Anantha Naik Nagappa and Uday Venkat Mateti
Manipal College of Pharmaceutical Sciences, Manipal University, Manipal-576104
What is Interprofessional Collaboration?
Healthcare delivery is multitasking and multi-professional for example the patients with chronic diseases are discharged while they are still having the condition. There is a need for monitoring the patients periodically to assess the condition and decide whether the patient is improving or his/her condition is deteriorating due to the treatment. The ambulatory care and community care are provided by pharmacists. Therese is a need of exchange of information among doctor and pharmacist as the goal of the therapy is to improve and sustain a quality of life for the patient. Apart from this the doctor or nurse may need to consult the pharmacist regarding the specific accurate information of a drug while treating the patients in the hospitals. So Interprofessional Collaboration is a mandatory to achieve the best patient safety and efficacy.
What is the importance of Interprofessional Collaborations?
The patient's condition mandates the doctor, nurse and pharmacists for inter and intra professional opinion while treating condition for example the patients admitted to hospital with infections develops kidney and liver diseases. The patient conditions become critical and hypersensitive to normal doses due to altered liver and kidney functions. The intra-professional collaborations with nephrology and gastroenterology become mandatory. Due to altered liver and kidney functions the ability to metabolites and excrete gets altered. Therese is a need of pharmacist to begin therapeutic drug monitoring and suggest suitable dosage adjustments to ensure the patient safety and efficacy.
What is the contribution of Interprofessional Collaborations?
The aim of the therapy is to minimize the suffering and death due to disease of the patients. In a hospitalized condition one cannot predict and be confident about outcomes and prognosis. The healthcare professionals in critical care should be alert to the changing scenario of the patient condition and team work is best suited to bring the patient out of danger. However in ambulatory and community settings the patients approach the pharmacists for their issues and problems. The pharmacist after studying the patient condition decides for referral to the doctor. In case of major conditions otherwise treats the patients with Over-the-counter (OTC) medicines and advice for the patients. Avoiding the patients visiting the doctor and wasting his/her time meant for treating major conditions.
Identify the role and responsibility key healthcare professionals in healthcare delivery
The three key healthcare professionals involved in therapy are Doctors, Nurses and Pharmacists. There are several specialties of each professional for example among doctors there are specialist in general medicine, surgery, gynecologic, cancer etc. Among nurses the specialties includes psychiatric, gynecology, medical surgical, cardiology etc., and among the pharmacists clinical, community and hospital pharmacists. The doctor's role is to study the patient condition and confirm the diagnosis on which the therapy to the patient is initiated. Nurses support the treatment in the hospital and also engaged in nursing care which is going to help the patients to undergo treatment in the hospital. Clinical Pharmacist is located in the hospital and responsible for all aspects of drugs including patient safety and outcome of the therapy. The pharmacist in community pharmacy is going to take the responsibility of dispensing drugs and advice patients in the disease management.
Figure 1: Key healthcare professionals in healthcare delivery
What are the limitations of each key health care professional in Healthcare delivery?
The objective of the healthcare delivery is achieving the best outcomes in terms of efficacy, safety and Quality of life for the patients. These can be achieved by complementing services of each healthcare professional by team work. As doctors are specialized in pathology and diagnosis. They are the professionals on deciding the modalities of treatment. The prescribed treatment is shared with nurses and pharmacists to execute the treatment and ensure the patients safety while giving the treatment. Nurses being experts in patients care or assist in doctors to monitor the prescribed care. The pharmacists being experts in drugs are responsible to take care of all issues arising while using medications.
How does collaboration improve the outcomes of therapy?
The treatment has multi-dimensional inputs and outcomes which are identifiable by nurse and pharmacist due to their practical experience and expertise. When treatment is given it is also followed-up by nurse and pharmacists from the view of principles of nursing care and pharmacy practice. In case any discrepancies arising due to lack of professional insight can be picked-up and appropriate alarm raised could mitigate the therapy related accidents for example if the doctor has prescribed the same medicine in duplicate and triplicate as the difference brands of the medicines. Pharmacists can easily identify the duplication of medicine in prescription and alert the prescriber regarding the duplication. The prescribed and amend the prescription and save the patient from excessive exposure of the medicines.
Give the examples of collaborative care in healthcare delivery
The healthcare delivery is becoming complex due to information overflow and information technology which has made possible to utilize the latest development in healthcare delivery. On the other side the patients are demanding the quality care as their right and healthcare services are under consumer regulations. The professional developments in drug delivery are important for nurses while administering the treatment. The doctors in variably seek the pharmacists opinion and services in therapeutic drug monitoring. The patients always depend on services of pharmacists for doubts and issues related to drug usage. Hence the collaborative care is the centre of effective and safe healthcare delivery.
How accountability issue of each healthcare professional is fixed in healthcare delivery?
