Helene Hjalmarson NHPRC 2013

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Developing interprofessional collaboration

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Helene Hjalmarson NHPRC 2013

  1. 1. A longitudinal case of secondary prevention for patients with osteoporosis *Developing interprofessional collaboration Hjalmarson, Åhgren, & Strandmark 2013 Journal of Interprofessional Care, (27) 161-170
  2. 2. 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)
  3. 3. 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
  4. 4. 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)
  5. 5. 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)
  6. 6. 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
  7. 7. 2013-06-18 Promoting Health in everyday settings / 7th Nordic Research conference in Health promotion, Hjalmarson., Åhgren., Strandmark *
  8. 8. 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)
  9. 9. 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)
  10. 10. 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
  11. 11. 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…
  12. 12. 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
  13. 13. 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…
  14. 14. 2013-06-18 Promoting Health in everyday settings / 7th Nordic Research conference in Health promotion, Hjalmarson., Åhgren., Strandmark *
  15. 15. 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
  16. 16. 2013-06-18 Promoting Health in everyday settings / 7th Nordic Research conference in Health promotion, Hjalmarson., Åhgren., Strandmark Thank You! helene@kau.se

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