creation in Healthcare; (3) Value co-creation in the encounter process; (4) Value co-creation in preventive health services.

Conclusion

The scoping review findings suggest several potential key aspects, including the interdependence between patients and healthcare organizations, organizational culture in healthcare, and the role of patient-centered approaches that focus on relationships, communication, and social support in healthcare. This can be achieved through patient engagement, patient-centered care and communication, health literacy, psychosocial support services, comprehensive psychosocial assessments, care coordination, and continuity of care. Integrating psychosocial elements in VHBC enhances quality and optimizes resource use. Findings highlight the need to develop practical guidance on how to implement a culture of value in care that takes into account the psychosocial aspects that have emerged, but not fully addressed. The pandemic teaches that the workforce poorly receives sudden and unsystematic changes. This review could provide an initial basis for the redesign of value in healthcare and a paradigm shift that has already begun with patient-centered medicine and patient engagement.

Advanced nurse and midwife practitioners' experience of interprofessional collaboration when implementing evidence-based practice into routine care: An interpretative phenomenological analysis

AIM

To understand advanced nurse and midwife practitioners' experience of interprofessional collaboration in implementing evidence-based practice into routine care.

DESIGN

A qualitative interpretative phenomenological analysis.

METHODS

A purposeful sample of 10 Registered Advanced Nurse and Midwife Practitioners from a range of practice settings in the Republic of Ireland participated in semi-structured interviews over a 10-month timeframe. Interviews were transcribed verbatim and data were analysed using a multi-stage approach in line with guidance for interpretative phenomenological analysis.

RESULTS

Six superordinate themes emerged: Understanding of advanced practice; 'Treated as an equal and as a "nurse"'; Nursing management support; 'A voice to implement anything new'; Confidence and Emotional intelligence. These factors impacted interprofessional relationships and the extent to which advanced practitioners could implement evidence-based practice.

CONCLUSION

There is scope to improve advanced practitioners' ability to collaborate with the interprofessional team in implementing evidence-based practice into routine care.

IMPACT AND IMPLICATIONS

The study findings demonstrate that enhancing understanding of the advanced practice role; increasing organizational support for advanced practitioners and augmenting specific practitioner skills and attributes will increase their ability to collaborate effectively and implement evidence-based practice. Supporting advanced practitioners in this important aspect of their role will positively influence health outcomes for patients.

CONTRIBUTION TO THE WIDER GLOBAL CLINICAL COMMUNITY

As numbers of both nurse and midwife practitioners increase globally, this study provides timely evidence from a range of practice settings to guide the design of education programmes and policies governing advanced practice. Study recommendations have broad applicability to all healthcare professionals who are engaged in implementing evidence-based practice into routine care.

REPORTING METHOD

Consolidated criteria for reporting qualitative research (COREQ).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Experiences of young adults with cerebral palsy in pediatric care transitioning to adult care

AIM

To increase understanding regarding the experiences and values of young adults with cerebral palsy (CP), and their caregivers, regarding pediatric rehabilitation-related care, including perceived barriers and potential facilitators to transition to adult care.

METHOD

This was a qualitative descriptive study that used 20 semi-structured interviews (13 caregivers and seven patient-caregiver dyads).

RESULTS

We identified four major themes: (1) the value and security of long-term relationships; (2) feeling 'rudderless' navigating the logistics of transition; (3) differences in pediatric versus adult models of care; and (4) perceived lack of provider expertise and comfort in adult care settings. Young adults with CP who had not yet transitioned to adult rehabilitation care and their caregivers placed high value on provider relationships and expertise, advanced planning, communication, and coordination of care.

INTERPRETATION

Identified barriers and potential facilitators to the transition to adult rehabilitation care reflected the uncertainty that accompanies leaving an established healthcare relationship. Challenges related to the logistics of this transition, differences in models of care, and perceived lack of provider comfort and expertise in adult care settings were also noted. Our findings could be used to develop and study patient-centered and family-centered transition processes for individuals with CP to promote age-appropriate and developmentally appropriate lifespan care.

Development of a master of science, nursing and interprofessional leadership program: AACN essentials in action

BACKGROUND

Leadership acumen, interprofessional relationships, and knowledge of healthcare operations are essential proficiencies for nurses to navigate the dynamic and complex healthcare landscape. The American Association of Colleges of Nursing (AACN) re-envisioned the academic nursing standards, The Essentials: Core Competencies for Professional Nursing Education (Essentials), to guide curricular development in preparing nurses with the aptitude to meet these challenges.

PURPOSE

The purpose of this project was to develop an innovative Master of Science nursing program to address the challenges facing the RN workforce.

METHODS

A relationship-based framework and the Analysis, Design, Development, Implementation and Evaluation (ADDIE) model were used to guide the development of the program using the Essentials to inform curricular design.

RESULTS

A Nursing and Interprofessional Leadership Master of Science program was designed comprising seven core courses with two tracks, Bachelor of Nursing and Post Graduate Option.

LIMITATION

The program was created during the COVID-19 pandemic, which may have influenced the data used for the program's design.

CONCLUSION

Healthcare complexities are requiring nursing education to evaluate curricula for advanced knowledge and skills. A Nursing and Interprofessional Leadership Master of Science degree program guided by the Essentials was developed to meet this challenge.

[Experts' uncertainties in decisions on the indication for rehabilitation as part of the assessment of long-term care needs: Results of semi-structured interview]

OBJECTIVE

As part of assessment of long-term care needs, Medical Services of the compulsory German Health Insurance have to decide whether medical rehabilitation is indicated. The aim of this study was to identify uncertainties and associated factors while deciding whether rehabilitation was indicated in this standardized review process.

METHOD

Semi-structured interviews were conducted with a total of twelve nursing experts and six physician experts from six different Medical Services. In the interviews of the two professional groups, thinking aloud and problem-centered methods were used. They were subjected to a cognitive pretest prior to data collection. All interviews were conducted over telephone in May 2021, digitally recorded and transcribed thereafter. They were analyzed based on the method of structuring qualitative content analysis using the MAXQDA software.

RESULTS

Uncertainties in decision-making can arise both from case-related characteristics and case-independent contextual factors. Nursing experts associated uncertainties in assessing the criteria of rehabilitation indication primarily with certain diseases (especially dementia or mental illnesses), multimorbidity, an unclear illness and ambulatory care situation, as well as a negative rehabilitation-related attitude of the persons being assessed. The physician experts, who based their decisions on available documentation in the case files, described uncertainties, particularly due to insufficient information relevant to the decision (e. g., on diagnostics, course of disease and treatment, weighting of existing limitations) in the nursing experts' assessments. Across all criteria, the experts' own professional or private rehabilitation experience and their understanding of the role of rehabilitation before and during the need for long-term care, as well as aspects of communication practice and the professional exchange between the nursing and the physician experts also influenced the overall decision-making process.

