Sustainable Implementation of Interprofessional Education Using an Adoption Model Framework

Interprofessional education (IPE) is a growing focus for educators in health professional academic programs. Recommendations to successfully implement IPE are emerging in the literature, but there remains a dearth of evidence informing the bigger challenges of sustainability and scalability. Transformation to interprofessional education for collaborative person-centred practice (IECPCP) is complex and requires “harmonization of motivations” within and between academia, governments, healthcare delivery sectors, and consumers. The main lesson learned at the University of Manitoba was the value of using a formal implementation framework to guide its work. This framework identifies key factors that must be addressed at the micro, meso, and macro levels and emphasizes that interventions occurring only at any single level will likely not lead to sustainable change. This paper describes lessons learned when using the framework and offers recommendations to support other institutions in their efforts to enable the roll out and integration of IECPCP.  L’éducation interprofessionnelle (EIP) fait l’objet d’un intérêt grandissant parmi les enseignants des programmes universitaires pour professionnels de la santé. Bien que des recommandations pour une mise en œuvre réussie de l’EIP fassent leur apparition dans les publications académiques, il existe encore un manque de données probantes sur les défis plus importants que représentent la durabilité et la modularité. La transformation de l’EIP vers une pratique interprofessionnelle et collaborative axée sur la personne (PPCAP) est complexe et nécessite l’« harmonisation des motivations » entre différents secteurs (universitaire, gouvernemental, des soins de la santé et de la consommation), et au sein de ceux-ci. La principale leçon qu’a reçue l’Université du Manitoba a été la nécessité d’employer une structure formelle de mise en place pour diriger ses travaux. Cette structure identifie les caractéristiques essentielles que l’on doit aborder à petite, moyenne et grande échelle et souligne l’importance de ces interventions à plusieurs niveaux, sans quoi le changement n’est pas durable. Cet article décrit les leçons apprises avec la structure et propose des recommandations afin d’aider d’autres institutions dans leurs efforts de création et d’intégration de la PPCAP

“Working the system”: The experience of being a primary care patient

Health care providers and system administrators are in the midst of a paradigm shift; moving from paternalism toward an egalitarian approach. For patient centred care to occur, health care providers must prioritize patient needs; provide information regarding treatments while taking patient preferences and expectations into account. While there is literature regarding patient centredness, there is less information from the patient perspective about the experience of being a patient and the influence on behaviour. Using phenomenological research methods and the theory of planned behaviour as a theoretical framework, this study addressed the questions, a) what is the essence of being a primary health care patient, and b) what influence do beliefs, attitudes, and experience have on people’s behaviour as a patient? Nineteen individuals participated. Seven shared elements of being a primary health care patient were identified and contributed to the development of a composite vignette. The patient experience was a socially oriented, governed and reinforced cyclical process. Patients described themselves as actively engaged in their health care – “working the system” to get what they needed, when they needed it. Patients changed their beliefs, attitudes and behaviour as a result of experiences with their physicians, and their perceived success or failure in acquiring the best health care possible. Being a patient was not a single, observable behaviour, but rather a set of contextually dependent strategies patients’ directed at the specific goal of getting the best healthcare possible. The theory of planned behaviour was unsuitable for understanding patients’ beliefs, attitudes and behaviour

Quantifying Interprofessional Learning In Health Professional Programs: The University of Manitoba Experience

