helene hjalmarson nhprc 2013

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




*

*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




*

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




*

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




*

Structure Process Outputs Outcomes

Professional

Management

Patient

Developing

Interprofessional

Collaboration

Integrating seondary

prevention activities

of osteoporosis

2013-06-18




*

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*

*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




*

*”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




*

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




*

*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




Hjalmarson,Åhgren,Strandmark (2013)

Journal of Interprofessional Care

2013-06-18




*

*”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…

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*

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*

* 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




Thank You!

[email protected]

helene hjalmarson nhprc 2013

Education