Improving outcomes in adults with diabetes through an interprofessional collaborative practice program

Abstract

In 2014, the Midwest Interprofessional Practice, Education and Research Center partnered with a Federally Qualified Health Center (FQHC) to implement an interprofessional collaborative practice (IPCP) education program to improve the health of adult patients with diabetes and to improve practice efficiency. This partnership included integrating an interprofessional team of students with the practice team. Twenty-five students and 20 staff engaged in the IPCP program, which included completion of educational modules on IPCP and implementation of daily huddles, focus patient visits, phone calls, team-based case presentations, medication reconciliation, and student-led group diabetes education classes. This study used a sequential mixed methods design. Tools used for collecting data from staff and students included demographic forms, the Interdisciplinary Education Perception Scale (IEPS), the Entry-level Interprofessional Questionnaire, the Collaborative Practice Assessment Tool, and pre/post module knowledge tests completed at baseline and at one-year post implementation. Patient clinical indicators included HgbA1c, glucose, lipid panel laboratory assessments, body mass index, blood pressure, and documentation of annual dental, foot, and eye examinations. Practice efficiency was measured by the average number of patients seen per provider per hour. Both students and staff showed significant knowledge gains in IPCP on Team Dynamics and Tips for Behavioural Changes knowledge tests (p < .05). Patients who had an HgbA1c of ≥ 7% significantly decreased their HgbA1c (p < .05) and glucose (p < .01). However, BMI and annual dental and eye examinations did not improve. Providers demonstrated an increase in the number of patients seen per hour. This IPCP intervention showed improvement in practice efficiencies and select patient outcomes in a family practice clinic.

Impact of Physician-Pharmacist Collaboration on Diabetes Outcomes and Health Care Use

“…5,[14][15][16] The involvement of clinical pharmacists in direct patient care has been shown to improve clinical outcomes in many chronic disease states, including but not limited to diabetes, hypertension, and dyslipidemia. 2,[6][7][8][9]12,13,[16][17][18][19][20] Data also supports that clinical pharmacy services improve provider work-life 21 and reduce health care costs. 12,13,16,17,22,23 Matzke et al 17 found that the inclusion of clinical pharmacists in a collaborative care model demonstrated significant improvements in glycosylated hemoglobin, blood pressure, low-density lipoprotein (LDL) cholesterol, and total cholesterol in the collaborative care group compared with the usual care group.…”

“…3 Pharmacists within the primary care setting practice in collaboration with physicians and provide clinical pharmacy services that may include counseling and medication education, comprehensive medication management, chronic care management, and population health management for a variety of disease states. [2][3][4][5][6][7][8][9][10][11][12][13] As of 2016, 48 states in the United States allow pharmacists and prescribers to enter into a collaborative practice agreement, although specific restrictions and regulations vary by state. 14 Collaborative practice agreements provide pharmacists the ability to manage chronic disease states in collaboration with physicians to improve patient outcomes and patient satisfaction.…”

“…4,15 With the high prevalence of diabetes, along with the complex medication management and the association of high health care costs, there is a substantial amount of literature to support the involvement of clinical pharmacists in diabetes management to improve and meet clinical goals. 2,6,9,[16][17][18][19][23][24][25] Despite the support of published literature showing the effect of clinical pharmacists on improvement of patient outcomes, very few studies compare collaborative pharmacist management to that of physician-only care in a primary care setting. In addition, data for cost evaluation of clinical pharmacy services in a primary care clinic is limited.…”

Effect of student-led health interventions on patient outcomes for those with cardiovascular disease or cardiovascular disease risk factors: a systematic review

“…Student-led health interventions were primarily located in a clinic setting [31][32][33][34][35][36][37][38][39][40][41][42][43][44]. Of the student-led clinics, five studies described the service provided as a "free clinic" [33,36,41,42,44].…”

Willingness of medical students to refer patients to a physician associate or a doctor based on clinical scenarios when time is a trade-off

“…On the other hand there is some evidence to suggest that increased time spent exploring each other's profession can increase trust, familiarity and interprofessional teamwork. [18] To address this question we surveyed a cohort of undergraduate and graduate entry medical students within the one School of Medicine in Ireland offering a PA programme. The research builds on studies which have explored "willingness to be seen" from the patient's perspective.…”