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Ensuring the Success of Interprofessional Teams: Key Lessons Learned in Memory Clinics*

Published online by Cambridge University Press:  17 December 2013

Linda Lee*
Affiliation:
The Centre for Family Medicine, Kitchener, Ontario Department of Family Medicine, McMaster University
Loretta M. Hillier
Affiliation:
St. Joseph’s Health Care London and Lawson Health Research Institute
W. Wayne Weston
Affiliation:
Schulich School of Medicine & Dentistry, Western University
*
Correspondence and requests for reprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Linda Lee, M.D. The Centre for Family Medicine 10B Victoria St. South Kitchener, ON N2G 1C5 (lee.linda.lw@gmail.com)

Abstract

Primary care–based memory clinics are attracting increasing interest because they present an opportunity to improve dementia diagnosis and management. In Ontario, more than 30 primary care setting participated in a training program aimed at assisting participants to establish an independent memory clinic in their practice setting. This article outlines the key lessons learned in implementing these clinics, on the basis of a study that – used an interview methodology with memory clinic team members and – identified facilitating factors, challenges, and suggestions for sustainability. Of key importance was access to training that facilitates knowledge transfer and supports practice change, interprofessional collaboration, and ongoing infrastructure support. Suggestions for clinic implementation and ongoing capacity building were identified. Lessons learned are applicable to the implementation of other chronic-disease care models aimed at improving the primary care management of complex chronic conditions.

Résumé

Cliniques de mémoire en soins de santé primaires suscitent un intérêt croissant, car elles offrent la possibilité d’améliorer le diagnostic et le traitement de la démence. En Ontario, plus de 30 établissements de soins primaires ont participé à un programme de formation visant à aider les participants à établir une clinique de mémoire indépendante dans leur milieu de pratique. Cet article présente les principales leçons acquises dans la mise en oeuvre de ces cliniques sur la base d’une étude qui a utilisé une méthodologie d’entrevue avec les membres des équipes de cliniques de mémoire et a identifié les facteurs favorables, les défis et les recommandations pour la soutenabilité. L’accès à la formation qui facilite le transfert des connaissances et soutient les changements dans la pratique, la collaboration interprofessionnelle, et le soutien de l’infrastructure en cours était d’une importance capitale. Des suggestions pour la mise en place de cliniques et de renforcement des capacités continues ont été identifiés. Les leçons apprises sont applicables à la mise en oeuvre d’autres modèles de prise en charge des maladies chroniques dont le but est la gestion des soins de santé primaires de maladies chroniques complexes.

Type
Articles
Copyright
Copyright © Canadian Association on Gerontology 2013 

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Footnotes

*

Funding for this study was provided by the Canadian Institutes of Health Research (Catalyst Grant Program: Primary and Community-Based Healthcare; Grant No. 212207).

