University of Missouri-Kansas City The Importance of Cultivating Community Engagement in the Development of Interprofessional Clinical Practice Teams.

University of Missouri-Kansas City

The Importance of Cultivating Community Engagement in the Development of

Interprofessional Clinical Practice Teams

Objectives:

1. Discuss the pre-grant writing steps needed to develop IPCP teams in community clinics.

2. Discuss the essential recommended steps to develop effective pre-clinical training for faculty, students and clinic providers.

3. Discuss outcomes from the project to date related to team identity and team trainings.

Project Team:Susan Kimble, DNP, RN, ANP-BC, MSN Project Director

Steven C. Stoner, PharmD, BCPP School of Pharmacy Lead

Michael D. McCunniff, DDS, MS School of Dentistry Lead

Margaret Brommelsiek, PhD Director of IPE

Heather J. Gotham, PhD Project Evaluator

Jeremy Kirchoff, MD Hope Family Care Center

Sudeep Ross, MD SURHC Medical Director

Martha Lofgreen, MSN School of Nursing Faculty

Renee Endicott, DNP School of Nursing Clinical Faculty

School of Pharmacy Faculty Preceptors:

Andrew Bzowyckyj, PharmD; Maqual Graham, PharmD; Cameron Lindsey, PharmD, BC-ADM, CDE, BCACP; Valerie Ruehter, PharmD, BCPP; Mark T. Sawkin, PharmD, AAHIVP; Stephanie Schauner, PharmD, BCPS

Background:• Community engagement and team building

• Essential to develop trust, allies, relationships to improve health outcomes, address challenges

• Interprofessional Collaborative Practice (IPCP)

• Extending classroom IPE experiences at two primary care urban community clinics (Community based and Federally funded health center)

Background:• Advanced practice nursing• Pharm D• Dental students • Clinic Providers (MD and NP)

• Students gain advanced knowledge and skills caring for vulnerable and medically underserved patients

Background:• Collaboration with two urban clinics

• Multiple meetings to discuss and pre-plan project

• Larger organization (FQHC) undergoing leadership changes• Providers MDs and NPs

• Smaller private organization seeking to expand access to care beyond one primary care physician

• Relationship building prior to application for funding

Methods:• Utilizing recommendations from Principles of Community

Engagement (NIH, 2011)

• Project’s faculty team met with leaders from both clinics

• Develop innovative opportunities for incorporating IPCP teams

• Project intent focused on student interprofessional education (IPE)

• Evidence of need for IPE training including the clinical staff

Methods: • Create an executive oversight committee

• Ensure project success and communication• Pre-rotation team training • Student participants and providers

• Four IPE competencies: • roles/ responsibilities• values/ethics• interprofessional communication• teams/teamwork

• emphasis on working with vulnerable populations

Methods: • Evaluation tools utilized:

• Student surveys (pre/post rotations)• Student and provider focus groups• Patient satisfaction surveys• Student reflective journaling on clinical

experiences• Clinical case study presentations by student

groups

• Clinical huddles to determine patient care

Methods: • Readiness for Interprofessional Learning Scale – pre-

clinical

• Interprofessional Collaboration Scale – post-clinical

• Attitudes Toward Health Care Teams Scale – pre/post

• Team Skills Scale – pre/post

• Cultural Competence Assessment – pre/post

• Focus groups - post

• n

Results:

• Outcomes included team informed care

decisions

• Students gained new perspectives regarding

vulnerable patient populations

• Improved team communication skills

Results:• Students realized each profession serves as a

change agent• Instilled confidence in challenging situations• Overcoming preconceived assumptions• Establish open and honest communication• Integral to team identify and socialization• Impacted both health delivery and desired patient

outcomes

Preliminary results: After 6 semester rotations:

• 16 NP students

• 56 Pharmacy students

• 16 Dental students

• 56 females, 32 males

• 84.5% White, 8.3% Black, 10.7% Asian, 4.8% American Indian

• 28 years old (mean, 22-49 range)

• 4.10 days (mean, 0-37 range) on rotation

Results – patients seen – Clinic 1Small, young community-based health center:

• NP students, Pharmacy students, Dental students

• 451 patients seen (67% female; 0 - 65+ yrs)

26

66

215

Race/Ethnicity

WhiteBlackHispanicAsianOther

Most Frequent Diagnoses26 – Essential Hypertension24 – General medical exam20 – Health supervision infant/child16 – Diabetes Mellitus11 – General Symptoms10 – Other Disorders, Joint10 – Other Disorder, Back10 – Abdominal/pelvic symptoms

Results – patients seen – Clinic 2Large, urban federally-qualified healthcare center:

• NP students, Pharmacy students

• 790 patients seen (66% female; 0 - 65+ yrs)

613

45

10

26

Race/Ethnicity

WhiteBlackHispanicAsianOther

Most Frequent Diagnoses75 – Health supervision infant/child64 -- Vaccination54 – General medical exam53 – Essential Hypertension32 – Normal pregnancy25 – Special investigation/exam20 – Secondary Diabetes Mellitus20 – Disorders of lipoid metabolism

Discussion:• Students gained new perspectives regarding caring

for vulnerable patient populations

• Increased interactions across professions (nursing, dentistry, pharmacy and medicine) with patient populations illustrating the importance of working within IPCP teams

• Students felt better prepared to become a future leaders in the healthcare arena

Discussion:• Students made informed care decisions regarding

vulnerable patient populations • Students reported an increase in cultural

competency across several areas:attitudesexperiencesbehaviors

Student FeedbackConducted focus groups after each rotation:

• “I mean, even just stepping outside from us, we have learned so much from each other. I just think it can only be beneficial to everybody so…”

• “I would say the more students that have the opportunity to do it, the more learning will take place because I learn every single time I’m with the pharmacy students. So it would be nice to be available to more students.”

