Innovations in oral health: A toolkit for interprofessional education

The integration of oral health competencies into non-dental health professions curricula can serve as an effective driver for interprofessional education (IPE). The purpose of this report is to describe a replicable oral-health-driven IPE model and corresponding online toolkit, both of which were developed as part of the Innovations in Oral Health (IOH): Technology, Instruction, Practice, and Service programme at Bouvé College of Health Sciences, Northeastern University, USA. Tooth decay is a largely preventable disease that is connected to overall health and wellness, and it affects the majority of adults and a fifth of children in the United States. To prepare all health professionals to address this problem, the IOH model couples programming from the online resource Smiles for Life: A National Oral Health Curriculum with experiential learning opportunities designed for undergraduate and graduate students that include simulation-learning (technology), hands-on workshops and didactic sessions (instruction), and opportunities for both cooperative education (practice) and community-based learning (service). The IOH Toolkit provides the means for others to replicate portions of the IOH model or to establish a large-scale IPE initiative that will support the creation of an interprofessional workforce—one equipped with oral health competencies and ready for collaborative practice.     

Understanding faculty perspectives of supports and barriers to interprofessional collaboration within a clinical scholars program: A qualitative study

AimThis study explores the faculty perspective of an interprofessional clinical scholars program to identify recommendations for strengthening team collaboration between academia and clinical practice.BackgroundInterprofessional evidence-based practice, pairing higher education and clinical practice, is a critical part of nursing education.DesignThis qualitative study consisted of two phases of participant engagement, in both data collection and data analysis.MethodsSpecifically, faculty participated in a focus group discussion followed by a card sort of initial codes.ResultsThe major themes identified are Unifying the Team and Navigating Layers of Challenge, encompassing concepts of teamwork and programmatic context that supported or disrupted interprofessional collaboration. This study affirms the importance of role clarity, connectedness, intentionality and continuity within clinical teams. Moreover, faculty identified barriers to teamwork based on workload, leadership turnover and constraining environmental forces.ConclusionsRecommendations for effective teamwork in an interprofessional setting will strengthen future collaboration between higher education and clinical settings.     

Development and evaluation of an interprofessional seminar pilot course to enhance collaboration between health professions at a student-run clinic for underserved populations

ABSTRACT

This report describes the development and evaluation of an interprofessional pilot course aimed at health science students. The course was developed through collaboration of three health professions: Dentistry, Kinesiology, and Pharmacy. The coursework comprised of traditional lecture-based learning, interprofessional experiential education through four on-site visits at two area clinics that participate in team-based care, four student self-reflections following each site visit, and demonstration of interprofessional education and collaboration (IPEC) competencies through student evaluation of current interprofessional care at those existing clinics with a component for key improvement intervention. The study aims include evaluating both the course’s effectiveness and quality in increasing student preparedness for interprofessional practice and its ability to enhance collaboration between health professions at two area clinics. Methods of evaluation include the Interprofessional Collaborative Competency Attainment Survey (ICCAS) instrument, pre- and post- course surveys, and course evaluation survey. The results show that students felt their knowledge and skills increased across the four IPEC core competency domains: interprofessional communication, values and ethics, roles and responsibilities, and team and teamwork. We suggest that using an integrated course framework is an effective measure in enhancing interprofessional education (IPE) outcomes.     

Education-service partnership to promote best practices in a latent tuberculosis infection program

The education-service partnership described addresses the challenges presented to local health departments and public health nurses in completing required latent tuberculosis (LTBI) follow-up in population groups. A service learning partnership between the local health department and a Midwestern university school of nursing resulted in the development of an LTBI follow-up program that completed contacts with 193 subjects. Populations served by the program included immigrants to the community and workers from several occupational settings. Outcome data from the project included recommendations for the management of the information database for local health department LTBI follow-up. Nursing students gained an appreciation for the complexities involved in TB surveillance, and improved their cultural competence in the interface with Latino, African, and East European immigrant populations. Students gained first-hand experience with the current health care system, which resulted in communication challenges between health care providers and economic barriers in compliance with the CDC protocol for LTBI follow-up. The program demonstrated a successful partnership between service and education with positive results for the LTBI clients and the local health department nurses.     

