Wellness begins at home: Client-centered care

Wellness begins at home: Client-centered care

Abstracts / Journal of Interprofessional Education & Practice 1 (2015) 48e77 experiences underscore the need for providers to become full participant...

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Abstracts / Journal of Interprofessional Education & Practice 1 (2015) 48e77

experiences underscore the need for providers to become full participants in the dialogue of the practical value and practice of spirituality.

Conclusions 1. Healthcare providers who experience threats to their sense of purpose are at risk for spiritual and professional crisis. 2. Defending against the dehumanizing and bad-faith aspects of contemporary health care requires the cultivation of practices that are individualized, authentic, and consonant with the profession's virtues. 3. Spirituality experiences are woven into the beliefs of healthcare providers throughout their training and it is important to engage topics and reflective practices from training through initiation and into mature practice.

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In addition, advanced practice nurses, physicians and dentists worked together to develop referral resources for pregnant women. From the attempt to use PCOAT with patients, we learned that intent alone did not change practice. Before initiating the next step, use of oral health guidelines during pregnancy, the HCPs chose a theoretical framework to organize and guide implementation. A favorable experience with medical, nursing, and dental providers can help pregnant women develop a lifetime of healthy oral hygiene and dental care habits, and therefore improved overall health for themselves and their families. WELLNESS BEGINS AT HOME: CLIENT-CENTERED CARE Dawn Evans PT, DPT, DCE, Annmarie Kinsella MS, OTR, Cynthia LoveWilliams RN, DNS.

INTERPROFESSIONAL COLLABORATION FOR IMPLEMENTATION OF A PRIMARY CARE ORAL ASSESSMENT TOOL (PCOAT): AN ANALYSIS OF HEALTH CARE PROVIDER BEHAVIOR CHANGE

Background/Introduction Christine Cogil DNP, FNP-BC, Kimberly Espinoza DDS, MPH.

Background Myths and access to care issues often result in limited or no dental care during pregnancy. Improving the oral health of pregnant women has a positive correlation with fewer dental caries in their children in addition to underlying benefits the women receive. One way to reduce access barriers for pregnant women, and improve oral health in their children, is to provide oral health assessment, anticipatory guidance, and dental referrals to women during their prenatal care visits with primary health care providers (HCPs). HCPs do not customarily conduct oral assessments or offer anticipatory guidance about oral health. Oral assessment tools for HCPs do not exist. An interprofessional team of dentists and HCPs collaborated to develop a Primary Care Oral Assessment Tool (PCOAT) modeled after existing tools used by dentists. The team identified pregnant women as a population to benefit from use of the PCOAT.

Purpose The project evaluated the practice change patterns of HCPs in relation to implementation of PCOAT with pregnant women in a rural, central New Mexico primary care clinic. Methods To implement PCOAT, HCPs attended a one-time education session. A retrospective chart audit on all prenatal charts occurred six months later to establish a baseline of HCP behavior change. Analysis of the behavior change occurred by way of auditing documentation in the electronic health record. HCPs reviewed results of the first audit. They recommended changes aimed to increase use of the instrument by having medical assistants (MAs) initiate use of the PCOAT. A second retrospective audit occurred eight months after the practice change to observe for HCP behavior change and PCOAT use. Results MA initiation of the PCOAT with patients improved HCP behavior with PCOAT completion rates increasing from 13.5-73.3%. The relative risk for this outcome demonstrates a clinical significance with five times greater use of the tool when initiated by the MA. The likelihood that a patient would receive an oral exam and dental referral, as well as instructions on healthy food and fluids, snacks, xylitol gum, and brushing teeth, increased significantly after MA initiation of the PCOAT.

Infusing interprofessional education (IPE) through a curriculum can be a challenging task for academic institutions. The design and delivery of curricula to produce a “collaboration ready” healthcare workforce often focus on placement of inter-professional learning activities once students have formed their professional identities. In this project, a case was developed using a common core element (wellness) spanning multiple disciplines. The case was created using a real individual: an obese preadolescent male. Through use of an authentic case, students are introduced to IPE and practice at a very early stage in their academic careers. A common element addressing wellness in a community setting removes the medical model and engages a greater diversity of learners and academic programs. This novel teaching and learning approach fostered collaboration on interventions for the preadolescent and a greater understanding and appreciation for the professions included.