• “We don’t get the assessment aspect that you guys do. You know we are not making diagnoses, we are taking diagnosis and making the treatment plan. So having you guys say well this is what I think and putting that together I think is beneficial. Together we all make a pretty good team. And most people realize that.”

Student FeedbackConducted focus groups after each rotation:

• “It would be really nice in an ideal world in the actual practice setting, like at a family practice office, you have your providers that are seeing patients and then you actually have a pharmacist right there. Not to dispense drugs, but as a resource to talk about drug to drug interactions and second line and third line, and this isn’t working according to the guidelines. It would be ideal to have a pharmacist on staff just as a reference or a resource to the providers.”

• I was anticipating that it would be a positive experience, and it was. I mean after I’m finished here, I would welcome the opportunity to work in an environment like that again.”

Student FeedbackConducted focus groups after each rotation:

• “I would say safety is the greatest asset…I mean again the more providers, more eyes on the same case, people are going to find things that maybe one provider might have missed.”

• “I enjoyed working with other student groups and just seeing what each person brings to the table. I really didn’t have an understanding before, but now I do.”

• And I think too, showing that as we are working together that it’s like a cooperative collaboration. I think that makes the patient feel more at ease. It’s not someone’s trying to talk over someone else in the room. We are all working together to provide our own expertise to give the patient the best well-rounded care experience.

Student FeedbackConducted focus groups after each rotation:

• “I think it’s really interesting because you go into it knowing that we each have these expertise so to speak, and then, seeing how flawlessly they work together in that environment and how the questions would flow into one another, the counseling points back and forth, the education points back and forth. We really do work together as a team and we’re designed that way. And it’s nice to know that when you actually get put in that situation, it works.”

• “I honestly wish it could happen in the real world that it could be like that and then have the dental office right here and the pharmacy right here and they get it all in one area. It only makes sense. So seeing that and then being frustrated with the way things are and how it is broken is, is saddening. I wish it was a medical utopia out there.”

Results:

• Team informed care decisions

• Acquiring new perspectives regarding vulnerable patient populations

• Improved communication through interactions with team members

• Opportunities to serve as change agents within own professions

CommonCompetencies

IndividualProfessional

Competencies: Complementary IP

CollaborativeCompetencies

Results:

• Instilled confidence in challenging situations

• Overcoming preconceived assumptions

• Established a platform for open and honest communication

• Integral to team socialization

• Impacted health delivery and desired outcomes

Conclusions:

• Project in final year

• Outcomes guiding IPE curriculum development

• Challenges regarding scheduling

• Smaller teams advantageous for cohesiveness

• Stay in same clinical teams-semester minimum

• Flexibility paramount

• Clinics desire to continue collaboration

Recommendations:• Create community partnerships in advance• Data supports importance of developing team

identity early in the process• IPE training for all members of the team• Executive committee leadership essential to project

success• Work through issues of clinical schedules, staffing,

and measuring identified outcomes• Routine feedback and communication between the

students, faculty, and clinical preceptors essential

This project was made possible through a grant from the Health Resources and Services Administration

Nurse Education, Practice, Quality, and Retention: Interprofessional Collaborative Practice

Questions?

[email protected]

[email protected]

[email protected]@umkc.edu

References:Heinemann, G.D., Schmitt, M.H., Farrell, M.P., & Brallier, S.A. (1999). Attitudes Toward Health Care Teams Scale. Development of an Attitude Toward Health Care Teams Scale. Evaluation & Health Professions, 22(1), 123-42.

Hepburn, K., Tsukuda, R., & Fasser, C. (1998). Team skills scale, 1996. In Siegler, K., Hyer, T., Fulmer, T., & Mezey, M. (Eds.), Geriatric interdisciplinary team training. (pp. 264-5). New York: Springer.

IOM. (2003). Unequal treatment: Confronting racial and ethnic disparities in healthcare. Washington, DC: National Academies Press.

IOM . (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.

Kenaszchuk, C.,Reeves, S., Nicholas, D., & Zwarenstein, M. (2010). Validity and reliability of a multiple-group measurement scale for interprofessional collaboration. BMC Health Services Research, 10:83.

References:McFadyen, A.K., Webster, V.S. & MacLaren, W.M. (2006). The test-retest reliability of a revised version of the Readiness for Interprofessional Learning Scale (RIPLS). Journal of Interprofessional Care, 20, 633-639.

National Institutes of Health. (2011). Principles of community engagement. U.S. Department of Health and Human Services. Government Printing Office, NIH Pub. No. 11-7782.

National Prevention Council. (2011). National prevention strategy. Washington, D.C.: Office of the Surgeon General, US Department of Health and Human Services

Parsell, G. & Bligh, J. (1999). Readiness for Interprofessional Learning Scale: The development of a questionnaire to assess the readiness for health care students for interprofessional learning (RIPLS). Medical Education, 33, 95-100.

Schim, S. M., Doorenbos, A. Z., Benkert, R., & Miller, J. (2004). Development of a cultural competence assessment instrument. Journal of Nursing Measurement, 11(1), 29-40.U.S. Department of Health and Human Services. Healthy People 2020. Rockville, MD: Office of Disease Prevention and Health Promotion, ODPHP Pub. No. B0132; 2010.

Wagner, E. (1998). Community practice: Learning, meaning and identity. Cambridge: Cambridge University Press.