Partnership to promote interprofessional education and practice for population and public health informatics: A case study

Abstract

Team-based healthcare delivery models, which emphasize care coordination, patient engagement, and utilization of health information technology, are emerging. To achieve these models, expertise in interprofessional education, collaborative practice across professions, and informatics is essential. This case study from informatics programs in the Academic Health Center (AHC) at the University of Minnesota and the Office of Health Information Technology (OHIT) at the Minnesota Department of Health presents an academic–practice partnership, which focuses on both interprofessionalism and informatics. Outcomes include the Minnesota Framework for Interprofessional Biomedical Health Informatics, comprising collaborative curriculum development, teaching and research, practicums to promote competencies, service to advance biomedical health informatics, and collaborative environments to facilitate a learning health system. Details on these Framework categories are presented. Partnership success is due to interprofessional connections created with emphasis on informatics and to committed leadership across partners. A limitation of this collaboration is the need for formal agreements outlining resources and roles, which are vital for sustainability. This partnership addresses a recommendation on the future of interprofessionalism: that both education and practice sectors be attuned to each other’s expectations and evolving trends. Success strategies and lessons learned from collaborations, such as that of the AHC-OHIT that promote both interprofessionalism and informatics, need to be shared.     

Exploring the role of advanced clinical practitioners (ACPs) and their contribution to health services in England: A qualitative exploratory study

BackgroundAn extended role being explored globally is the advanced clinical practitioner (ACP). In England this is an extended role for allied health professions, nurses and midwives in a range of settings.ObjectivesThis paper focuses on three research questions: 1) What is the role of ACPs in England? 2) What are the barriers and facilitators to implementing the role? and 3) What is the contribution of ACPs to health services in England?Design/settingA qualitative, exploratory study to explore perspectives on the ACP role in a range of clinical settings.ParticipantsWe recruited 63 stakeholders, including 34 nurses, working in a ACP role or ACP education. A purposive snowball sampling technique identified participants meeting inclusion criteria.MethodsOne-to-one semi-structured interviews throughout 2020, recorded and transcribed verbatim, anonymised and thematically analysed.ResultsThe ACP role in England was undertaken in a broad range of clinical contexts. In England ‘advanced clinical practitioner’ was not a protected title. There were high levels of variability and ambiguity of understanding and deployment of the ACP role in England. Facilitators to the implementation process included training and education, clinical supervision and organisational support. Lack of protection for the role and variances in experience were barriers. Employer support facilitated development of the ACP role, however where support was limited, at either an individual or organisation level, this was a barrier. Our study highlighted the wide range of ways the ACP role benefitted patient outcomes and workforce development.ConclusionsThis study outlines the contribution that ACPs can make to health services, contributing factors and key barriers and facilitators to implementing this role. The work showed the positive contribution ACPs can make to service redesign, workforce development and patient outcomes, whilst accepting there is much work to do to ensure protected status and parity across all professions and clinical contexts     

A systematic review of the effects of interprofessional education on staff involved in the care of adults with mental health problems

Interprofessional education (IPE) is commonly advocated in policy documentation as a means of enhancing collaboration between heath and social care staff. However, little is known about the effects of this type of education. This paper reports findings from a systematic review which was commissioned to search and begin assessing the quality of the published evidence relating to the effects of IPE on staff involved in the care of adults with mental health problems. Results from this study indicate that there is a current lack of rigorous evidence into the effects of IPE in this field. Conclusions from this work are made in connection to mental health policy and recommendations are offered for strengthening the evaluation of IPE.     

Evaluation of a midwifery initiated oral health-dental service program to improve oral health and birth outcomes for pregnant women: A multi-centre randomised controlled trial