Internationally, a growing number of interprofessional education (IPE) offices are being established within academic institutions. However, few are applying educational improvement methodologies to evaluate and improve the interprofessional (IP) learning opportunities offered. The University of Manitoba IPE Initiative was established in 2008 to facilitate the development of IP learning opportunities for pre-licensure learners. The research question for this secondary analysis was: what, if any, changes in the number and attributes of IP learning opportunities occurred in the academic year 2008–2009 compared to 2011–2012? The Points for Interprofessional Scoring (PIPES) tool was used to quantify the attributes of each IP learning opportunity. Most notably in 2012, eight (73%) of 11 IP learning opportunities achieved the highest PIPES score (> 55), compared to only four (36%) in 2009. The concept of the PIPES score is introduced as an educational improvement strategy and a potential predictor of achieving the desired educational outcome: collaborative competence.   Les institutions académiques du monde accueillent de plus en plus de bureaux d’éducation interprofessionnelle. Par contre, très peu mettent en pratique des méthodologies d’amélioration de l’enseignement pour évaluer et améliorer ces occasions d’apprentissage interprofessionnelles (OAI). En 2008, afin de faciliter la création de telles occasions pour les apprenants avant l’obtention de leur permis de pratique, l’Université du Manitoba lançait l’initiative d’éducation interprofessionnelle. Elle voulait savoir s’il existait des différences dans les nombres et les attributs des OAI entre les années 2008-2009 et 2011-2012. Les attributs de chaque OAI ont été quantifiés en utilisant une version adaptée de l’outil « Points for Interprofessional Scoring » ou (PIPEs). En 2012 notamment, 73 % d’occasions d’apprentissage interprofessionnel (soit 8 sur 11) avait atteint le score PIPES (>55) le plus élevé, comparativement à 36 % en 2009. Le concept du score « PIPES » est présenté comme une stratégie d’amélioration du secteur de l’éducation et comme un potentiel de prédiction du résultat éducationnel désiré : une compétence collaborative

Through Teaching Are We Learning? Learning Through Teaching: Facilitating Interprofessional Education Experiences

Background: Despite a growing recognition of the value of collaborative patientcentred practice (CPCP) there is a lack of evidence identifying key elements and approaches to an effective interprofessional (IP) education intervention for clinical team members. The present study was conducted to address the paucity of rigorous mixed methods research to address the question: Does clinician team facilitation and mentorship of senior pre-licensure learners participating in IP clinical placements improve team members' attitudes, knowledge, skills, and perceived behaviours in CPCP?Methods: Based on the assumption that Geriatric Day Hospital clinical teams were already highly collaborative, educational experiences for clinical team members were not designed a priori. Rather, the educational experience was grounded in Mezirow's transformative learning theory, proposing that learning is a process of becoming aware of one's assumptions and revising these assumptions based on critical self-reflection. The option to participate in structured observation and feedback by an external observer using the Team Observation Scale provided important and unique opportunities for team reflection. Using the Controlled Before and After (CBA) design, the Attitudes Toward Health Care Teams Scale (ATHCTS), Team Skills Scale (TSS), and Knowledge Questionnaire were administered pre- and post-clinical placements to intervention and control groups. Data were analyzed by descriptive, bivariate, and repeated measures ANOVA. Qualitative data (evaluation and self-reflective forms) were analyzed using content analysis techniques.Results: Eleven IP clinical placements at 3 sites occurred between January 2007 and March 2008 (intervention N = 48; control N = 7). There was no significant change over time between intervention and control groups for the ATHCTS Quality of Care or Physician Centrality subscale scores, the TSS scores, or the Knowledge scores. Qualitative results suggested that participants were more aware of IP teaming, reflective of their own practice, and reported making changes in their own practice and mentorship of students as a result of their engagement in the study.Conclusions: This study demonstrated the viability of using structured observation and feedback processes as a reflective learning exercise. Further research is required to help identify key approaches and elements to an effective IPE intervention in clinical practice

Cultural Adaptation of a Compliance Questionnaire for Patients with Rheumatoid Arthritis to a Korean Version

Background/Aims: The Compliance Questionnaire-Rheumatology (CQR) is a validated scale to evaluate patient compliance for anti-rheumatic medications. We developed a Korean version of the CQR (KCQR) and confirmed its reliability and validity. Methods: We prepared the KCQR by translating and back-translating the original CQR with modifications to adapt it to Korean culture. Fifty Korean patients with rheumatoid arthritis (RA) were enrolled in this study. The test-retest reliability of the KCQR was evaluated at a 2-week interval using the intraclass correlation coefficient (ICC). The validity of the KCQR was assessed by identifying associations between KCQR scores and patient compliance, measured using pharmacy refill data. Results: The reliability of the KCQR was adequate, with an ICC of 0.71 for test-retest reliability. With respect to validity, the summed score of the weighted KCQR showed a significant correlation with pharmacy refill data (r2 = 0.57) on multiple regression analysis. Conclusions: Our results indicate that the KCQR is a reliable, valid instrument to evaluate compliance of Korean patients for RA medications

See It – Do It – Learn It: Learning Interprofessional Collaboration in the Clinical Context