References

Baeza, J., Bailie, R., & Lewis, J. M. (2009). Care for chronic conditions for indigenous Australians: Key informants’ perspectives on policy. Health Policy, 92, 211217.Google Scholar
Bardach, S. H., & Rowles, G. D. (2012). Geriatric education in the health professions: Are we making progress? The Gerontologist, 52, 607618.CrossRefGoogle ScholarPubMed
Barrett, J. J., Haley, W. E., Harrell, L. E., & Powers, R. E. (1997). Knowledge about Alzheimer disease among primary care physicians, psychologists, nurses, and social workers. Alzheimer Disease and Associated Disorders, 11, 99106.CrossRefGoogle ScholarPubMed
Borrill, C., West, M., Shapiro, D., & Rees, A. (2000). Team working and effectiveness in health care. Health Care Management, 6, 364371.Google Scholar
Bradford, M. A., Kunik, M. E., Schulz, P., William, S. P., & Singh, H. (2009). Missed and delayed diagnosis of dementia in primary care. Prevalence and contributing factors. Alzheimer Disease and Associated Disorders, 23, 306314.Google Scholar
Bradley, E. H., Holmboe, E. S., Mattera, J. A., Roumanis, S. A., Radford, M. J., & Krumholz, H. M. (2003). The roles of senior management in quality improvement efforts: What are the key components? Journal of Healthcare Management, 48, 1529.Google Scholar
Broad, M. L. (2005). Beyond transfer of training: Engaging systems to improve performance. San Francisco, CA: Pfeiffer.Google Scholar
Callahan, C. M., Hendrie, H. C., & Tierney, W. M. (1995). Documentation and evaluation of cognitive impairment in elderly primary care patients. Annals of Internal Medicine, 122, 422429.Google Scholar
Coleman, E. A., Grothaus, L. C., Sandhu, N., & Wagner, E. H. (1999). Chronic care clinics: A randomized controlled trial of a new model of primary care for frail older adults. Journal of the American Geriatrics Society, 47, 775783.Google Scholar
Davis, D. A., O’Brien, M. A., Freemantle, N., Wolfe, F. M., Mazmanian, P. E., & Taylor-Vaisey, A. (1999). Impact of formal continuing medical education: Do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? Journal of the American Medical Association, 282, 867874.CrossRefGoogle ScholarPubMed
Davis, D. A., O’Brien, Thomson, , M. A., Oxman, A. D., & Haynes, R. B. (1992). Evidence of the effectiveness of CME. Journal of the American Medical Association, 268, 11111117.Google Scholar
Diachun, L. L., Charise, A., & Lingard, L. (2012). Old news: Why the 90-year crisis in medical elder care? Journal of the American Geriatrics Society, 60, 13571360.Google Scholar
Epstein, R. M. (2013). Whole mind and shared mind in clinical decision-making. Patient Education and Counseling, 90, 200206.Google Scholar
Feldman, H. H., Jacova, C., Robillard, A., Garcia, A., Chow, T., Borrie, B., et al. (2008). Diagnosis and treatment of dementia: 2. Diagnosis. Canadian Medical Association Journal, 178, 825836.CrossRefGoogle ScholarPubMed
Fillit, H. (2007). Commentary on “The Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, 2006.” Clinical guidelines are not enough: System-wide, population-based programs are needed to improve the care of patients with Alzheimer’s disease and related dementias. Alzheimer’s & Dementia, 3, 441443.Google Scholar
Green, L. W. & Kreuter, M. W. (1991). Health promotion and planning. An educational and environmental approach. (2nd ed.) Toronto, ON: Mayfield Publishing.Google Scholar
Greening, L., Greaves, I., Greaves, N., & Jolley, D. (2009). Positive thinking on dementia in primary care: Gnosall Memory Clinic. Community Practitioner, 52, 2023.Google Scholar
Hogan, B. (2001). Human resources training and geriatrics. Geriatrics Today: Journal of the Canadian Geriatric Society, 4, 710.Google Scholar
Hollander, M. J., & Prince, M. J. (2008). Organizing health care delivery systems for persons with ongoing care needs and their families: A best practices framework. Healthcare Quarterly, 11, 4454.Google Scholar
Jolley, D., Benbow, S. M., & Grizzell, M. (2006). Memory clinics. Postgraduate Medical Journal, 82, 199206.CrossRefGoogle ScholarPubMed
Koch, T., & Iliffe, S. (2010). Rapid appraisal of barriers to the diagnosis and management of patients with dementia in primary care: A systematic review. BMC Family Practice, 11, 20.Google Scholar