CONCLUSION

The identification of uncertainties in experts' decision-making process and associated factors enables the development of strategies to strengthen specifically the certainty of experts' decision-making and thus may contribute to the promotion of a needs-based rehabilitation access via long-term care assessment.

Interprofessional Education with Simulations in Primary Care

The introduction of interprofessional primary care (IPC) as a model of collaborative patient care is increasingly vital in the context of complex healthcare systems and the growing needs of patients. Its benefits include improved patient outcomes, enhanced efficiency, and reduced costs. However, the successful implementation of IPC faces challenges due to the differences in training and backgrounds among healthcare professionals, emphasising the importance of effective teamwork and collaborative education. Educational approaches utilising simulations have gained prominence, particularly in addressing the challenges of interprofessional primary care. Notably, simulations facilitate team learning, enhancing team management and confidence, which ultimately leads to improved performance in real-life scenarios. They also contribute to patient safety by providing comprehensive training and creating a safe environment for professionals to practice and refine their skills without risking real patient harm. Moreover, simulations promote psychological safety, allowing healthcare workers to manage stress effectively and prepare for critical situations. Ethical considerations are met through simulation-based education, ensuring patient confidentiality, and creating a standardised and just learning environment for all students. Simulations contribute to promoting equity in medical education by providing equal access to high-quality training opportunities for all healthcare professionals. In conclusion, successful IPC implementation requires a comprehensive approach that includes interprofessional education and the integration of simulations as an essential component of the curriculum at all levels of healthcare education. This approach fosters effective communication, teamwork, and confidence among primary care teams, ultimately leading to improved patient care and outcomes.

[Quality Development in Psychiatric Care: A Standardized Treatment Process for the Medical Therapeutic Services of UPK Basel]

OBJECTIVE

Within the framework of a quality development project, the aim of this study was to examine the existing, heterogeneous structures and processes and content of various specialised therapies offered by the Medical Therapeutic Services (MTD) at the University Psychiatric Clinics Basel (UPK), and the methods and documentation procedures, for internal and external evidence, in order to create transparency, and to standardise them where possible and thus to increase their efficiency and effectiveness.

METHODS

The current-state analysis included a literature review of efficacy studies, guidelines, assessments and indications for the therapies. In addition, performance and personnel indicators of the MTD were systematically determined. The target definition was carried out by means of an iterative project procedure. In a working group, contents of the current-state analysis were compiled in open and exploratory procedures (brainstorming, mind mapping), analyzed in subsequent discussions, and used for developing criteria, evaluations, mapping of process flows and structural specifications.

RESULTS

The project resulted in a comprehensive revision of the range of therapies, core concepts of the services and a sharpening of the indications. In addition, an overall process for the MTD was defined, checklists and sample job descriptions were developed, new functions were introduced (responsible for professional training) and a fixed allocation of staff to all departments was established. With the introduction of the ICF, a uniform basis was created with regard to diagnostics, intervention planning and documentation.

CONCLUSION

This practical report shows how evidence-based care can be implemented from the perspective of medical therapeutic services with regard to inpatient psychiatric treatment, what effects are hoped for as a result and what challenges are associated with it. The project for quality assurance through standardisation offers clarity and and transparency for all professional groups in the treatment process, which enables patients to receive more effective and individualised treatment, especially through improved indications and diagnostics.

Perceptions of interprofessional collaborative practice in South Africa: A systematic review

Background

Interprofessional education (IPE) and interprofessional collaborative practice (IPCP) were developed to address the health needs of communities through collaborative practice across healthcare disciplines. The impact of IPE on IPCP and clinical service delivery in South Africa is not evident, possibly because of the lack of IPCP experiences among healthcare professionals.

Aim

International literature reports facilitators and barriers of IPCP implementation, but there was a need to filter the evidence to identify literature from the South African context regarding the perceptions of healthcare workers' perceived barriers and facilitators of IPCP.

Setting

South African literature.

Methods

A systematic review was conducted to synthesise evidence from articles published between January 2017 and December 2021. Only qualitative studies targeting health professionals in South Africa who had been exposed to IPCP were included. Consistent with Preferred Reporting Items for Systematic reviews and Meta-Analysis, a multi-database search yielded 424 articles, which were screened for relevance and appraised for quality using the Critical Appraisal Skills Programme (CASP) tool. A thematic synthesis of the findings was conducted by applying ethical principles.

Results

Synthesis of barriers and enablers for IPCP implementation in the South African context included key aspects of healthcare systems, management and team leadership.

Conclusion

The integration of IPCP into clinical practice in South Africa is still limited as healthcare professionals operate in silos.

Contribution

Recommendations of this study include greater integration of services combined with competent management and visionary leadership, together with the incorporation of IPE into undergraduate professional training programmes.

Experiences of an interprofessional follow-up program in primary care practice

BACKGROUND

An integrative cooperation of different healthcare professional is a key component for high quality health services. With an aging population and many with long-term conditions, more health tasks and follow-up care are being transferred to primary care and locally where people live. Interprofessional collaboration among providers of different professional designations will be of increasing importance to optimizing primary care capacity in years to come. There is a call for further exploration of models of interprofessional collaboration that might be applicable in Norwegian primary care. The aim of this study was to explore experiences of interprofessional collaboration between primary care physicians and nurses working in primary care by applying an intervention for people with type 2 diabetes. Specifically, this study was designed to strengthen and gain deeper insight into interprofessional collaboration between primary care physicians and nurses in primary care settings.

METHODS

We applied Interpretive Description as a research strategy. The participants within this study were primary care physicians and nurses from four different primary care practices in the western and eastern parts of Norway. We used semi-structured telephone interviews for collecting the data between January and September 2021.

RESULTS

The analysis revealed two key features of the primary care physicians and the nurses experience with interprofessional collaboration in primary care practices. The first involved managing the influence of discrepancies in their expectations of IPC and the second involved becoming aware of the competence they developed that allowed for better complementarity consultation.

CONCLUSIONS

This study indicates that interprofessional collaboration in primary care practice requires that primary care physicians and nurses clarify their expectations and, in turn, determine how flexible they can become in changing their usual primary care practices. Moreover, findings reveal that nurses and primary care physicians had discrepancies in expectations of how interprofessional collaboration should be carried out in primary care practice. However, both the nurses and primary care physicians appreciated the blending of complementary competencies and skills that facilitated a more collaborative care practice. They experienced that this interprofessional collaboration represented an essential quality improvement in the primary care services.

