Interprofessionalism and shared decision-making in primary care: a stepwise approach towards a new model

Two Universities from Oulu, Finland organised integrated and interprofessional (IP) type 2 diabetes training periods for undergraduate medical and nursing students in collaboration with the University Hospital and Health and Wellbeing Centre of Oulu. There is an ongoing health, social services and regional government reform in Finland. The services will be organised in a customer-orientated way and the reform will combine the primary and secondary services. The training was tailored to reflect the real life future setting in Finnish primary care, and this model fits well with the principles of collaborative education. The study aimed at investigating students’ attitudes and readiness for inter professional learning and their learning experience in combined primary and secondary care settings. The second aim was to strengthen students’ professional skills by working with patients in a patient-centred manner. The “Readiness for Interprofessional Learning Scale” was used with added questions about pair training. Students’ perceptions of their clinical skills were evaluated. The students valued the mutual learning experience in outpatient primary care. They felt comfortable with working together and complemented each other. Students performed well with IP competencies such as patient centredness, communication and team functioning. Patients in general were very satisfied with the visit. Teamwork and collaboration, professional identity and pair work were highly scored in both student groups while roles and responsibilities were evaluated a little less positively. Collaboration between different levels of care and health policies is important when developing health professionals’ education. This IP teamwork experience helps both future and current health-care professionals to better organise the care of chronic illnesses.

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“…The link between practice and education systems is essential in order to build relevant IP competencies that students require. [16,26]…”

Section: Discussionmentioning

confidence: 99%

Collaborative diabetes training in outpatient primary care

Tervaskanto-Mäentausta

Taanila

Ukkola

et al. 2017

Journal of European CME

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“…A few SDM models acknowledge the potential impact of visit context on SDM, but do not identify how individual contextual drivers impact SDM. [20][21][22] Implementation science models identify contextual drivers that impact implementation of an innovation, but do not address specifically how SDM is affected. 23,24 CONCEPTUAL MODEL OF ORGANIZATIONAL CONTEXT AND SHARED DECISION MAKING Therefore, we outline a conceptual model ( Fig.…”

Section: Introductionmentioning

confidence: 99%

A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients

et al. 2016

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Shared decision making (SDM) occurs when patients and clinicians work together to reach care decisions that are both medically sound and responsive to patients' preferences and values. SDM is an important tenet of patient-centered care that can improve patient outcomes. Patients with multiple minority identities, such as sexual orientation and race/ethnicity, are at particular risk for poor SDM. Among these dualminority patients, added challenges to clear and open communication include cultural barriers, distrust, and a health care provider's lack of awareness of the patient's minority sexual orientation or gender identity. However, organizational factors like a culture of inclusion and private space throughout the visit can improve SDM with lesbian, gay, bisexual, and transgender (BLGBT^) racial/ethnic minority patients who have faced stigma and discrimination. Most models of shared decision making focus on the patient-provider interaction, but the health care organization's context is also critical. Context-an organization's structure and operations-can strongly influence the ability and willingness of patients and clinicians to engage in shared decision making. SDM is most likely to be optimal if organizations transform their contexts and patients and providers improve their communication. Thus, we propose a conceptual model that suggests ways in which organizations can shape their contextual structure and operations to support SDM. The model contains six drivers: workflows, health information technology, organizational structure and culture, resources and clinic environment, training and education, and incentives and disincentives. These drivers work through four mechanisms to impact care: continuity and coordination, the ease of SDM, knowledge and skills, and attitudes and beliefs. These mechanisms can activate clinicians and patients to engage in high-quality SDM. We provide examples of how specific contextual changes could make SDM more effective for LGBT racial/ethnic minority populations, focusing especially on transformations that would establish a safe environment, build trust, and decrease stigma.

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“…Providers are not typically compensated for SDM despite the greater time commitment, [10] perhaps fostering negative attitudes toward the process. [12,18] IP-SDM presents additional barriers to implementation including lack organizational resources and processes to implement IP-SDM as this model may require greater collaboration among professionals. [9,10,18,28] In addition, because of the team nature of IP-SDM, there are challenges specific to working in teams including turnover and difficulty establishing cohesion.…”

Section: Benefits Of Ip-sdmmentioning

confidence: 99%

“…Effective engagement in the SDM process requires more time than a typical patient visit and patients may vary in their level of health literacy. [9,12,18,28,29] SDM must afford time for the patient to process decision-related information and reach a conclusion, both of which may add time to the encounter. Providers are not typically compensated for SDM despite the greater time commitment, [10] perhaps fostering negative attitudes toward the process.…”

Section: Benefits Of Ip-sdmmentioning

confidence: 99%

“…[9][10][11][12][13][14] Makoul and Clayman [15] identify 8 steps in an SDM protocol: identifying and explaining the decision to be made, discussing the risks and benefits of each option, eliciting patient values and preferences, discussing patient's ability and self-efficacy, presenting recommendations, checking and clarifying patient understanding, making or explicitly deferring decision, arranging follow up. In a traditional SDM context, these steps are preformed by the physician, typically within a single visit but can be distributed across visits.…”

Section: Definition Of Ip-sdmmentioning

confidence: 99%

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Inter-professional shared decision making – increasing the “shared” in shared decision making

Sieck

Johansen

Stewart

2015

IJH

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Shared decision making (SDM) has been shown to increase patient engagement, patient satisfaction and adherence to treatment. Yet SDM remains underutilized in primary care due to factors such as the additional time required to implement, particularly for individual physicians. Inter-professional SDM (IP-SDM) is a model of SDM that distributes the tasks of SDM across different professionals involved in the care of the patient. IP-SDM has the potential to increase efficiency, provide more opportunities for patients to discuss the decision, and increase patient and provider satisfaction. Office visit workflows aligned to the steps of SDM allow team members to leverage their unique skills and training and enhances the decision making process for the patient. We argue that this approach should receive greater attention in primary care and throughout the healthcare system.

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Interprofessionalism and shared decision-making in primary care: a stepwise approach towards a new model

Cited by 262 publications

References 26 publications

Collaborative diabetes training in outpatient primary care

Collaborative diabetes training in outpatient primary care

A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients

Inter-professional shared decision making – increasing the “shared” in shared decision making

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