helene hjalmarson nhprc 2013
DESCRIPTION
Developing interprofessional collaborationTRANSCRIPT
A longitudinal case of secondary prevention for patients with osteoporosis
*Developing
interprofessional
collaboration
Hjalmarson, Åhgren, & Strandmark 2013
Journal of Interprofessional Care, (27) 161-170
2013-06-18
Promoting Health in everyday settings / 7th
Nordic Research conference in Health
promotion, Hjalmarson., Åhgren., Strandmark
*
Osteoporosis implies an increased risk for fractures attributable to low bonemass
microarchitectual deterioration of bone tissue resulting in bone fragility
In Scandinavia every third women (70-75 years) suffering osteoporosis
The risk for Swedish women having a low trauma fracture after the age of 50, is 50%
Detection of osteoporosis is less than 30 % in patients with low-trauma fractures (Sweden
less than 23%)
Collaboration concerning
fracture prevention needs
to be strengthened
(Ström et al. 2011, Besette et
al. 2008)
2013-06-18
Promoting Health in everyday settings / 7th
Nordic Research conference in Health
promotion, Hjalmarson., Åhgren., Strandmark
*
*Explore the development of interprofessional
collaboration, over almost a 4-year period,
aiming to improve secondary prevention of
osteoporosis
* Keywords: Bottom-up approach, case study,
interprofessional collaboration, osteoporosis, secondary
prevention
2013-06-18
Promoting Health in everyday settings / 7th
Nordic Research conference in Health
promotion, Hjalmarson., Åhgren., Strandmark
*
There is limitied knowledge about the impact of interprofessional learning practice (Zwarenstein & Reeves 2008)
and a need to conceptualize the links between interprofessional collaboration and the interplay between inputs, process and outcomes (Reeves et al. 2011, Dámour et al 2005)
There is a special need to clarifying research about how interprofessional collaboration and integrated care can be developed between the orthopedic speciality and primary health care (Jaglag et al. 2010.; Feldstein et al. 2008)
2013-06-18
Promoting Health in everyday settings / 7th
Nordic Research conference in Health
promotion, Hjalmarson., Åhgren., Strandmark
*
Orthopedic department
Rehabilitation
department
8 Primary Health
Care units
3 Division directors
6 Department directors
23 key
stakeholders -
”owners of the
process
A systematic approach for health promotion planning inspired by the idea
to incorporating community empowerment into top –down driven structures (Laverack & La Bonte 2000)
2013-06-18
Promoting Health in everyday settings / 7th
Nordic Research conference in Health
promotion, Hjalmarson., Åhgren., Strandmark
*
Structure Process Outputs Outcomes
Professional
Management
Patient
Developing
Interprofessional
Collaboration
Integrating seondary
prevention activities
of osteoporosis
2013-06-18
Promoting Health in everyday settings / 7th
Nordic Research conference in Health
promotion, Hjalmarson., Åhgren., Strandmark
*
2013-06-18
Promoting Health in everyday settings / 7th
Nordic Research conference in Health
promotion, Hjalmarson., Åhgren., Strandmark
*
*A leadership style that supported interdependency.
*Continous sharing of clinical experiences and increasing the professional´s space for freedom of actions with focus on patient-centred integrated care.
”In contrast to what is traditionally done, we did not begin by coordinating our health care program policies based on top-down deciscions instead, we begun by trying to find forms for collaboration” (Physiotherapist in year 2)
2013-06-18
Promoting Health in everyday settings / 7th
Nordic Research conference in Health
promotion, Hjalmarson., Åhgren., Strandmark
*
*”One major factor determining the success of
the process has been and remains the ongoing
feedback we get, the fact that we regularly
receive confirmation about what is happening
in the process, since we become blinded to it
ourselves” (Occupational therapist, workshop in year 3)
2013-06-18
Promoting Health in everyday settings / 7th
Nordic Research conference in Health
promotion, Hjalmarson., Åhgren., Strandmark
*
Feedback generated
* Ability to identify collective actions
* Knowledge about the benefits of collaboration
* A sense of collective efficacy
* Trust and shared responsibility between professionals
* Interactions skills for instance developed discursive power
2013-06-18
Promoting Health in everyday settings / 7th
Nordic Research conference in Health
promotion, Hjalmarson., Åhgren., Strandmark
*
*Practicing new approaches by incorperating
empowerment aspects in patient
communications (MI, Learning circles, shcedule
time for reflection…)
*New organizational innovations: assessment
instruments, patient information,
communication guides, flow charts, physical
profile, new routines for follow-ups…
2013-06-18
Promoting Health in everyday settings / 7th
Nordic Research conference in Health
promotion, Hjalmarson., Åhgren., Strandmark
Hjalmarson,Åhgren,Strandmark (2013)
Journal of Interprofessional Care
2013-06-18
Promoting Health in everyday settings / 7th
Nordic Research conference in Health
promotion, Hjalmarson., Åhgren., Strandmark
*
*”Working like this is very inspiring, as seeing patients at the hospital and knowing they will be followed up at the primary care unit. Today we have a strong chain of care, and we can feel it” (Nurse in year 3)
* The detection of osteoporosis increased from less than 30% before 2007 to 83% in 2009/2010
* 86% of patients diagnosed with osteoporosis were followed up with a telephone call
* Almost 90% had a post-fracture follow-up with their general practitioner
* Almost 50% achieved lifestyle changes like increased physical activity, calcium intake or quit using tobacco…
2013-06-18
Promoting Health in everyday settings / 7th
Nordic Research conference in Health
promotion, Hjalmarson., Åhgren., Strandmark
*
2013-06-18
Promoting Health in everyday settings / 7th
Nordic Research conference in Health
promotion, Hjalmarson., Åhgren., Strandmark
*
* A balance between bottom-up and top-down structures triggered improvements in the development of interprofessional collaboration furthermore shows a way to manage knowledge translation of EBM in osteoporosis
* The results demostrate some possibilites to better understand some interprofessional issues generating inputs, outputs with outcomes and thus reveal parts of ”the black box” -
* The findings show interprofessional collaboration to be a successful way of facilitating clinical innovations to reduce care gaps and improve secondary prevention activities
* Leaders may consider: accepting complexity, focusing on communication based on interprofessional experiences, measuring collective performance and highlight the importance of feedback
2013-06-18
Promoting Health in everyday settings / 7th
Nordic Research conference in Health
promotion, Hjalmarson., Åhgren., Strandmark
Thank You!