TRIAL REGISTRATION

The trial is registered 03/09/2019 in ClinicalTrials.gov (ID: NCT04076384).

Developing criteria for a profession to be considered as profession of allied health in Malaysia: a qualitative study from the Malaysian perspective

BACKGROUND

The Malaysian Allied Health Profession Act (Act 774) regulates the practice of allied health practitioners in Malaysia, with two described professions viz. allied health profession (AHP) and profession of allied health (PAH). While AHPs have been clearly identified by the law, comprehensive implementation of the act requires development of specific criteria in defining any profession as PAH in the Malaysian context. Hence, the research aims to explore and identify the criteria for defining such professions for healthcare policy direction in Malaysia.

METHODS

This research utilised two methods of qualitative research (document review and focus group discussions (FGDs) involving 25 participants from four stakeholders (higher education providers, employers, associations and regulatory bodies). Both deductive and inductive thematic content analysis were used to explore, develop and define emergent codes, examined along with existing knowledge on the subject matter.

RESULTS

Sixteen codes emerged from the FGDs, with risk of harm, set of competency and skills, formal qualification, defined scope of practice, relevant training and professional working within the healthcare team being the six most frequent codes. The frequencies for these six codes were 62, 46, 40, 37, 36 and 18, correspondingly. The risk of harm towards patients was directly or indirectly involved with patient handling and also relates to the potential harms that may implicate the practitioners themselves in performing their responsibilities as the important criterion highlighted in the present research, followed by set of competency and skills.

CONCLUSIONS

For defining the PAH in Malaysia, the emerged criteria appear interrelated and co-exist in milieu, especially for the risk of harm and set of competency and skills, with no single criterion that can define PAH fully. Hence, the integration of all the empirically identified criteria must be considered to adequately define the PAH. As such, the findings must be duly considered by policymakers in performing suitable consolidation of healthcare governance to formulate the appropriate regulations and policies for promoting the enhanced framework of allied health practitioners in Malaysia.

The Impact of Advance Care Planning on Healthcare Professionals' Well-being: A Systematic Review

CONTEXT

Advance care planning (ACP) improves care for patients with chronic illnesses and reduces family stress. However, the impact of ACP interventions on healthcare professionals' well-being remains unknown.

OBJECTIVE

To systematically review the literature evaluating the impact of ACP interventions on healthcare professionals' well-being.

METHODS

We followed the Joanna Briggs Institute methodology for systematic reviews and registered the protocol in PROSPERO (CRD42022346354). We included primary studies in all languages that assessed the well-being of healthcare professionals in ACP interventions. We excluded any studies on ACP in psychiatric care and in palliative care that did not address goals of care. Searches were conducted on April 4, 2022, and March 6, 2023 in Embase, CINAHL, Web of Science, and PubMed. We used the Mixed Methods Appraisal Tool for quality analysis. We present results as a narrative synthesis because of their heterogeneity.

RESULTS

We included 21 articles published in English between 1997 and 2021 with 17 published after 2019. All were conducted in high-income countries, and they involved a total of 1278 participants. Three reported an interprofessional intervention and two included patient partners. Studies had significant methodological flaws but most reported that ACP had a possible positive impact on healthcare professionals' well-being.

CONCLUSION

This review is the first to explore the impact of ACP interventions on healthcare professionals' well-being. ACP interventions appear to have a positive impact, but high-quality studies are scarce. Further research is needed, particularly using more rigorous and systematic methods to implement interventions and report results.

The psychiatric-mental health nurse practitioner as coordinating practitioner in the Netherlands: A multiple case study

BACKGROUND

Psychiatric-mental health nurse practitioners (PMHNPs) in the Netherlands have been allowed to perform the role of coordinating practitioner (CP) since 2018. This role is reserved for mental health care specialists who are trained and qualified at the master's degree level. Earlier studies have not addressed how PMHNPs perform that role and what mechanisms and contextual factors determine their performance. This understanding could help optimize their performance in this role and promote effective deployment of PMHNPs in mental health care.

PURPOSE

To understand how PMHNPs perform this role and what mechanisms and contextual factors underlie that performance.

METHODOLOGY

A multiple case study involving PMHNPs who work in various settings as CPs. Data were collected and analyzed using the realistic evaluation approach.

RESULTS

We identified four mechanisms related to the performance of PMHNPs in the role of CP: (1) autonomous performance; (2) unique expertise; (3) accessibility, availability, and professional involvement; and (4) additional roles. The extent to which these mechanisms are present is largely determined by organizational factors, team factors, and individual factors.

CONCLUSIONS

Psychiatric-mental health nurse practitioners are seeking to identify and interpret the role of CP. This study helps to elucidate the mechanism of role performance by PMHNPs and what they should focus on to deliver effective and patient-centered mental health care.

IMPLICATIONS

Policymakers, health care professionals, and educators should consider the mechanisms and contextual factors to facilitate and support PMHNPs' employment and training in the role of CP.

[Interprofessional collaboration of general practitioners and nurses in primary care: A qualitative study]

Interprofessional collaboration of general practitioners and nurses in primary care: A qualitative study Abstract. Background: There is a need to strengthen interprofessional collaboration of general practitioners and home care nurses in the primary care of people with chronic diseases and long-term care needs. Aim: This study investigated a) how general practitioners and nurses in Germany perceive their collaboration in primary care and b) which development perspectives of collaboration exist from their point of view. Methods: Expert interviews were conducted with seven general practitioners and eight home care nurses. The data were analysed using thematic-structured qualitative content analysis. Results: The interviewees from both professional groups report that their collaboration is hindered by poor mutual accessibility. At the same time, they emphasise their appreciation of the professional exchange with the other professional group. Nevertheless, the perceptions of the professional competence of home care nurses differ. To improve their cooperation, the interviewees recommend the establishment of interprofessional meetings and cooperation in spatial proximity for regular professional exchange. They expect this to lead to a joint development of trust and competence and to an expansion of the area of responsibility of home care nurses in primary care. Conclusions: Binding communication structures, cooperation in spatial proximity and an expansion of the area of responsibility of home care nurses offer high potential for strengthening primary care in Germany.

Barriers and enablers to implementing interprofessional primary care teams: a narrative review of the literature using the consolidated framework for implementation research

BACKGROUND

Interprofessional primary care teams have been introduced across Canada to improve access (e.g., a regular primary care provider, timely access to care when needed) to and quality of primary care. However, the quality and speed of team implementation has not kept pace with increasing access issues. The aim of this research was to use an implementation framework to categorize and describe barriers and enablers to team implementation in primary care.

