Interprofessional Collaboration and Chronic Disease Prevention



hi we're group 11 and today we will be discussing the role that interprofessional collaboration plays in chronic disease prevention our presentation will explain the concept of interprofessional collaboration through practical examples as well as how interprofessional collaborative teams can better be used to improve chronic disease prevention interprofessional collaboration can be defined as multiple professionals working together as a team to accomplish a common goal to provide care and share decision-making with the patient according to Conway coil in sonnenfeld 2017 Tang Xue Chanin Liao 2017 interprofessional collaboration has been around for decades but has gained more attention and support in the last 20 years according to green and Johnson 2015 it has become more and more necessary as health conditions have increased in complexity and extend beyond the scope of just one professional nurses physicians social workers pharmacists dietitians and physiotherapists are just some of the professionals that may be involved in the care of a patient each profession has their own unique set of skills and knowledge that allows them to perform certain tasks with ease while other professionals excel in different areas according to green and Johnson 2015 this is why it is so important for members of the healthcare team to collaborate across professions with the complexity of patient conditions it is necessary to utilize the shared knowledge of all professions in order to provide the best patient care the national competency framework for interprofessional collaboration includes patient centered care interprofessional communication role clarification team functioning interprofessional conflicts of resolution and collaborative leadership as a domains necessary for achieving effective collaboration according to the Canadian interprofessional health collaborate 2010 before these things are possible however healthcare teams need to break free from the separation of professions known as silos and communicate appro across professions to begin collaboration according to honda-san 2006 chronic diseases are complex and therefore health care teams must utilize the knowledge of various professions through interprofessional collaboration in order to address the root cause is manage and prevent chronic disease according to the national competency framework for interprofessional collaboration there are a few things that need to be in place in order to achieve effective collaboration role clarification is the first domain according to C IH C 2010 this refers to one's understanding of their own responsibilities as well as the responsibilities of the other team members every individual needs to be aware of the task at hand and who is taking care of each one without this established then tests may be unnecessarily performed multiple times or a task might be missed clarifying the roles of each person will ensure that care is provided for the patient in an organized manner team functioning focuses on group dynamics and how the team works with this to achieve effective collaboration it is within this domain that trust respect values goals and relationships are established the team should decide together how are they going to function conflict resolution goes hand-in-hand with team functioning as the team has to decide collectively how they will address conflicts or disagreements that arise the team has to establish norms and values that will assist a system in constructively addressing any issues that arise with a plan in place the team will remain strong even following conflict collaborative leadership is essential in health care there are a number of leadership styles each with their own place in health care an authoritative leader is one who makes decisions for the team and does not encourage member participation according to Mohamed 2015 this is beneficial in an emergency situation when a decision needs to be made quickly however this framework highlights collaborative leadership or the leader is more of a facilitator than an authority this type of leader inspires member participation in order to utilize the collective knowledge within the team it also emphasizes the idea of shared leadership where each member displays leadership qualities whether they are a formal leader or not according to C IH C 2010 each person works together but is ultimately responsible for their own actions patient-centered care and interprofessional communication sir all of the previous domains these aspects of collaboration got every other part by keeping the patient at the center of care the goals and values of the team will reflect what the patient desires additionally effective communication among all team members will ensure that everyone is included and team work is strong according to C IH C 2010 although interprofessional collaboration is important in health care it can be difficult to implement and maintain there are a number of factors that influence the way in which healthcare teams interact with each other and ultimately how they collaborate according to van which in 2019 as previously mentioned each profession has their own set of knowledge and values that come from education as well as observation of professionals in that field as a result there may be a conflict between the expectations of the healthcare team and the expectations of one's own profession the problem here begins all the way back and how these professionals are educated each profession is taught about their own values skills and responsibilities according to Vega and Bernard 2017 in general healthcare professionals are not taught how to interact and collaborate with other professionals in the workplace this is a barrier to collaboration similarily the silos that separate professions encourage independent work among those of the same profession instead of encouraging open dialogue between all members of the healthcare team according to van which in 2019 hierarchies even exist where some professions are viewed as more important or more knowledgeable than others preventing members from fully participating in decision-making this is a barrier to collaboration since the decisions are being left to one or two individuals instead of the entire team beyond this even logistical factors can be a barrier to effective collaboration each individual has their own work schedule and their own tasks outside the healthcare team for one patient this makes it extremely difficult to gather all members at the same time for a face-to-face meeting about the healthcare plan it is factors like these that make effective collaboration difficult to achieve so why is interprofessional collaboration so important there are many benefits to this healthcare approach that impact not only the healthcare team but also the patient family and even the organization through interprofessional collaboration the healthcare team can achieve more and less time than they would on their own according to green and Johnson 2015 they have the ability to access resources through the knowledge and connections of other team members to increase their productivity and share costs collaboration also allows the opportunity to discuss possible care plans to determine the best one for the patient this greatly improves patient outcomes decreases the length of stay in the hospital and increases provider satisfaction according to C IH C 2010 when collaboration is implemented Kara's enhanced