Inter-professional Care Teams: a London Case Study
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Overview
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Background
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Progress
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Project Team
This collaborative project involves establishing and monitoring the development of an inter-professional health care team to explore the factors that facilitate and hinder team functioning, and inter-professional practice more broadly. Interviews with practitioners and patients involved with the team at different points in time are being conducted.
Principal Investigator
Tracey Adams, Ph.D.
Sociology, Faculty of Social Science
The University of Western Ontario
Project Summary
Brief Description
Diabetes foot ulceration is a complex health problem and requires care provision by many different health professionals. Multidisciplinary diabetes foot ulcer services have been shown to effectively reduce major amputation rates by over 80% and minor amputation rates by over 70% (Krishnan, 2008: 698). Multidisciplinary care suggests independent input by team members of different disciplines on the same task, whereas interdisciplinary (or interprofessional) care involves participants taking into account the contributions of other team members and a melding of responsibilities by team members. The complexity of the health problems associated with diabetes, and the increasing specialization of health care workers involved in care provision has led to the promotion of interprofessional collaboration in patient care (Vyt, 2008:699). Whilst research in this area is still growing, improvement in care effectiveness for persons with a chronic disease (Weiss, 1997: #700), higher degrees of work satisfaction by health care workers (Curley, 1998: 701) and improved patient satisfaction with care (Zimmer, 1985:704) have been shown using an interprofessional model.
The Interprofessional Diabetes Foot Ulcer Team (IPDFUT) was developed to manage people with diabetes (PWD) with foot ulcers in South West Ontario, Canada. This new Interprofessional Care (IPC) team aims to manage PWD who have a foot ulcer, following international clinical guidelines, in the local community utilizing patient-centred IPC. The effect of IPC on perspectives of the health professionals in the team, and patients involved in care provided by the team and students/health professionals attending placements at this service will be evaluated.
Aim
Our project aims to assess the experiences of health professional IPDFUT members, patients seeking care from the IPDFUT and students/health professionals on placement with the IP-DFUT in this new IPC, patient centred community clinic in SW Ontario, Canada.
Objectives:
To evaluate the impact of being involved in an interprofessional team on health professionals, patients and students involved in the IP-DFUT in London, Ontario Canada.
Hypotheses:
- Patients undergoing treatment for foot ulcers will find the care they receive from the IPC team more inclusive.
- IP-DFU team members will demonstrate a change in their socialization and collaborative team working skills as a result of their development during the project.
- Students undertaking placement with the IP-DFUT will report a better understanding of their holistic care of PWD and foot ulceration.
- Students will demonstrate evidence of re-socialization to dual professionals and interprofessional identities and an enhanced understanding of the roles, knowledge and skills of students in other disciplines who participated in the placement with them.
Background
The Interprofessional DiabetesFoot Ulcer Team (IP-DFUT):
This study will utilize qualitative methods to evaluate the impact of IPC on health professional, patient and student perspectives on this new type of care of PWD who have foot ulcers.
Setting:
The IPDFUT is located in a community setting in SW Ontario, Canada. It is a clinic that has been specifically created in order to see PWD who have foot ulcers. The IPDFUT includes a diabetes foot ulcer chiropodist, an orthotist, a wound nurse, a clinical psychologist, a physical therapist, an infectious diseases physician, 3 Diabetes Educators (2 dietitians and one nurse), a community chiropodist and a Social Worker. Placement was offered to students undertaking Masters of Clinical Science (Wound Care) course at the local university, and to health care professionals currently providing care to PWD or to patients with wounds.
Approximately three months prior to patient management starting, all IP-DFUT members were involved in IP team building. This team building included health professionals involved in the team and three people with diabetes (PWD) who had a history of foot ulceration. The team building involved 4, 3-hour on-line sessions and 6, 2 hour face to face workshops provided by the Office of Interprofessional Health Education and Research (IPHER). These team building sessions were formulated based on the current, accepted, philosophies pertaining to developing an IP collaborative team.
Study design:
This study is a prospective qualitative evaluation of a new interprofessional program of people involved in the IP-DFUT, including the health professionals providing the care, the patients seeking care, and students/health professionals attending placement in the IPDFUT clinic.
Participants:
Evaluation of team building and interprofessional care activity will be undertaken in three different population groups:
- Healthprofessionals comprising the IPDFUT.
- People with diabetes who are being seen by the IP-DFUT for foot ulcer management.
- Students/Health Professionals attending placement with the IP-DFUT.
Data collection:
All evaluations will be undertaken prospectively. There will be 2 different streams of evaluations.
- Team functioning: This area will involve in-depth evaluations of how the team functions, whilst patients are being seen by the IP-DFUT, using semi-structured interviews. Evaluations will include how each member perceives the team is working and to identify any barriers or concerns, as well as highlighting any positives that may result. These one hour semi-structured interviews will be undertaken with:
- Health professionals - all team members will be invited to participate in one hour interviews:
- Prior to the team building.
- Two months after team building exercises have been completed, and patient management is actively occurring.
- Five months after team building exercises have been completed, and patient management is actively occurring.
- Patients - ten patients involved with the IP-DFUT will be invited to be involved in a one hour interview upon first being seen by the IP-DFUT, then at discharge, or December 2010, whichever is sooner.
- Health professionals - all team members will be invited to participate in one hour interviews:
- IP Student/Health Professional evaluations: Two students/health professionals who had observational placement with the IPDFUT will be invited to interviews for in depth evaluation of the impact of their involvement with the IP-DFUT on their understanding of patient care and how it may affect their future practice. These will be undertaken after their placement at the IPDFUT.
The qualitative interviews were undertaken by a sociologist (TA), from the Sociology Department at University of Western Ontario, and her research assistant. These researchers were not involved in the IP-DFUT patient care or team building process. The interviews were held in a separate, private room at a location to suit both the interviewer and interviewee.
Qualitative data collection tools:
- Health professional qualitative interview guides were developed for pre team building, 2 months and 5 months after team building by the sociologist and project manager (diabetes foot ulcer chiropodist), and included aspects perceived by both to be impacted by team building and IPC.
- Interview guideswere also developed for PWD being cared for by the IP-DFUT pre (or early) and post team involvement. As per health professional guides, these included aspects expected to be affected by IPC.
- Studentsundertaking placement with the team - post placement.
Principal Investigator
Tracey Adams, Ph.D.
Sociology, Faculty of Social Science
The University of Western Ontario
(2014) Tracey L. Adams, Carole Orchard, Rajna Ogrin, and Pamela Houghton, "The metamorphosis of a collaborative team: from creation to operation" in Journal of Interprofessional Care 28(4):339-344.