METHODS

A narrative review that prioritized systematic reviews and evidence syntheses was conducted. A search using pre-defined terms was conducted using Ovid MEDLINE, and potentially relevant grey literature was identified through ad hoc Google searches and hand searching of health organization websites. The Consolidated Framework for Implementation Research (CFIR) was used to categorize barriers and enablers into five domains: (1) Features of Team Implementation; (2) Government, Health Authorities and Health Organizations; (3) Characteristics of the Team; (4) Characteristics of Team Members; and (5) Process of Implementation.

RESULTS

Data were extracted from 19 of 435 articles that met inclusion/exclusion criteria. Most barriers and enablers were categorized into two domains of the CFIR: Characteristics of the Team and Government, Health Authorities, and Health Organizations. Key themes identified within the Characteristics of the Team domain were team-leadership, including designating a manager responsible for day-to-day activities and facilitating collaboration; clear governance structures, and technology supports and tools that facilitate information sharing and communication. Key themes within the Government, Health Authorities, and Health Organizations domain were professional remuneration plans, regulatory policy, and interprofessional education. Other key themes identified in the Features of Team Implementation included the importance of good data and research on the status of teams, as well as sufficient and stable funding models. Positive perspectives, flexibility, and feeling supported were identified in the Characteristics of Team Members domain. Within the Process of Implementation domain, shared leadership and human resources planning were discussed.

CONCLUSIONS

Barriers and enablers to implementing interprofessional primary care teams using the CFIR were identified, which enables stakeholders and teams to tailor implementation of teams at the local level to impact the accessibility and quality of primary care.

Building and maintaining interprofessional collaborative practice in eyecare: Learnings from the Queensland Paediatric Optometry Alignment Program

PURPOSE

The Queensland Children's Hospital Paediatric Optometry Alignment Program commenced with a pilot phase to assess its feasibility, effectiveness and acceptability. This study identified the barriers that hinder effective interprofessional collaboration and the facilitators that contribute to its success, and assessed changes in optometrists' satisfaction since the pilot phase of the collaborative care programme.

METHODS

Qualitative deductive and inductive content analysis was applied to open-ended free-text survey responses collected in 2018 from the optometrists involved in the Program's pilot phase. The responses were coded using the Theoretical Domains Framework (TDF) to categorise barriers and facilitators into key themes. Key behavioural determinants were mapped to the COM-B (Capability, Opportunity, Motivation-Behaviour) elements of the Behaviour Change Wheel model to identify intervention strategies. Intervention recommendations were derived from behaviour change mapping and compared with programme quality improvement initiatives. A cross-sectional explanatory survey informed by the TDF was conducted within the current 2023 cohort, and a longitudinal comparative analysis was carried out using data from the 2018 survey.

RESULTS

Among the 97 surveys distributed in 2018, 44 respondents participated; from this group, 38 individuals contributed a total of 200 free-text responses. Facilitators (240 comments) outnumbered barriers (65 comments). Key facilitators were accessible and timely care, professional development, confidence and positive outcome beliefs. Barriers included communication, information handover, credibility, relationships and skill gaps. Optometrists actively engaged in the programme in 2023 reported heightened satisfaction with their involvement, increased confidence and greater engagement in paediatric eyecare delivery. However, challenges in clinical information transfer persist.

CONCLUSION

The interprofessional collaborative model of paediatric eyecare has contributed efficiencies within the health system by building paediatric care capacity in the community, fostering professional credibility and promoting interdisciplinary trust. Insights gained should prove valuable for other paediatric eyecare services exploring hospital-to-community care models.

Interprofessional Therapeutic Drug Monitoring of Carbapenems Improves ICU Care and Guideline Adherence in Acute-on-Chronic Liver Failure

(1) Background: Acute-on-chronic liver failure (ACLF) is a severe, rapidly progressing disease in patients with liver cirrhosis. Meropenem is crucial for treating severe infections. Therapeutic drug monitoring (TDM) offers an effective means to control drug dosages, especially vital for bactericidal antibiotics like meropenem. We aimed to assess the outcomes of implementing TDM for meropenem using an innovative interprofessional approach in ACLF patients on a medical intensive care unit (ICU). (2) Methods: The retrospective study was conducted on a medical ICU. The outcomes of an interprofessional approach comprising physicians, hospital pharmacists, and staff nurses to TDM for meropenem in critically ill patients with ACLF were examined in 25 patients. Meropenem was administered continuously via an infusion pump after the application of an initial loading dose. TDM was performed weekly using high-performance liquid chromatography (HPLC). Meropenem serum levels, implementation of the recommendations of the interprofessional team, and meropenem consumption were analyzed. (3) Results: Initial TDM for meropenem showed a mean meropenem serum concentration of 20.9 ± 9.6 mg/L in the 25 analyzed patients. Of note, in the initial TDM, only 16.0% of the patients had meropenem serum concentrations within the respective target range, while 84.0% exceeded this range. Follow-up TDM showed serum concentrations of 15.2 ± 5.7 mg/L (9.0-24.6) in Week 2 and 11.9 ± 2.3 mg/L (10.2-13.5) in Week 3. In Week 2, 41.7% of the patients had meropenem serum concentrations that were within the respective target range, while 58.3% of the patients were above this range. In Week 3, 50% of the analyzed serum concentrations of meropenem were within the targeted range, and 50% were above the range. In total, 100% of the advice given by the interprofessional team regarding meropenem dosing or a change in antibiotic therapy was implemented. During the intervention period, the meropenem application density was 37.9 recommended daily doses (RDD)/100 patient days (PD), compared to 42.1 RDD/100 PD in the control period, representing a 10.0% decrease. (4) Conclusions: Our interprofessional approach to TDM significantly reduced meropenem dosing, with all the team's recommendations being implemented. This method not only improved patient safety but also considerably decreased the application density of meropenem.

Facilitators and barriers to communication in rehabilitation services across healthcare levels: a qualitative case study in a Norwegian context

BACKGROUND

People with problems in functioning following severe injury or illness often need multiple and combined interventions in their rehabilitation processes. In these processes, communication and collaboration between the involved healthcare professionals are essential. Despite efforts in research and policy, communication across hospital and primary healthcare services and within the primary healthcare settings remains challenging. In one region of Norway, a new intermunicipal rehabilitation team has been established to supplement the traditional services and context-bound research is needed to gain insight into the complexity of the new communication structures that are developing. The aim of this study was to explore facilitators and barriers to communication to inform further improvement of the services.