Background: The primary goal of the Interprofessional Education in Geriatric Care (IEGC) project was to design, deliver, and evaluate interprofessional (IP) clinical placements for pre-licensure learners in geriatric day hospitals.Methods: Project evaluation was guided by the modified Kirkpatrick's Model of Educational Outcomes. Using a controlled before-after design, the Attitudes Toward Health Care Teams Scale (ATHCTS), Team Skills Scale (TSS), and Knowledge Questionnaire were administered to intervention and control learners pre-, post-, and 6 months post clinical placements. Quantitative data were analyzed using descriptive and multivariate statistics. Qualitative data collected through journals and questionnaires were analyzed using content analysis.Findings: Eleven IP clinical placements occurred at 3 test sites involving 32 intervention and 11 control learner participants. There was no significant change, over time, in the ATHCTS quality of care and physician centrality scores for the combined group (i.e., intervention and control) and between intervention and control groups. Time effects were noted in the quality of care scores for the intervention group after controlling for prior IPE (p = .031). The Knowledge scores were higher for the intervention group compared with controls over time (p = .004). Both intervention and control groups demonstrated significant improvements in their TSS scores over time (p = .000), although there was no significant difference in the magnitude of the change between groups (p = .112). Themes observed through qualitative analysis of learners' journals and post-program reflective questionnaires supported the quantitative findings.Conclusions: The IEGC experience was valuable to senior pre-licensure learners in helping them understand collaborative patient-centred practice and team skills. Future research should strive for larger sample sizes through multi-site projects to allow for comparisons within and between clinical sites

Drug–drug Interactions in Hospitalized Cardiac Patients

Drug–drug interactions (DDIs) are defined as two or more drugs interacting in such a manner that the effectiveness or toxicity of one or more drugs is altered. DDI in patients receiving multidrug therapy is a major concern. The aim of the present study was to assess the incidence and risk factors of DDIs in patients admitted in cardiology unit of a teaching hospital. A prospective, observational study was carried out for a period of 3 months (April–July 2009). During the study period, a total of 600 prescriptions were analyzed and it was found that 88 patients had at least one DDI. The percentage of DDIs was higher in females compared to males (56.82% vs. 43.18%). DDIs were observed more in the age group of 60 years and above (57.96). Patients with more than 10 prescribed drugs developed DDIs more frequently [58 (65.91%)]. Heparin [55 (62.25%)] and aspirin [42 (47.72%)] were the most common drugs responsible for DDIs. Bleeding was the commonest clinical consequence [76 (86.63%)] found in this study population. On assessment of severity of DDIs, majority of the cases were classified as moderate in severity (61.36%). Aging, female gender and increase in concurrent medications were found to be associated with increased DDIs. Patients having these risk factors can be actively monitored during their stay in the cardiology department to identify DDIs

Adherence with statins in a real-life setting is better when associated cardiovascular risk factors increase: a cohort study

<p>Abstract</p> <p>Background</p> <p>While the factors for poor adherence for treatment with statins have been highlighted, the impact of their combination on adherence is not clear.</p> <p>Aims</p> <p>To estimate adherence for statins and whether it differs according to the number of cardiovascular risk factors.</p> <p>Methods</p> <p>A cohort study was conducted using data from the main French national health insurance system reimbursement database. Newly treated patients with statins between September 1 and December 31, 2004 were included. Patients were followed up 15 months. The cohort was split into three groups according to their number of additional cardiovascular risk factors that included age and gender, diabetes mellitus and cardiovascular disease (using co-medications as a <it>proxy</it>). Adherence was assessed for each group by using four parameters: <it>(i) </it>proportion of days covered by statins, <it>(ii) </it>regularity of the treatment over time, <it>(iii) </it>persistence, and <it>(iv) </it>the refill delay.</p> <p>Results</p> <p>16,397 newly treated patients were identified. Of these statin users, 21.7% did not have additional cardiovascular risk factors. Thirty-one percent had two cardiovascular risk factors and 47% had at least three risk factors. All the parameters showed a sub-optimal adherence whatever the group: days covered ranged from 56% to 72%, regularity ranged from 23% to 33% and persistence ranged from 44% to 59%, but adherence was better for those with a higher number of cardiovascular risk factors.</p> <p>Conclusions</p> <p>The results confirm that long-term drug treatments are a difficult challenge, particularly in patients at lower risk and invite to the development of therapeutic education.</p