InterProfessional Collaboration for Patient Centred Care: evidence for supporting adherence

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Inter-Professional Collaboration for Patient
Centred Care evidence for supporting adherence

• Kathleen MacMillan, RN, PhD
• Dean, School of Health Sciences
• Humber Institute of Technology Advanced
  Learning
• Toronto, ON

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Inter-Professional Collaboration (IPC)

• Background
• Over 40 years of discussion on the concept of
  health care team in Canada (Herbert, 2005)
• Despite efforts to co-educate and opportunities
  to practice together in shared spaces, IPC
  remains elusive
• Interdisciplinary does not equal IPC artificial
  division of knowledge silo-like division of
  scopes of practice that does not meet needs of
  clients or professionals (DAmour Oandasan,
  2005)

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IPC Defined

• Goal system of cooperating interdependent
  equals (Herbert 2005)
• Response to fragmented health care practices and
  increasing complexity of client needs
• Involves continuous interaction information
  sharing to solve issues, with optimized patient
  participation, within a cohesive practice
• Largely unrealized

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Changing Models

• Old model of Interdisciplinary Practice

Pharm
Nurse
MD
MSW
Physio
Client
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New Metaphor for IPC

• Evidence for Impact on Adherence

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Patient-Centred
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Adherence IPC

• Evidence of better patient outcomes with NPs
• Patients who receive care from NPs demonstrate
  greater compliance with medication/treatment
  regimens.
• Efficacy and safety is demonstrated in patient
  populations with chronic illness such as
  hypertension, Parkinsons, obesity, depression,
  diabetes, and asthma. Patients with hypertension
  respond better than those cared for by MDs.
  (Mythbusters, Canadian Health Services Research
  Foundation 2000)
• For patients with hypertension , diastolic BP
  rates were lower for the NP group (p .04).
  (Mundinger et al. 2000)

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Adherence IPC

• Statistically significant difference in content
  of talk between NPs and GPs. NP content
  concerned treatments, how to use the treatments,
  discussion of side effects more than GPs. NPs
  recommended a greater number of treatments and
  demonstrated greater concern about the
  acceptability and cost of treatments to patients
  (Seale et al, 2006)
• NPs offer more holistic care and provide more
  information to patients this may be related to
  the longer consultation time and greater
  satisfaction levels with care reported by other
  investigators. (Seale et al. 2006)
• Patients who received care from ACNPs reported
  higher levels of care coordination (p .000)
  participation in care (p .000), counseling (p
  .000) and education (p .000) than patients who
  received care from physician residents. These
  reflect differences in processes of care that
  could influence quality and cost outcomes.(Sidani
  et al. 2006 )

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NPs and IPC

• NPs do not work solo but function within a
  collaborative team (Way Jones 2001)
• Usually physician, NP and pharmacist minimally
  collaborate to provide care
• So outcomes of research likely confounded by
  presence of IPC
• Improved outcomes may be a product of improved
  team functioning and focus on patient plus
  better use of professional knowledge and skills
• system of cooperating interdependent equals 
  (Herbert 2005)

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IPC Synthesis Report, CHSRF

• There is high-quality evidence supporting
  positive outcomes for patients/clients, providers
  and the system in specialized areas such as
  interprofessional collaboration in mental health
  care, and chronic disease prevention and
  management.
• There are findings of cost benefits of
  interprofessional collaboration in some primary
  healthcare settings (for example, decreased
  average provider and patient costs for blood
  pressure control, and lower readmission rates and
  costs for team-managed, home-based
• primary care).
• Although findings in the literature and in
  jurisdictions demonstrate the positive outcomes
  of interprofessional collaboration, they do not
  identify how variation among interprofessional
  collaborative models affect outcomes.
• (Executive Summary, Barrett et al. 2005)

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IPC Synthesis Report, CHSRF

• patients/clients receiving health services
  through an interprofessional collaborative
  approach report different health practices (for
  example, improved self-care, lifestyle and
  preventive service access) compared to
  patients/clients receiving health services from a
  primary healthcare provider working in a
  uni-professional model.
• interprofessional collaborative models can
  provide better health outcomes for
  patients/clients (for example, blood pressure
  control, diabetes control, health status, quality
  of life), when compared to a uni-professional
  model of primary healthcare delivery.
• patient/client-reported benefits of enhanced
  satisfaction, acceptance of treatment and
  improved health outcomes
• (Barrett et al. 2007)
• All suggestive of improved adherence

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Why IPC Now?

• Were in a new place were not on the edge of
  the old place. Were not pushing the envelope
  were in a totally new envelope. So the rules
  have changed. Every fundamental premise of the
  old way of thinking no longer applies.
• Sister Elizabeth Davis Chair, Canadian Health
  Services Research Foundation, 2005

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References

• Barrett J, Curran V, Glynn L, Godwin, M
  (2007).CHSRF Synthesis Interprofessional
  Collaboration and Quality Primary Healthcare.
  www.chsrf.ca
• DAmour D Oandasan I (2005). Interprofessionalit
  y as the field of interprofessional practice and
  interprofessionaleducation An emerging concept.
  J. of Interprofessional Care 19 (Supp 1), 8-20
• Hall, P (2005). Interprofessional teamwork
  Professional cultures as barriers. J. of
  Interprofessional Care 19 (Supp 1), 188-196
• Herbert, CP (2005) Changing the culture
  interprofessional education for collaborative,
  patient-centred practice in Canada. J. of
  Interprofessional Care 19 (Supp 1), 1-4.
• Mundinger MO et al. (2000). Primary care outcomes
  in patients treated by nurse practitioners or
  physicians a randomized trial. JAMA 283(1)
  59-68.
• Mythbusters.2002.www.chsrf.ca
• Seale, C, Anderson, E Kinnersley, P (2006).
  Treatment advice in primary care a comparative
  study of nurse practitioners and general
  practitioners. J of Advanced Nursing, 54(5),
  534-541.
• Sidani, S et al. (2006). Processes of care
  comparisons between nurse practitioners and
  physician residents in acute care. Can J of Nurs
  Leadership 19(1) 69-85.
• Villeneuve M Macdonald J (2006. Toward 2020 
  Visions and Voices for Nursing, Canadian Nurses
  Association, http//www.cna-nurses.ca/CNA/document
  s/pdf/publications/Toward-2020-e.pdf
• Way D, Jones L, Baskerville B Busing N. (2001).
  Primary health care services provided by nurse
  practitioners and family physicians in shared
  practice. Canadian Medical Association Journal,
  165(9), 1210-14.

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IPC The New Place