METHODS

A qualitative case study design was used to explore the exchange of patient information in the rehabilitation processes of four patients. Data collection included participant observations in communication situations and an exploration of the electronic patient records of these four patients. Reflexive thematic analysis was used to analyse the empirical data.

RESULTS

The complex rehabilitation processes explored involved a large number of actors across healthcare organisational levels. Lacking a common culture for rehabilitation, poor access to written information and unclear responsibility for sharing information across organisational boundaries seemed to represent barriers to interprofessional communication. Joint meetings, the use of common rehabilitation tools and language and establishing informal communication channels served to facilitate communication.

CONCLUSION

The intermunicipal team collaborating across different organisational levels added complexity to communication structures, but also facilitated interprofessional communication by promoting formal and informal ways of exchanging information. However, the intricate organisational divisions of healthcare provision in the Norwegian context represent boundaries which can be difficult to overcome. Therefore, cross-organisational coordination services should be developed.

Models of shared care for the management of psychotic disorder after first diagnosis in Ontario

OBJECTIVE

To describe the provision of care for young people following first diagnosis of psychotic disorder.

DESIGN

Retrospective cohort study using health administrative data.

SETTING

Ontario.

PARTICIPANTS

People aged 14 to 35 years with a first diagnosis of nonaffective psychotic disorder in Ontario between 2005 and 2015 (N=39,449).

MAIN OUTCOME MEASURES

Models of care, defined by psychosis-related service contacts with primary care physicians and psychiatrists during the 2 years after first diagnosis of psychotic disorder.

RESULTS

During the 2-year follow-up period, 29% of the cohort received only primary care, 30% received only psychiatric care, and 32% received both primary and psychiatric care (shared care). Among the shared care group, 72% received care predominantly from psychiatrists, 20% received care predominantly from primary care physicians, and 9% received approximately equal care from psychiatry and primary care. Variation in patient and physician characteristics was observed across the different models of care.

CONCLUSION

One in 3 young people with psychotic disorder received shared care during the 2-year period after first diagnosis. The findings highlight opportunities for increasing collaboration between primary care physicians and psychiatrists to enhance the quality of care for those with early psychosis.

Supporting professionals to implement integrated, person-centered care for people with chronic conditions: the TARGET pilot study

OBJECTIVE

The TARGET program for integrated, person-centered care for people with chronic conditions offers primary care (PC) professionals a set of tools and trainings to actively engage in population segmentation and person-centered needs assessments (PCNAs). A pilot study was conducted to gain insight into the program's feasibility and acceptability, and identify preconditions for successful implementation.

DESIGN AND SETTING

Seven Dutch PC practices participated in a half-year pilot study starting in August 2020. We performed a review of the population segmentation tool, observed four training sessions and 15 PCNAs, and interviewed 15 professionals and 12 patients.

RESULTS

Regarding feasibility and acceptability, we found that the tools and trainings provided professionals with skills to use the segmentation tool and take a more coaching role in the well-appreciated PCNAs. Concerning implementation preconditions, we found that team commitment and network connections need improvement, although work pleasure increased and professionals generally wanted the program to continue.

CONCLUSIONS

While the content of the TARGET program is supported by its users, the implementation process, for instance team commitment to the program, needs more attention in future upscaling efforts.

Interprofessional collaboration in primary care: what effect on patient health? A systematic literature review

BACKGROUND

In a period of change in the organization of primary care, Interprofessional Collaboration (IPC) is presented as one of the solutions to health issues. Although the number of inter-professional interventions grounded in primary care increases in all developed countries, evidence on the effects of these collaborations on patient-centred outcomes is patchy. The objective of our study was to assess the effects of IPC grounded in the primary care setting on patient-centred outcomes.

METHODS

We conducted a systematic literature review using the PubMed, Embase, PsycINFO and CINAHL databases from 01/01/1995 to 01/03/2021, according to the PRISMA guidelines. Studies reporting the effects of IPC in primary care on patient health outcomes were included. The quality of the studies was assessed using the revised Downs and Black checklist.

RESULTS

Sixty-five articles concerning 61 interventions were analysed. A total of 43 studies were prospective and randomized. Studies were classified into 3 main categories as follows: 1) studies with patients at cardiovascular risk (28 studies)-including diabetes (18 studies) and arterial hypertension (5 studies); 2) studies including elderly and/or polypathological patients (18 studies); and 3) patients with symptoms of mental or physical disorders (15 studies). The number of included patients varied greatly (from 50 to 312,377). The proportion of studies that reported a positive effect of IPC on patient-centred outcomes was as follows: 23 out of the 28 studies including patients at cardiovascular risk, 8 out of the 18 studies of elderly or polypathological patients, and 11 out of the 12 studies of patients with mental or physical disorders.

CONCLUSIONS

Evidence suggests that IPC is effective in the management of patients at cardiovascular risk. In elderly or polypathological patients and in patients with mental or physical disorders, the number of studies remains very limited, and the results are heterogeneous. Researchers should be encouraged to perform studies based on comparative designs: it would increase evidence on the positive effect and benefits of IPC on patient variables.

A revisited version of the disputatio for pharmacological training: An educational study

OBJECTIVE

The disputatio is a pedagogical method existing since the Middle-Ages where students had to debate about a question asked by a "master", exercising their thinking and oratory skills. To move away from traditional vertical teaching methods, the disputatio has been revived by pharmacologists. Thus, for almost three successive years, several groups of young French pharmacologists and therapists confronted their ideas concerning a medical question at a therapeutic impasse. The aim here is to describe the initial feedback received from participants.

METHODS

An anonymous questionnaire was sent by email in May 2023 to the participants of the different disputationes of 2019, 2022 and 2023. Participants were asked about different aspects of their feelings before, during and after the disputatio, using the 5-point Likert scale. They were also asked to describe the event in 2 to 5 words. Finally, participants could leave their comments in a free-field and were asked to give an overall satisfaction score out of 10.

RESULTS

Out of the 39 participants, 27 (69.2%) answered the questionnaire. Although 50% of respondents reported a feeling of anxiety before participating, most enjoyed the expert talks as well as working with people they did not know. Besides, over 66% reported having underestimated the skills they could share with colleagues from different backgrounds. Over 55% of respondents reported progress in methodology, and over 83% in pharmacology and/or therapeutics. Participants reported an overall satisfaction score of 8.6/10, and the main terms used to describe the event were "sharing", "enriching" and "meeting".

CONCLUSION

The disputatio is an innovative training program whose pedagogical and human values were underlined by most of the participants. Beyond pharmacology and therapeutics, the principle of disputatio could be extended to other disciplines, spanning the centuries.

Associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians: a national representative sample

BACKGROUND

Physicians' work is often stressful. The digitalization of healthcare aims to streamline work, but not all physicians have experienced its realization. We examined associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians. The moderating role of the length of work experience was investigated for these associations.

METHODS

We used representative survey data on Finnish physicians' (N = 4271) experiences of digitalization from 2021. The independent variables included perceptions on statements about work transformations aligned with digitalization goals, and the extent that information systems and teleconsultations were utilized. Stress related to information systems (SRIS), time pressure, and psychological stress were the dependent variables. We analyzed the associations using multivariable linear and logistic regressions.

RESULTS

Respondents had a mean SRIS score of 3.5 and a mean time pressure score of 3.7 on a scale of 1-5. Psychological stress was experienced by 60%. Perceptions associated with higher SRIS comprised disagreements with statements asserting that digitalization accelerates clinical encounters (b = .23 [95% CI: .16-.30]), facilitates access to patient information (b = .15 [.07-.23]), and supports decision-making (b = .11 [.05-.18]). Disagreement with accelerated clinical encounters (b = .12 [.04-.20]), and agreements with patients' more active role in care (b = .11 [.04-.19]) and interprofessional collaboration (b = .10 [.02-.18]) were opinions associated with greater time pressure. Disagreeing with supported decision-making (OR = 1.26 [1.06-1.48]) and agreeing with patients' active role (OR = 1.19 [1.02-1.40]) were associated with greater psychological stress. However, perceiving improvements in the pace of clinical encounters and access to patient information appeared to alleviate job strain. Additionally, extensive digital work was consistently linked to higher strain. Those respondents who held teleconsultations frequently and had less than 6 years of work experience reported the greatest levels of time pressure.

CONCLUSIONS

Physicians seem to be strained by frequent teleconsultations and work that does not meet the goals of digitalization. Improving physicians' satisfaction with digitalization through training specific to the stage of career and system development can be crucial for their well-being. Schedules for digital tasks should be planned and allocated to prevent strain related to achieving the digitalization goals.

Discovering risk patterns in people with affective disorder-induced disabilities associated with their healthcare delay

BACKGROUND

People with affective disorder-induced disabilities (ADIDs) often experience complex needs that delay their healthcare. Discovering hidden patterns in these people for real-world use of health services is essential to improve healthcare delivery.

METHODS

A cross-sectional study population (2501 adults with ADIDs) was obtained from the Australian national representative survey of disability in 2015, including 21 demographic, health and social characteristics and healthcare delay information in general practice, specialist and hospital services. The Self-Organising Map Network was used to identify hidden risk patterns associated with healthcare delay and investigate potential predictors of class memberships by means of simple visualisations.

RESULTS

While experiencing disability avoidance showed across different healthcare delays, labour force appeared not to have any influence. Approximately 30% delayed their healthcare to general practice services; these were young, single females in great need of psychosocial support and aids for personal activities. Those who delayed their healthcare commonly presented a lack of social connections and a need for contact with family or friends not living in the same household.

CONCLUSIONS

The pattern evidence provides an avenue to further develop integrated care strategies with better targeting of people with ADIDs, considering social participation challenges facing them, to improve health service utilisation.

"I don't see the whole picture of their health": a critical ethnography of constraints to interprofessional collaboration in end-of-life conversations in primary care

CONTEXT

Interprofessional collaboration is recommended in caring for frail older adults in primary care, yet little is known about how interprofessional teams approach end-of-life (EOL) conversations with these patients.

OBJECTIVE

To understand the factors shaping nurses' and allied health clinicians' involvement, or lack of involvement in EOL conversations in the primary care of frail older adults.

METHODS/SETTING

A critical ethnography of a large interprofessional urban Family Health Team in Ontario, Canada. Data production included observations of clinicians in their day-to-day activities excluding direct patient care; one-to-one semi-structured interviews with clinicians; and document review. Analysis involved coding data using an interprofessional collaboration framework as well as an analysis of the normative logics influencing practice.

PARTICIPANTS

Interprofessional clinicians (n = 20) who cared for mildly to severely frail patients (Clinical Frailty Scale) at the Family Health Team.

RESULTS

Findings suggest primary care nurses and allied health clinicians have the knowledge, skills, and inclination to engage frail older adults in EOL conversations. However, the culture of the clinic prioritizes biomedical care, and normalizes nurses and allied health clinicians providing episodic task-based care, which limits the possibility for these clinicians' engagement in EOL conversations. The barriers to nurses' and allied health clinicians' involvement in EOL conversations are rooted in neoliberal-biomedical ideologies that shapes the way primary care is governed and practiced.

CONCLUSIONS

Our findings help to explain why taking an individual-level approach to addressing the challenge of delayed or avoided EOL conversations, is unlikely to result in practice change. Instead, primary care teams can work to critique and redevelop quality indicators and funding models in ways that promote meaningful interprofessional practice that recognize the expertise of nursing and allied health clinicians in providing high quality primary care to frail older patients, including EOL conversations.

Healthcare professionals and pregnant and post-natal women's perceptions of interprofessional collaboration in a maternity care facility: A qualitative study from Botswana

OBJECTIVE

To explore the perceptions of healthcare professionals and pregnant and post-natal women regarding interprofessional collaboration in a maternity care setting in Botswana, a low-to-middle-income country in Sub-Sahara Africa.

DESIGN

A descriptive qualitative design using in-depth interviews with forty participants, including healthcare professionals and women in maternity wards. Data were transcribed and thematically analysed.

SETTING

Antenatal, delivery and post-natal maternity wards in a referral hospital that provides basic and specialist care in Botswana.

PARTICIPANTS

We interviewed 13 pregnant and post-natal women and 27 healthcare professionals in the maternity care wards.

FINDINGS

Participants perceived several interrelated factors that influenced the delivery of interprofessional collaborative care. Interpersonal factors such as poor communication, disrespectful behaviours and inadequate teamwork practices prevented interprofessional collaboration. Other barriers to collaboration included lack of understanding of each other's roles and responsibilities, ineffective coordination of resources, hierarchical power struggles and poor collaborative leadership.

KEY CONCLUSIONS

Effective interprofessional collaboration remains elusive in this maternity care setting. Healthcare systems in low-to-middle-income countries may benefit from interventions for healthcare professionals to learn and practice interprofessional collaborative care.