due to the shared knowledge and wisdom of multiple professions according to green and Johnson 2015 by bringing together the experience and opinions of various professions innovation takes place as the team learns how to incorporate the skills of each person into the care of the patient research has shown that an improvement in population and health chronic disease outcomes as health care professionals you should be familiar with Ontario's chronic disease prevention and management framework it has been developed to guide the redesign of healthcare practices and systems in order to improve chronic disease prevention and management this type of framework uses evidence-based population-based and client centered approaches according to mo H LTC 2007 changing the delivery of care in order to improve patient outcomes requires fundamental system changes in the design of practicing and providing self-management supports this is where interprofessional collaboration comes in this framework can be used as a roadmap for effective chronic disease management the delivery designed system refers to the ways in which clinical healthcare practice is organized and carried out according to mo H LTC 2007 because we are focused on chronic disease prevention redesigning the current delivery system is essential to seeing improved outcomes the first portion of the delivery system design involves an interdisciplinary care team would define roles and responsibilities we know that chronic diseases are increasing in Canada and no single professional can provide expert care do the complexity of the patient's needs according to MOH LTC 2007 an interdisciplinary team working collaboratively has the ability to improve the care of chronically ill patients thus introducing effective preventative measures the involvement of specific specialties is dependent on how complex the patient cases for example a care team for a non complex patient may only include a nurse farm assistant physician however a clinically complex patients care team may also include a health educator dietitian physiotherapist social worker and palliative care professional clear communication of roles as well as collectively working towards a common goal is essential for any interdisciplinary team to be successful in providing effective patient-centered care each team members roles and responsibilities will vary depending on whether the patient is considered clinically complex according to the Ministry of Health and long-term care 2007 the Kaiser Permanente's risk stratification pyramid categorizes patients into three groups or levels based on complexity for those who aren't very familiar with this diagram there are three levels that outline the degree of complexity and chronic patients this pyramid is read from top to bottom which means that the first level is level three patients categorized at this level will have multiple complex chronic illnesses and therefore receive intensive care from a wide range of health and social care professionals according to the Ministry of Health and long-term care 2007 level 2 represents patients who have a complex single need or multiple conditions an interdisciplinary primary key care team with specialist support will be provided to these patients in order to ensure proactive planned care and preventive services patients that fall under the level 1 category will receive care provided by a multi multidisciplinary team that will focus on helping them and their families develop the knowledge skills and confidence to care for their condition effectively according to mo H LTC 2007 it is important for each healthcare professional on the team to understand what is expected from each team member this means that each team member should have define role and understand the roles and responsibilities that their fellow health care professionals bring to the team diagnosing heart failure is based on a clinical judgment fueled by the patient's medical history a physical examination and further investigations or testing to confirm the diagnosis according to jars ma 2005 the signs and symptoms associated with heart failure give an indication of how complex the disease can be especially if not managed properly therefore it is important for healthcare professionals to work collaboratively so that the diagnosis and underlining etiology of the disease can be found and treated in a timely manner needless to say even finding the right treatment for a patient diagnosed with heart failure can become increasingly complex the problem is not with the medication itself but rather the dosage level that is being prescribed for example according to George MA 2005 certain medications are titrated based on an individual improvement alone rather than following the advice guidelines an interprofessional care team is therefore essential in aiding with the decision and provision of a heart failure treatment heart failure can also introduce secondary conditions such as hypertension or ischemia which can also have an impact on the progression of the disease as well as the patient's response to treatment according to jars month 2005 this can also result in an increased intake of medication in an attempt to manage the additional disorders this is why it's imperative to have a range of health care professionals involved in choosing an appropriate regimen for a patient with comorbidities these are three optimal models used when delivering interprofessional care according to jars May 2005 the first one is the heart failure outpatient clinic which involves the interaction between a cardiologist and a nurse the nurse who specializes in heart failure plays an important role in coordinating and facilitating care the second one is home based management programs this is where the health care provider sees the patient face to face or communicates with the patient over the phone this type of care is delivered primarily in the patient's home and or in a home facility the last model is home telemonitoring telemonitoring can be part of a multidisciplinary approach where the patient uses a special telecare device in conjunction with a telecommunication system using either of these three models a heart failure a team can comprised of several members depending on the goals of care the population served and the availability of resources team formation is vital during this process because a team needs to come up with a common goal knows who's doing what and how it will get done the professionals involved vary depending on the patient's needs for instance after a patient has been seen by the coal yard cart cardiologist or heart failure nurse and discharged the primary care physician will continue the patient's course of treatment according to George may 2005 a general practitioners role in this case is to aim for a positive prognosis through follow-up arrangements initial diagnosis and implementation of evidence-based treatments according to Jarvan one 2005 a dietitian is also involved with the patient's treatment plan they might focus on creating a diet plan which includes specific nutrition and recommendations for the patient to follow pharmacists are also involved their role is to ensure that there won't be any drug interactions or adverse events when new drugs are initiated during the course of treatment the pharmacists can also collaborate with the physician in providing advice about which drug regimen and dosage is preferred for the patient interprofessional collaboration allows healthcare providers to