BackgroundOral health care during pregnancy is important for the health of the mother and child. However, pregnant women have limited knowledge about maternal oral health and seldom seek dental care. Further, due to limited training antenatal care providers like midwives rarely discuss oral health with pregnant women. The Midwifery-Initiated Oral Health Dental Service program was developed to address current gaps in oral promotional interventions during pregnancy.ObjectivesTo assess the effectiveness of a Midwifery-Initiated Oral Health Dental Service program in improving uptake of dental services, oral health knowledge, quality of oral health, oral health status and birth outcomes of pregnant women.DesignMulti-centre randomised controlled trial.SettingThree large metropolitan public hospitals in Sydney, Australia.ParticipantsPregnant women attending their first antenatal appointment who were at least 18 years old and had a single low risk pregnancy between 12 and 20 weeks gestation.Methods638 pregnant women were allocated to three groups using block randomisation (n = 211) control group, intervention group 1 (n = 215), intervention group 2 (n = 212) and followed up till birth. Study investigators and data collectors were blinded to group allocation. Intervention group 1 received a midwifery intervention from trained midwives involving oral health education, screening and referrals to existing dental pathways. Intervention group 2 received the midwifery intervention and a dental intervention involving assessment/treatment from cost free local dental services. The control group received oral health information at recruitment. Primary outcome was uptake of dental services. Secondary outcomes included oral health knowledge, quality of oral health, oral health status and birth outcomes.ResultsSubstantial improvements in the use of dental services (20.2% Control Group; 28.3% Intervention group 1; 87.2% Intervention group 2; Odds Ratio Intervention group 2 vs Control Group = 29.72, 95% CI 15.02–58.53, p < 0.001), women’s oral health knowledge (p = 0.03); quality of oral health (p < 0.001) and oral health outcomes (sulcus bleeding, dental plaque, clinical attachment loss, decayed/filled teeth- p < 0.001) were found in Intervention group 2. No difference in the rate of preterm or low-birth weight was found.ConclusionsThe Midwifery-Initiated Oral Health Dental Service program (Intervention group 2) improved the uptake of dental services and oral health of pregnant women and is recommended during antenatal care. A cause and effect relationship between this intervention and improved birth outcomes was not supported.     

Reducing Ventilator Associated Pneumonia in the NICU through oral care education: A quality improvement project

BackgroundInadequate oral care in the Neonatal Intensive Care Unit (NICU) can lead to Ventilator Associated Pneumonia (VAP). VAP rate was reported at 2.52 per 1000 ventilator days for the 12 months prior to intervention. A root cause analysis of VAPs during this period revealed only 70% compliance with oral care. VAP contributes to higher costs for the hospital, patient pain and suffering, morbidity and mortality, length of time on mechanical ventilation and increased hospital length of stay. This Quality Project aims to reduce VAP in the NICU through multidisciplinary re-education on the importance of oral care, and fostering an interdisciplinary oral care team of Respiratory Therapists and Registered Nurses.MethodAn IRB approved interventional pre and post intervention review of VAP rate was conducted on intubated neonatal patients from June 1, 2015–May 31, 2017. Intervention consisted of education perform as an interdisciplinary oral care team. Education was coordinated between Respiratory (RT) and Nursing (RN) educators, Lactation, and unit leaders to ensure standardized education to all staff. An oral care poster was created and presented to both RT and NICU RN staff at department meetings. An oral care PowerPoint was created and sent to all NICU RN's and was required as annual mandatory education for all RT's. Encouragement was provided through random chart audits from June 2016–May 2017, praising staff that coordinated care, and reminding staff who did not through friendly face to face interaction and email of the importance of routine, coordinated oral care.ResultsNICU VAP rates dropped during June, and came back up in July 2016 and dropped again in March 2017. Chart review revealed insufficient oral care (72% and 78%) in the two days prior to VAP events. Oral Care poster and education were re-introduced in August 2016 and April 2017. NICU VAP rates post intervention, June 2016–May 2017, was reported as 0.78 per 1000 ventilator days.ConclusionsIdentifying the primary factor through VAP root cause analysis made us aware of a VAP bundle component that was not being routinely followed. Having identified oral care as a problem in our unit enabled us to form an educational intervention with a standardized oral care technique that was effective in increasing the frequency and efficacy of oral care. Utilizing a multidisciplinary team for oral care fosters a sense of importance and responsibility to the staff and improved collaboration in care.     