Purpose 1. Common core elements identified across academic programs. 2. Case constructed using a real client in a community setting who has impaired wellness. 3. Client and family centered management in a non-medical model engaged multiple disciplines.

Methods/Design I. Preparatory Stage - Faculty from three disciplines collaborated on a health and wellness IPE initiative and created the authentic case study.* - Students from five different academic programs (Education, Nursing, OT, PT, Therapeutic Recreation) within the School of Health Professions and Education were recruited for voluntary participation in the co-curricular learning activity. - Selected literature on health and wellness was posted to an online learning platform to prepare students for the IPE experience. * Core Competencies for Inter-professional Collaborative Practices (IECEP, 2011) II. Active Stage - Students participated in asynchronous online discussions centered around five concepts: Health & Wellness, Inter-professional Education, Childhood Obesity, Mental Health Promotion, and Children Facing Mortality. - Students participated in live, synchronous case study facilitated by four faculty members - Students assigned to IPE groups: Education, Nursing, OT, PT, and Therapeutic Recreation - Introductions and Ice breaker completed - Case study presented with preliminary questions provided to each group - Students viewed a video of a typical day in the life of the preadolescent - Students viewed a video of an assessment by a school nurse and OT professional - Post-video review collaboration among groups to: -Identify roles/responsibilities of each discipline -Present management ideas related to health and wellness - Debriefing: by facilitators and case closure

Lessons Learned Results

Prenatal HCPs have a “window of opportunity” to influence oral care habits and overall health for pregnant women. While HCPs want to implement best practices, they find practice change challenging. Supportive activities to assist with behavior change included having a dentist available once a week at the primary care clinic, monthly grand rounds focusing oral health issues, and quarterly meetings to facilitate interprofessional collaboration.

Emerging appreciation/awareness of the unique cultures and roles of other disciplines; Appropriate assessment addressing the health care needs through understanding of self and other professional roles; Responsive and respectful communication in small group activities and large group discussions; Ability to create an inter-professional plan of care through positive group dynamics and application of relationship-building values.

Abstracts / Journal of Interprofessional Education & Practice 1 (2015) 48e77

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Conclusions/Lessons Learned Students' awareness and appreciation for health care professionals and educators was mutually acknowledged. THE INTERPROFESSIONAL MANAGEMENT OF PSYCHOTROPIC MEDICATIONS IN ELDERLY DEMENTIA PATIENTS RESIDING AT AN ASSISTED LIVING CENTER Abimbola Farinde PhD.

Purpose The complex and progressive nature of dementia requires the involvement of multiple disciplines in order to achieve optimal patient care. The collaborative efforts of multiple disciplines is critically important when it comes to the selection, adjustment, and ongoing management of psychotropic medications. Within the framework of an assisted living facility, individuals with dementia can receive health care services from various disciplines which can provide opportunities for the integration of services among the disciplines of psychiatry, pharmacy, and psychology. The purpose of this study is to examine the impact that interprofessional approach among psychiatry, pharmacy, and psychology can have on psychotropic medications (e.g. antipsychotics, antidepressants, and anxiolytics) among elderly dementia patients (65 years and older) at an assisted living facility.

Purpose To work collaboratively to seek funding to support an interdisciplinary team to investigate ways to improve colorectal screening for colon cancer.

Methods The study will involve the examination of antipsychotics, antidepressants, and anxiolytics use during a six month time frame with an evaluation of medication initiations, dosage adjustments, and ongoing monitoring with the involvement of psychiatry, pharmacy, and psychology. A comparison of whether improved therapeutic outcomes, defined as reduction in behavioral disturbances, were achieved in patients that received an interprofessional approach to medication management versus those that did not receive a similar approach will be examined. The primary outcome of this study will be measurement of behavioral changes as assessed by the Brief Agitation Rating Scale and the Neuropsychiatric Inventory. Results The results of this study is currently pending full analysis of the collected data but preliminary analysis indicate at 25% improvement clinical outcome (Brief Agitation Rating Scale) and 20% on the Neuropsychiatric Inventory as a result of interprofessional approach to psychotropic medication management in elderly dementia patients.