provide comprehensive care for patients chronic disease prevention and management requires multiple professions and their unique knowledge base to comprehensively address the needs of the patient in chronic disease management an interdisciplinary health care team can better help meet the physical mental and social needs of clinically complex patients by working collaboratively towards a common goal according to book II Bassett a all 2017 such interdisciplinary health care teams may involve physicians nurses home care workers social workers and many other professionals additionally prevention and management of chronic disease typically occurs inside as well as outside of the hospital community care goes beyond the hospital but is an essential part of chronic disease men working together with professionals in various healthcare fields is necessary when dealing with chronic conditions with this combined knowledge patients will receive the best possible care according to Bonin camp at al 2014 an interprofessional collaborative approach to care in cancer patients has improved the quality of care as well as produced the best patient health outcomes additionally interprofessional collaboration enables prevention and management in communities for example collaboration has shown to a more precise and accurate diagnosis of diabetic foot ulcers according to so Maya GA all 2017 interprofessional collaboration is proven to be difficult to implement however it has also been identified as being extremely beneficial to the healthcare team the patient the organization and the health of the total population therefore it is imperative that healthcare teams find a way to get past the barriers that are in place as shown in Ontario's chronic disease prevention and management framework there are many people involved in chronic disease prevention that extend even beyond the hospital due to the complexity of these conditions according to government Ontario 2007 additionally prevention requires care outside of the hospital which includes community assessments to determine the root causes of chronic conditions this is done so that the issues can be addressed and the chronic conditions as well as secondary illnesses can be prevented this cannot be done from the hospital nor can it be done with only one professional for this reason effective collaboration between professions becomes an even bigger necessity studies have been conducted that ask healthcare professionals what they believe is necessary to implement collaboration at the center of it all there needs to be mutual trust and respect between all team members as well as willingness to change according to Conley 20 2007 without either of these things collaboration will not be possible the question remains how do we establish this mindset in the team members the answer according to be airing a all 2009 is interprofessional education through this two more professionals come together to discuss the concept of collaboration and begin to understand how to implement it into practice effective ways to interact with team members how to resolve conflict and collaborative decision decision-making are discussed ideally this education would be implemented into schooling before these professionals are in practice however it can also be used as training seminar within hospitals that are looking to prioritize interprofessional collaboration interprofessional collaboration can help to create a willingness to change simply through the awareness of the benefits of collaboration when professionals learned that it will improve their practice be more cost effective and change patient outcomes for the better it is likely that they will strive to achieve this according to Buehring a-all 2009 similarily this education allows professionals to learn about other professions and their skills this is the first step to establishing mutual trust and respect because individuals will begin to see the work that each member is capable of performing they will see why each person is essential to the functioning of the team according to being a all 2009 there have been improvements in attitudes towards other professions after the implementation of interprofessional education on the more practical side a dedicated workspace has been identified as a necessary part of interprofessional collaboration according to Conley 2007 nurses and physicians themselves have reported that a meeting room with limited seating creates a barrier for interprofessional collaboration because the space is not conductive to a large team of people this fact alone inhibits discussions and challenges the concept of teamwork as collaborative meetings become inconvenient therefore in order to implement effective interprofessional collaboration the meeting space needs to be large enough for the entire team allowing for a comfortable and effective meeting finally regular meetings with the healthcare team are imperative understanding of the concept of interprofessional collaboration and having a dedicated workspace are important but not enough the team has to put their knowledge into practice as they work with the team and communicate with each other this is an important but tricky part of collaboration as differing schedule make it seemingly impossible to get everyone in the same room at the same time according to Conley 2007 nonetheless regular meetings have been identified as essential to collaborative care and there must be flexibility on each team members part to make it happen brief meetings tend to work best for everyone's schedule so it is important to note that these meetings do not need to be long in order to be effective according to the Institute for Healthcare Improvement 2019 communication tools such as sbar which stands for situation background assessment recommendation are highly effective in facilitating communication that is thorough yet concise additionally we live in the age of technology and should use this to our full advantage ideally every team member would be present in person however phone conferences are another method of communication when meeting face-to-face isn't possible in the contents of chronic disease prevention face-to-face meetings may be more difficult as the team members are not found only in the hospital however teams of professionals at community health and public health organizations it can have health care teams and interprofessional collaboration just the same as in the hospital although gathering the team for meetings is a challenge it must be made a priority by each team member in order for collaboration to work face-to-face interactions are where the team begins to build trusting relationships and learn how to communicate effectively with each other according to Vega and Bernard 2017 it is where the facts about interprofessional collaboration are put into practice in conclusion chronic diseases are complex and therefore health care teams must utilize the knowledge of various professions through interprofessional collaboration in order to address the root causes manage and prevent chronic disease the interdisciplinary care model addresses how healthcare professionals should collaborate when treating a chronic disease patient by redesigning the delivery system to promote a more interdisciplinary collaborative approach clients will have access to well coordinated services which will positively impact their health and improve their overall quality of life thank you

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