Implementation of an Interprofessional Medication Therapy Management Experience

Objective. To measure the impact of an interprofessional experience (IPE) in medication therapy management (MTM) on students' attitudes and skills regarding interprofessional collaboration (IPC). Methods. This interprofessional MTM experience spanned three weeks, with health science students (medicine, nursing, nutrition, and pharmacy) meeting once weekly. The IPE facilitated interprofessional student collaboration via small-group sessions to conduct MTM consultations for patients with complex chronic conditions. Student learning and attitudinal changes were evaluated by comparing pre- and post-IPE survey responses and a qualitative summary of the students' clinical recommendations. Efficacy of student groups was measured via patient satisfaction surveys and was reported by frequency of response. Results. Twenty-seven students participated in the program and 22 completed both pre- and post-IPE surveys (81% response rate). The survey included open-ended and Likert-type items assessing students' attitudes and skills regarding the IPE as well as their reactions to the experience. Significant changes were observed for two attitudinal items regarding interprofessional teams: maintaining enthusiasm/interest and responsiveness to patients' emotional and financial needs. Patient-reported satisfaction and students' complex clinical recommendations provided further evidence of student learning. Conclusion. This novel IPE in MTM promoted interprofessional collaboration and education in this unique patient care area. Students' attitudes toward and skills in interprofessional collaboration improved, and the patients who received care reported positive experiences. Many health professions programs face challenges in meeting IPE requirements. The results of our study may provide the impetus for other institutions to develop similar programs to meet this urgent need.This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Descriptive Analysis of Common Functional Limitations Identified by Patients with Shoulder Pain

Context: Recent establishment of G-codes by the US government requires therapists to report function limitations at initial evaluation. Limited information exists specific to the most common limitations in patients with shoulder pain. Objective: To describe the most commonly expressed shoulder limitations with activities and their severity/level of impairment from a patient’s perspective on the initial evaluation. Design: Descriptive. Setting: Patients reporting pain with overhead activity and seeking medical attention from one orthopedic surgeon were recruited as part of a cohort study. Patients: 176 with shoulder superior labral tear from anterior to posterior (SLAP), subacromial impingement, combined SLAP and rotator cuff, and nonspecific (female = 53, age = 41 ± 13 y; male = 123, age = 41 ± 12 y). Interventions: Data were obtained on the initial visit from the Patient-Specific Functional Scale (PSFS) questionnaire. Three researchers extracted meaningful concepts from the PSFS and linked them to the International Classification of Functioning (ICF) categories according to established ICF linking rules. Results: 176 participants yielded 765 meaningful concepts that were linked to the ICF with a 66% agreement between researchers before consensus. There were no differences between diagnoses. Of all patients, 88% reported functional limitations coded into meaningful concepts as represented by 10 ICF codes; 634 (83%) meaningful concepts were linked to the activities and participation domain while 129 (17%) were linked to the body function domain. Only 2 reported functional limitations that were considered nondefinable (nd). The overall average initial impairment score on the PSFS = 4 ± 2.5 out of 10 points. Conclusion: Meaningful concepts from the activities and participation domain were most commonly identified as functional limitations and were more prevalent than limitations from the body function domain. This information helps identify some of the most common limitations in patients with shoulder pain that therapists can use to efficiently document patient functional impairment

Use of Coronary Computed Tomographic Angiography to guide management of patients with coronary disease

Background In a prospective, multicenter, randomized controlled trial, 4,146 patients were randomized to receive standard care or standard care plus coronary computed tomography angiography (CCTA). Objectives The purpose of this study was to explore the consequences of CCTA-assisted diagnosis on invasive coronary angiography, preventive treatments, and clinical outcomes. Methods In post hoc analyses, we assessed changes in invasive coronary angiography, preventive treatments, and clinical outcomes using national electronic health records. Results Despite similar overall rates (409 vs. 401; p = 0.451), invasive angiography was less likely to demonstrate normal coronary arteries (20 vs. 56; hazard ratios [HRs]: 0.39 [95% confidence interval (CI): 0.23 to 0.68]; p < 0.001) but more likely to show obstructive coronary artery disease (283 vs. 230; HR: 1.29 [95% CI: 1.08 to 1.55]; p = 0.005) in those allocated to CCTA. More preventive therapies (283 vs. 74; HR: 4.03 [95% CI: 3.12 to 5.20]; p < 0.001) were initiated after CCTA, with each drug commencing at a median of 48 to 52 days after clinic attendance. From the median time for preventive therapy initiation (50 days), fatal and nonfatal myocardial infarction was halved in patients allocated to CCTA compared with those assigned to standard care (17 vs. 34; HR: 0.50 [95% CI: 0.28 to 0.88]; p = 0.020). Cumulative 6-month costs were slightly higher with CCTA: difference $462 (95$303 to $621). Conclusions In patients with suspected angina due to coronary heart disease, CCTA leads to more appropriate use of invasive angiography and alterations in preventive therapies that were associated with a halving of fatal and non-fatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590