Factors Influencing the Implementation of Interprofessional Collaborative Practice in Teaching Hospital Setting: A Mixed-Method Study

Introduction

Health service in the current global era requires health workers to provide qualified service, this also applies to teaching hospitals. Collaboration between several professions involved (doctors, nurses, and pharmacists) in an interprofessional collaboration system is needed in providing such service. Factors influencing interprofessional collaboration is unique to each health care center. The purpose of this study was to determine the factors that influence the implementation of interprofessional collaborative practice among health workers in Dr. Wahidin Sudirohusodo General Hospital.

Methods

This is a mixed-method explanatory sequential design study, utilizing quantitative and qualitative data. Quantitative data were obtained from the Indonesian-validated Collaborative Practice Assessment Tool (CPAT) questionnaire. CPAT in Indonesian language has been validated in previous research by Findyartini, et al. in 2019 in Indonesian population. The questionnaire was internally validated with the study population with Cronbach alpha of 0.812. All health care professionals meeting the selection criteria were enrolled for the quantitative study. The questionnaire was given to 152 health professionals enrolled as research subjects, including nutritionists, nurses, doctors, pharmacists, and medical rehabilitation specialists serving in Dr. Wahidin Sudirohusodo Hospital for >3 years. Five participants with highest and lowest CPAT score from each profession were invited for FGD entitled "Exploring factors involved in interprofessional collaboration in Wahidin Sudirohusodo General Hospital" and divided into 2 groups according to the CPAT score. The score from each subscale in the questionnaire is obtained for each research subjects and the median is compared among each profession group using Kruskall-Wallis test significant to a p value of <0.05. Qualitative data as recording transcript is acquired from FGD; the transcript was then coded into several general themes by 2 of the authors and was discussed using thematic analysis using MaxQDA.

Results

Research subjects were predominantly women (121 respondents (79.6%)), 32.9% were nurses, and most of the healthcare professional (81 subjects (55.1%)) have been working for >10 years. Among profession groups (Doctors, Pharmacists, Medical Rehabilitation Specialists, Nutritionists, and Nurses), difference in score distribution (p<0.05) was found in relationships among team members (40 vs 39 vs 39.5 vs 36 vs 42, p<0.001), barriers to team collaboration (10 vs 18.5 vs 14 vs 18 vs 10, p<0.001), and leadership (20 vs 20 vs 23 vs 20 vs 20, p 0.045). From the FGD, factors influencing interpersonal collaborative practice are leadership factors, system/rule factors, and personal factors.

Conclusion

This research showed that personal, system/organizational and leadership factors influence the implementation of interprofessional collaboration. In this study, there is a different perception regarding relationships among team members, barriers to team collaboration, and leadership among profession group.

Social workers' formal and informal leadership in interprofessional primary care teams in Ontario, Canada

The development of interprofessional teams in primary care presents opportunities for social workers to take on new leadership positions. This study seeks to describe how social workers engaged in leadership roles in primary care during the COVID-19 pandemic. A cross-sectional on-line survey was disseminated to primary care social workers across Ontario, Canada, with a total of 159 respondents. Most respondents engaged in informal leadership roles and showcased a range of leadership skills promoting team collaboration and consultations, along with adapting to virtual care transitions. Findings suggest there needs to be intentional cultivation of social work leaders through supportive environments and training. Social workers in primary care have leadership capacity and are providing leadership to their primary care teams through formal and informal means. The leadership potential of social workers in primary care teams, however, is being underutilized and can be further developed.

Conceptualizing Interprofessional Digital Communication and Collaboration in Health Care: Protocol for a Scoping Review

BACKGROUND

Effective communication and collaboration among health professionals are essential prerequisites for patient-centered care. However, interprofessional teams require suitable structures and tools to efficiently use their professional competencies in the service of high-quality care appropriate to the patient's life situation. In this context, digital tools potentially enhance interprofessional communication and collaboration and lead to an organizationally, socially, and ecologically sustainable health care system. However, there is a lack of studies systematically assessing the critical factors for successfully implementing tools for digitally supported interprofessional communication and collaboration in the health care setting. Furthermore, an operationalization of this concept is missing.

OBJECTIVE

The aim of the proposed scoping review is to (1) identify factors influencing the development, implementation, and adoption processes of digital tools for interprofessional communication in the health care sector and (2) analyze and synthesize the (implicit) definition, dimensions, and concepts of digitally supported communication and collaboration among health care professionals in the health care setting. Studies focusing on digital communication and collaboration practices among health care professionals, including medical doctors and qualified medical assistants, in any health care setting will be included in this review.

METHODS

To address these objectives, an in-depth analysis of heterogeneous studies is needed, which is best achieved through a scoping review. Within this proposed scoping review, which adheres to the Joanna Briggs Institute methodology, 5 databases (SCOPUS, CINAHL, PubMed, Embase, and PsycInfo) will be searched for studies assessing digital communication and collaboration among various health care professionals in different health care settings. Studies focusing on health care providers or patient interaction through digital tools and non-peer-reviewed studies will be excluded.

RESULTS

Key characteristics of the studies included will be summarized through descriptive analysis, using diagrams and tables. We will synthesize and map the data and conduct a qualitative in-depth thematic analysis of definitions and dimensions of interprofessional digital communication and collaboration among health care and nursing professionals.

CONCLUSIONS

Results from this scoping review may help in establishing digitally supported collaborations between various stakeholders in the health care setting and successfully implementing new forms of interprofessional communication and collaboration. This could facilitate the transition to better coordinated care and encourage the development of digital frameworks.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/45179.

Influencing factors of interprofessional collaboration in multifactorial fall prevention interventions: a qualitative systematic review

BACKGROUND

With the ageing population worldwide, falls are becoming a severe and growing health problem. Interprofessional multifactorial fall prevention interventions (FPIs) have effectively prevented falls in community-dwelling older adults. However, the implementation of FPIs often fails due to a lack of interprofessional collaboration. Therefore, gaining insight into the influencing factors of interprofessional collaboration in multifactorial FPI's for older adults living in the community is essential. Consequently, our aim was to provide an overview of factors influencing interprofessional collaboration in multifactorial FPIs for community-dwelling older adults.

METHODS

This qualitative systematic literature research was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Pubmed, CINAHL, and Embase electronic databases have been systematically searched for eligible articles, with a qualitative design. The quality was appraised using the Checklist for Qualitative Research by the Joann Briggs Institute. The findings were inductively synthesized using a meta-aggregative approach. Confidence in the synthesized findings was established using the ConQual methodology.

RESULTS

Five articles were included. Analysis of the included studies resulted in 31 influencing factors for interprofessional collaboration, which were labelled as findings. These findings were summarized in ten categories and combined into five synthesized findings. Results showed that communication, role clarity, information sharing, organization, and interprofessional aim influence interprofessional collaboration in multifactorial FPIs.