Krueger, R., & Casey, M. A. (2000). Focus groups. (3rd ed.) Thousand Oaks, CA: Sage.Google Scholar
Lee, L., Hillier, L. M., Stolee, P., Heckman, G., Gagnon, M., McAiney, C., et al. (2010). Enhancing dementia care: A primary care-based memory clinic. Journal of the American Geriatrics Society, 58, 21972204.CrossRefGoogle Scholar
Lee, L., Kasperski, M. J., & Weston, W. W. (2011). Building capacity for dementia: Training program to develop primary care memory clinics. Canadian Family Physician, 57, e249e252.Google Scholar
Lee, L., Weston, W. W., & Hillier, L. M. (2013). Developing memory clinics in primary care: An evidence-based interprofessional program of continuing professional development. Journal of Continuing Education in the Health Professions, 33, 2432.CrossRefGoogle ScholarPubMed
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Newbury Park, CA: Sage.CrossRefGoogle Scholar
Lingard, L. (2012). Rethinking competence in the context of teamwork. In Hodges, B. D. & Lingard, L. (eds.), The question of competence. Ithaca, NY: Cornell University Press.Google Scholar
Lingard, L., Vanstone, M., Durrant, M., Fleming-Carroll, B., Lowe, M., Rashotte, J., et al. (2012). Conflicting messages: Examining the dynamics of leadership on interprofessional teams. Academic Medicine, 87, 17621767.Google Scholar
Morgan, D. G., Crossley, M., Kirk, A., D’Arcy, C., Stewart, N., Biem, J., et al. (2009). Improving access to dementia care: Development and evaluation of a rural and remote memory clinic. Aging and Mental Health, 13, 1730.Google Scholar
Nazerali, N. (2006). Maximizing available time. Family doctor’s challenges with dementia. Canadian Family Physician, 52, 157160.Google Scholar
Orchard, M., Green, E., Sullivan, T., Greenberg, A., & Mai, V. (2008). Chronic disease prevention and management: Implications for health human resources in 2020. Healthcare Quarterly, 11, 3843.Google Scholar
Patton, M. Q. (2002). Qualitative evaluation and research. Thousand Oaks, CA: Sage.Google Scholar
Pullon, S., McKinlay, E., Stubbe, M., Todd, L., & Badenhorst, C. (2011). Patients’ and health professionals’ perceptions of teamwork in primary care. Journal of Primary Health Care, 3, 128135.Google Scholar
Quality Improvement Innovation Partnership. (2009). Learning collaborative one. An improvement journey for primary healthcare teams. Retrieved 15 January 2013 from www.Qiip.ca.Google Scholar
Rampatige, R., Dunt, D., Doyle, C., Day, S., & van Dort, P. (2009). The effect of continuing professional education on health care outcomes: Lessons for dementia care. International Psychogeriatrics, 21, S34S43.Google Scholar
Rosser, W. W., Colwill, J. M., Kasperi, J., & Wilson, L. (2010) Patient-centered medical homes in Ontario. N Eng J Med 362(2), e7.Google Scholar
San Martín-Rodríguez, L., Beaulieu, M. D., D’Amour, D., & Ferrada-Videla, M. (2005). The determinants of successful collaboration: A review of the theoretical and empirical studies. Journal of Interprofessional Care, 19 (1 Suppl), 132147.Google Scholar
Scott, I. (2008). Chronic disease management: A primer for physicians. Internal Medicine Journal, 38, 427437.Google Scholar
Shahady, E. J. (2006). Barriers to care in chronic diseases: How to bridge the treatment gap. Consultant, 46, 11491152.Google Scholar
Smetanin, P., Kobak, P., Briante, C., Stiff, D., Sherman, G., & Ahmad, S. (2009). Rising tide: The impact of dementia in Canada in 2008 to 2038. Toronto, ON: Risk Analytica.Google Scholar
Tsasis, P. (2009). Chronic disease management and the home-care alternative in Ontario, Canada. Health Services Management Research, 22, 136139.Google Scholar
Van der Cammen, T. J., Simpson, J. M., Fraser, R. M., Preker, A. S., & Exton-Smith, A. N. (1987). The memory clinic: A new approach to the detection of dementia. British Journal of Psychiatry, 150, 359364.Google Scholar
Whitehead, C. (2007). The doctor dilemma in interprofessional education and care: How and why will physicians collaborate. Medication Education, 41, 10101016.CrossRefGoogle ScholarPubMed
Xyrichis, A., & Lowton, K. (2008). What fosters or prevents interprofessional team work in primary and community care? A literature review. International Journal of Nursing Studies, 45, 140153.Google Scholar