Creating Collaborative Practices: Implementation of Interprofessional Experiences in a Family Medicine Clerkship Karen R. Sando, Pharm.D., BCACP, CDE Clinical Assistant Professor College of Pharmacy Robert L. Hatch, M.D., M.P.H. Professor Director, H James Free Center for Primary Care Education and Innovation College of Medicine University of Florida Gainesville, FL

Disclosures Presenters have no relevant financial relationships or commercial interests in conjunction with this presentation

Session Objectives At the end of this session, attendees will be able to: 1.Identify themes from the literature describing methods for promoting collaborative practice 2.Describe the design of a structured interprofessional experience for medicine and pharmacy in a family medicine clerkship 3.Discuss benefits and challenges of implementation of the new experience 4.Discuss methods for incorporating additional health disciplines into clerkships 5.Apply the interprofessional experience design to their own institution’s curriculum 6.Discuss potential benefits and barriers to implementation at their own institution 7.Share best practices and develop new ideas for interprofessional experiences in the clerkship setting

What is Collaborative Practice? “When multiple health workers from different professional backgrounds work together with patients, families, caregivers, and communities to deliver the highest quality of care” World Health Organization (WHO). (2010). Framework for action on interprofessional education and collaborative practice. Geneva: World Health Organization

In other words…

Evidence for Collaborative Practice 1999 IOM To Err is Human 2001 IOM Crossing the Quality Chasm 2010 Patient Protection and Affordable Care Act 2011 Core Competencies for Interprofessional Collaborative Practice 2012 IOM Core Principles & Values of Effective Team Based Care 2013 American College of Physicians publish position paper supporting clinical care teams

ApproachDescriptionExample CourseworkCourses on team-based skills or applying collaborative techniques to health issues (e.g. chronic disease care or patient safety) University of Pittsburgh’s “Basic Science of Care” mandatory intro course on interdisciplinary collaboration Areas of Concentration or Alternative Tracks Elective academic concentrations or topic specific tracks that enroll students across disciplines UCSF “Pathways to Discovery Program” Univ of Connecticut “Urban Service Track” Student InitiativesStudent-created and led organizations and competitions that reach across disciplines MUSC – teams develop team-based care plans Univ of Minnesota CLARION competition Interprofessional Education Centers Centers that serve as focal point for coordinated efforts and research across an institution Center for Interprofessional Education and Research at St. Louis University Campus-wide Quality Initiatives The integration of interprofessional education with broader quality improvement initiatives MUSC “Creating Collaborative Care” Program “e-Cases”Online, electronic case studies for students from multiple disciplines to practice team- based approaches to diagnosis and treatment McGill University – students develop discipline specific care plan which is then merged by faculty into single plan for review/discussion

Collaboration at the University of Florida MedicinePharmacyDentistry Public Health and Health Professions Nursing Veterinary Medicine

Creating a New Collaborative Experience One week Interprofessional Experience, including clinical experience with: –Pharmacists/Pharmacy Students –Dentists/Dental Students (Oral Surgery Clinic) –Podiatrist –Multidisciplinary QI Team (Hospital initiative) –PT? –Chiropractor?

Examples of Pharmacy and Medicine Collaboration at UF Pharmacy services within Community Health and Family Medicine clinics –Anticoagulation monitoring –Diabetes clinic –Smoking cessation clinic Internal Medicine Medication Therapy Management Clinic (I-MTM) Non-tuberculosis Medication Therapy Management Clinic (NTM MTM) Transitions of Care Student-run Equal Access Clinics

Gaps in Health Professional Education 2013 Cochrane Review on IPE– more quality studies needed to assess effect on patient/health outcomes Validated tools needed to assess interprofessional education and teamwork skills Majority of interventions focus on early didactic training –Experiential training is often unstructured Barriers and challenges –Culture –Administration –Curricula –Funding Schuetz B, Mann E, Everett W. Health Affairs (8):

Implementation of Interprofessional Experiences in Pharmacy and Medicine Clerkships Who 3 rd year medical students on family medicine clerkship 4 th year pharmacy student on ambulatory care APPE What Medical students scheduled ½ day per week with pharmacy clinic to participate in patient care and observe roles & responsibilities of pharmacists Pharmacy students scheduled ½ day per week with clinic physicians in order to participate in patient care and observe physicians during routine visits Evaluation Baseline (before intervention) – Attitudes Towards Health Care Teams (ATHCT) survey and qualitative statements regarding opinions of collaborative practice and team based care Follow-up (after intervention) – repeat ATHCT and qualitative feedback on experience

Experience Learning Objectives 1. Discuss the prevailing shift in the U.S. health care delivery model from independent clinicians toward team-based care. 2. Describe the role and responsibilities of physicians, clinical pharmacists, and other health professionals within a clinical care team. 3. Discuss ideal characteristics of a highly-functioning clinical team in a family medicine clinic.

Attitudes Towards Health Care Teams (ATHCT) Evaluates attitudes in 2 domains: –Quality of care/Process Perception of quality of care delivered by health care teams and quality of teamwork to accomplish this –Physician centrality Attitudes towards physician authority in teams and their control over information about patients 21 items rated on a 6-point Likert Scale (1=strongly disagree, 6-strongly agree) Heinemann GD et al. Development of an Attitudes toward Health Care Teams Scale. Eval Health Prof :123

Additional questions 6-point Likert scale (1=strongly disagree, 6=strongly agree) The interprofessional experiences I have had in my curriculum helped me understand the definition of collaborative practice The interprofessional experiences I have had in my curriculum helped me understand the value of collaborative practice When I graduate I plan on using a team-based approach to patient care I understand the training requirements of a physician practicing in a family medicine practice I understand the training requirements of a pharmacist in a family medicine clinic I have seen positive examples of team-based care in my clerkships or rotations I have seen negative examples of team-based care in my clerkships or rotations I have the skills required to function effectively in an interprofessional team I understand how a physician and pharmacist collaborate to develop a care plan for a patient A physician-pharmacist collaboration can improve patient outcomes

Early Pilot Results (n=7)

Notable Qualitative Statements Themes –Most students enjoyed interprofessional experiences during experiential training (e.g. rounding, shadowing, P&T committee) –Did not enjoy group projects, TBL sessions, or when team members disagreed –Most want to observe social workers, pharmacists, nursing –Most cited specific positive examples of team- based care on clerkships/rotations

Barriers and Challenges

Audience participation What activities have been implemented at your institutions to foster collaborative practice in the clerkship setting? What barriers and challenges have you experienced?

Thank you for your attention! Karen R. Sando, Pharm.D., BCACP, CDE Robert L. Hatch, M.D., M.P.H.