A model (CMBP) for collaboration between university college and nursing practice to promote research utilization in students' clinical placements: A pilot study

BackgroundA collaborative project was initiated in Norway between a university college and a hospital in order to improve RNs' and nursing students' research utilization in clinical placements. This paper describes the model (CMBP) that was developed, its first application, and evaluation.AimThe evaluation aimed at describing nurses' and students' experiences of the CMBP related to collaboration, facilitation, learning, and impact on nursing care.MethodsThirty-eight students from the second and third year of nursing education, and four nurses answered questionnaires with closed and open ended questions. In addition two of the nurses wrote diaries. Data were subjected to qualitative and quantitative analysis.FindingsAlmost all participants reported that collaboration between nursing college and nursing practice had been beneficial. Most students and all nurses reported about valuable learning, increased understanding of research utilization, and improved quality of nursing care. Both students and RNs recommended the CMBP to be used in all clinical placements to support academic learning and increase research utilization in clinical practice.ConclusionDespite study limitations the findings indicate that the CMBP has a potential to be a useful model for teaching RNs' and students EBP. However, further refinement of the model is needed, followed by a more comprehensive implementation and evaluation.     

Advocacy and actions to address disparities in access to genomic health care: A report on a National Academies workshop

BackgroundIn the United States, access to genomic risk assessment, testing, and follow up care is most easily obtained by those who have sufficient financial, educational, and social resources. Multiple barriers limit the ability of populations without those resources to benefit from health care that integrates genomics in assessment of disease risk, diagnosis, and targeted treatment.PurposeTo summarize barriers and potential actions to reduce genomic health care disparities.MethodSummarize authors' views on discussions at a workshop hosted by the National Academy of Medicine.DiscussionBarriers include access to health care providers that utilize genomics, genetic literacy of providers and patients, and absence of evidence of gene variants importance in ancestrally diverse underserved populations.ConclusionEngagement between underserved communities, health care providers, and policy makers is an essential component to raise awareness and seek solutions to barriers in access to genomic health care for all populations.     

Commentary: Statistical significance and clinical significance - A call to consider patient reported outcome measures,effect size,confidence interval and minimal clinically important difference (MCID)

In healthcare research an intervention may be statistically significant based on quantitative analysis; however, simultaneously it may be relatively insignificant to the health or quality of life of patients affected by a particular condition or disease being treated by the intervention – thus may be interpreted as having low clinical significance. An understanding of statistics is fundamental for evidence informed healthcare. Patient-reported outcome measures (PROMs) direct patients to evaluate aspects of their own health, including quality of life, disability and function. Data obtained from PROMs can be used to demonstrate the impact of healthcare interventions on these elements of a person's quality of life. To interpret outcome measure data for clinical decision making, a clinician must understand the concepts of statistical significance and clinical significance. This commentary explores the concepts of patient reported outcome measures (PROMs), their statistical and clinical significance, and explores their relationship with a practical example for the clinician. Limitations of research that only reports p-values and the need to consider effect size, confidence intervals, and minimal clinically important difference are also discussed. Together, these concepts can assist the clinician to evaluate whether an intervention may be suitable for their clinical practice.     

Association Between Clinical Tests Related to Motor Control Dysfunction and Changes in Pain and Disability After Lumbar Stabilization Exercises in Individuals With Chronic Low Back Pain

ObjectiveTo investigate whether clinical tests used to detect motor control dysfunction can predict improvements in pain and disability in patients with chronic nonspecific low back pain (LBP) who have undergone an 8-week lumbar stabilization exercise program.Study DesignA prospective cohort study.SettingOutpatient physical therapy university clinic.ParticipantsSeventy people with chronic nonspecific LBP were recruited, and 64 completed the exercise program (N=64).InterventionsThe lumbar stabilization program was provided twice a week for 8 weeks.Main Outcome MeasuresPain intensity (11-point numerical rating scale) and disability (Roland Morris Disability Questionnaire) and clinical tests, such as the Deep Muscle Contraction (DMC) scale, Clinical Test of Thoracolumbar Dissociation (CTTD), and Passive Lumbar Extension (PLE) test. Univariate and multivariate linear regression models were used in the prediction analysis.ResultsMean changes in pain intensity and disability following the 8-week stabilization program were ?3.8 (95% confidence interval [CI], ?3.2 to ?4.4) and ?7.4 (95% CI, ?6.3 to ?8.5), respectively. Clinical test scores taken at baseline did not predict changes in pain and disability at 8-week follow-up.ConclusionOur findings revealed that the DMC scale, CTTD, PLE test, clinical tests used to assess motor control dysfunction, do not predict improvements in pain and disability in patients with chronic nonspecific LBP following an 8-week lumbar stabilization exercise program.