Conventionally doctors are supposed to diagnose and prescribe, nurses to administer the drugs and provide nursing care while pharmacists suppose to handle all the issues of drugs like dispensing and to ensure patient safety and efficacy. In changed times the technology has reshaped conventional occupation into technology driven for example much emphasis is laid upon evidence based medicine practice and all attempts of empirical treatment minimized the analysis and lab reports are integral for decision making. The data bases like Micromedex are utilized for provision of drug information while giving healthcare. The evidence available by randomized controlled trial (RCT), Meta-analysis and systematic reviews are utilized for decision making. Hence the professionals participate in a team spirit to bring out best outcomes for the patients.
How collaborative care can be practiced in community pharmacy?
The pharmacist in-charge of community pharmacy services are frequented by patients or attendants of patients for supply of prescription medicines. The advent of e-prescriptions has in fact helped better communications between prescribers, patients and nurses. Where in the pharmacists maintains the prescriptions history for individual patients. He also maintains the drug allergies, episodes of adverse drug reactions and lab reports of individual patients and can share the same with nurse and doctor on request. In case of any discrepancies in prescriptions are brought to the knowledge of prescriber and can prevent causality if not alerted.
What is the contribution of Collaborative Care in practice of evidence based medicine?
The evidence based medicine is more acceptable than empirical treatment as the evidence based medicine is scientific and rational. The evidence available in data bases in the form of RCTs, Meta-analyses and systematic reviews need to be extra plotted and customized to the case being treated. The collaboration between the information technologist, pharmacist, nurse and physicians when they collaborate in an interactive manner can bring the best of evidence based medicine for the patient.
What is significance of knowledge sharing in Collaborative Care?
The knowledge available in databases cannot be utilized unless someone takes interest in the patient condition and applies to resolve the issue there is a need to promote the active direct care provider in the model of knowledge sharing for example if there is a potential harmful drug-drug interactions arising due to administration of two different drugs. The pharmacists are the first person to identify and predict an adverse eventuality. By sharing this information with the physicians the Collaborative Care model there can be avoidance of causality.
What are the hindrances to promote Collaborative Care?
The Collaborative Care fails take-up due disparity among healthcare professionals however the WHO has come out with an initiative called as Global Health Workforce Alliance (GHWA), which promotes equity and participation of all healthcare providers in order to cater the need of healthcare delivery. The cultural barriers, socioeconomic conditions along with beliefs of public act as a hindrance to establish a Collaborative Care.
What is the ethical binding in Collaborative Care?
The healthcare professionals in their professional ethics take oath to serve the patients and do not cause harm to the patient for personal gains and interest. The professional objective of each core healthcare professionals should act in the interest of patient and are bound ethically to share information and seek information from fellow healthcare peers to take the healthcare delivery most cost effective and safe.
What are the etiquettes of Collaborative Care?
The premises of Collaborative Care is understanding and appreciating the role and responsibility of each professional practice and to give opportunity for other professions to develop in the interest of achieving the best healthcare provided. The miss trust and loose talk about other healthcare professionals should be criticized and polarization of professional against other professionals should be avoided. The patients should be given an impression that all the healthcare professionals are giving their service in the interest of them.
What are conflicts of interest withholding Collaborative Care?
In a practicing model of healthcare the stand alone setups like private clinics, pharmacy shops, and nursing homes are seen competing each other for business. But however in a bigger facilities like corporate hospitals, dist. Health centers there is a consolidation and inter dependency of healthcare delivery is evident very much. Hence the conflict of interest to treat a patient as one in all is likely to happen when patient is treated initially.
What are communication devices used in Collaborative Care?
The system of healthcare delivery thrives on mutual participation including the patients. The advancement in technology offers many opportunities for inter and intra collaborations for example telehealth, e-Prescriptions, m-Health and health informatics are some of the communication devices promoting the Collaborative Care.
- Framework for action on interprofessional education and collaborative practice. Available from: http://www.who.int/hrh/resources/framework_action/en/
- Core Competencies for Interprofessional Collaborative Practice. Available from: http://www.aacn.nche.edu/education-resources/ipecreport.pdf
- Connected Health: The Drive to Integrated Healthcare Delivery. Available from: http://www.himss.eu/sites/default/files/Accenture-Connected-Health-Global-Report-Final-Web.pdf
- Bridges DR, Davidson RA, Odegard PS, Maki IV, Tomkowiak J. Interprofessional collaboration: three best practice models of interprofessional education. Medical Education Online 2011;16:10.
- Collaborative Care. Available from: http://www.wrha.mb.ca/professionals/collaborativecare/about.php
- A National Agenda for Research in Collaborative Care. Available from: http://www.ahrq.gov/research/findings/final-reports/collaborativecare/collabcare.pdf