Methods The goal was the formation of an interdisciplinary research team to investigate interventions to improve health literacy and colorectal cancer screening. The annual Health Literacy Research Conference provided the setting for individuals from different disciplines to meet and discuss ideas and goals to improve limited Health Literacy. The shared goal of improving health literacy provided the opportunity to combine team members, who had different expertise and experience, to begin to work collaboratively to seek funding to compare the effectiveness of two distinct follow-up strategies to promote colorectal cancer screening. The team consists of previously funded investigators, physicians, nurse practitioner, statistician, and content experts. The clinicians assisted in access to subjects and insight to clinical issues. The PI and Co-PI diligently sought input regarding research design and plan from all the team members. Results The interdisciplinary, multi-site team was awarded a five year $1.3 million dollar grant from the American Cancer Society (ACS RSG-13-021-01-CPPB). Health Literacy Interventions to Overcome Disparities in Colorectal (CRC) Screening.

Conclusion This study examined the potential benefits that may be observed with psychotropic medication management through the presence of an interprofessional approach that involves the collaborative efforts of psychiatry, pharmacy, and psychology. INTERDISCIPLINARY LITERACY

system overwhelming. Limited literacy negatively impacts health behaviors, health decisions and ultimately health outcomes. Limited health literacy is both an individual and population health problem and interventions must address both1. Health literacy is a key component in improving health outcomes, however complex problems require a multifaceted and optimally an interdisciplinary approach. National Academies3 defines interdisciplinary research as, A mode of research by teams or individuals that integrates information, data, techniques, tools, perspectives, concepts, and/or theories from two or more disciplines or bodies of specialized knowledge to advance fundamental understanding or to solve problems whose solutions are beyond the scope of a single discipline (p. 26). The challenge is to foster team formation and cohesion among individuals from different disciplines and perspectives. Tracy and Chlan4 discuss the complex issues of discipline perspective, experience, roles and responsibilities, time constraints, authorship and communication format and style that must be successfully negotiated before initiating the project. At the core of these issues, is the need to develop trust and collegiality among the various team members. According to Choi and Pak5 key components to insure success include maturity, flexibility and commitment of the team members in addition to the practical issues of incentives and institutional support. A shared vision is critical for interdisciplinary research team success.5

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Laurie Anne Ferguson(Co-I), Connie Arnold(PI), Terry Davis(Co-PI), James Morris(Co-I), Alfred Rademaker(Biostatistician), Michael S. Wolf(Co-I), Dean Schillinger(Consultant).

Background Today's healthcare environment is extraordinarily complex and requires increased patient responsibility to negotiate the system, make decisions about health as well as correctly follow therapeutic regimes. 1 Health literacy is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (p.15). 2 Even individuals who have above average literacy may find navigating the healthcare

Conclusions A common research interest and interdisciplinary conference can provide the initial setting for individuals from different disciplines to dialog and successfully negotiate and succeed in forming a funded interdisciplinary research team. HOW TO ENGAGE PATIENTS AND FAMILIES OF CHILDREN WITH COMPLEX CARE NEEDS: THE ROLE FOR INTERDISCIPLINARY ROUNDS IN PEDIATRIC PATIENT CENTERED MEDICAL HOME Mona Patel Gera MD, Majiney Eulingbourgh LVN, Wendy Parsons LVN, Jose Arreguin RN, Gracie Corona MA, Muriel Barton LCSW.

Introduction In the United States, there are 10.2 million (13.9%) children with special health care needs (CSHCN), who are at increased risk for or have a chronic physical, developmental, behavioral, or emotional condition and also require health and related services beyond those required by other