CONCLUSIONS

This review provides a comprehensive summary of findings on interprofessional collaboration, specifically in the context of multifactorial FPIs. Knowledge in this area is considerably relevant given the multifactorial nature of falls, which demands an integrated, multidomain approach, including both health and social care. The results can be utilized as a fundament for developing effective implementation strategies aiming to improve interprofessional collaboration between health and social care professionals working in multifactorial FPIs in the community.

How do former medical and nursing undergraduates describe their learning on an interprofessional training Ward 12-18 months later? - A retrospective qualitative analysis

BACKGROUND

Interprofessional training wards (IPTWs) seem to deliver good results in terms of development of interprofessional competencies. However, evidence of long-term effects of these training wards on learners' competency development is lacking and little is known about retrospective evaluation of IPTWs. Therefore, this study aimed to explore the retrospective evaluation of competency development and interprofessional collaboration of former undergraduates 12 or more months after a placement on an IPTW.

METHODS

Eight follow-up interviews were conducted with four nursing and four medical professionals 12-18 months after they had finished a placement on an ITPW throughout their vocational training. Interviews were translated verbatim and analysed deductively and inductively based on qualitative content analysis.

RESULTS

The qualitative content analyses deductively identified two main categories regarding the research question, namely the uniqueness of the programme and interprofessional competencies developed by the Interprofessional Education Collaborative. Sub categories were identified inductively, representing the perceived competency development and the learning opportunities on the IPTW as compared to other clinical placements throughout vocational training and in transition to practice. Interviewees seemed to have developed competencies that are important for interprofessional collaboration such as communication, roles and responsibilities, as well as competencies in patient care and management. Considered beneficial for learning were the opportunity to work self-responsibly and the interprofessional collaboration on the IPTW, both of which were neither possible in almost any other placement nor in transition to practice.

CONCLUSION

Findings show that IPTWs can be sufficient in competency development and role clarification and are perceived positively by learners, but structures in clinical practice can impede sustaining competency development and efficient interprofessional collaboration.

Prerequisites, barriers and opportunities in care for Q-fever patients: a Delphi study among healthcare workers

BACKGROUND

Q-fever is a zoonotic disease that can lead to illness, disability and death. This study aimed to provide insight into the perspectives of healthcare workers (HCWs) on prerequisites, barriers and opportunities in care for Q-fever patients.

METHODS

A two-round online Delphi study was conducted among 94 Dutch HCWs involved in care for Q-fever patients. The questionnaires contained questions on prerequisites for high quality, barriers and facilitators in care, knowledge of Q-fever, and optimization of care. For multiple choice, ranking and Likert scale questions, frequencies were reported, while for rating and numerical questions, the median and interquartile range (IQR) were reported.

RESULTS

The panel rated the care for Q-fever patients at a median score of 6/10 (IQR = 2). Sufficient knowledge of Q-fever among HCWs (36%), financial compensation of care (30%) and recognition of the disease by HCWs (26%) were considered the most important prerequisites for high quality care. A lack of knowledge was identified as the most important barrier (76%) and continuing medical education as the primary method for improving HCWs' knowledge (76%). HCWs rated their own knowledge at a median score of 8/10 (IQR = 1) and the general knowledge of other HCWs at a 5/10 (IQR = 2). According to HCWs, a median of eight healthcare providers (IQR = 4) should be involved in the care for Q-fever fatigue syndrome (QFS) and a median of seven (IQR = 5) in chronic Q-fever care.

CONCLUSIONS

Ten years after the Dutch Q-fever epidemic, HCWs indicate that the long-term care for Q-fever patients leaves much room for improvement. Facilitation of reported prerequisites for high quality care, improved knowledge among HCWs, clearly defined roles and responsibilities, and guidance on how to support patients could possibly improve quality of care. These prerequisites may also improve care for patients with persisting symptoms due to other infectious diseases, such as COVID-19.

Interprofessional collaboration within general practice teams following the inclusion of non-dispensing pharmacists

BACKGROUND

Pharmacists have been included in general practice teams to provide non-dispensing services in the Australian Capital Territory (ACT) since 2016. Interprofessional collaboration and team effectiveness are key considerations in providing high-quality patient care. These concepts have not been well studied following the inclusion of a pharmacist in general practice teams.

METHODS

A mixed methods study was conducted to explore collaboration between pharmacists and health professionals in eight general practices in the ACT, where pharmacists were included in their teams. A validated survey instrument was adapted and utilised to assess the changes in interprofessional collaboration over time following the addition of a pharmacist. Another validated survey was utilised to explore team effectiveness at the end of the study. Semi-structured interviews, with a thematic analysis, were conducted with a purposeful sample of general practice staff members to understand the factors influencing the development of interprofessional collaboration.

RESULTS

In total, 56 and 41 participants completed the baseline and follow-up survey, including 26 who completed both surveys to assess the change in collaboration over time. Interprofessional collaboration scores were high initially and did not change over time. Team effectiveness was also high at the end of the study. Twenty-one individuals participated in interviews, which generated four main interrelated themes related to interprofessional collaboration: professional working relationships, trust, commitment to collaboration, and barriers to collaboration. Trust was integral to professional working relationships and commitment to collaboration. The barriers to collaboration included not having a role description for pharmacists, inadequate interest to initiate working relationships, lack of dedicated time for interaction, lack of utilisation, and poor awareness of pharmacist-led activities in general practice.

CONCLUSION

Interprofessional collaboration was initially high and not influenced by the addition of a pharmacist, perhaps reflecting the inherent nature of the general practices willing to include a pharmacist within their team. Introducing a clear job description for pharmacists, and dedicating time to interact with pharmacists, could be beneficial in improving trust and professional working relationships and enhancing collaboration between the pharmacists and other general practice team members.

Piloting a Telehealth Interprofessional Diabetes Clinic During Covid 19: Continuing patient care and student learning

Due to the COVID-19 pandemic, a team of faculty from dietetics, nursing, pharmacy, and social work converted a long-standing effective Interprofessional Team Care Clinic (IPTCC) at two outpatient health centers to a telehealth clinic during 2020 and 2021. Preliminary data suggest that this pilot telehealth clinic for patients with diabetes or prediabetes was effective in significantly lowering average hemoglobin A1C levels and increasing students' perceived interprofessional skills. This article describes the pilot telehealth interprofessional model used to educate students and provide patient care, outlines preliminary data about its effectiveness, and makes recommendations for future research and practice.