Enhancing interdisciplinary primary care teams: The role of the Da Vinci clinical information system 1. Solidage McGill University-Université de Montréal Research Goup on Frailty, chronic diseases and Aging, McGill University, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada 2. Desautels Faculty of management, McGill University, Montreal, Quebec, Canada 3. Université de Montréal, Montreal, Quebec, Canada 4. Équipe de recherche en soins de première ligne. Centre de Santé et des Services Sociaux de Laval, Québec, Canada RESULTS METHOD CONTEXT Healthcare systems face two major challenges  A growing elderly population  An increasing number of patients with multiple chronic diseases (MCD) Multimorbidity is becoming the “rule rather than the exception”  The number of patients suffering from MCD keeps increasing  About 75% of patients who are 65+ suffer from at least one chronic health condition; of those 42% have MCD Interdisciplinary primary care (PC) teams are necessary to deal with the complexity of care for multimorbid patients  Unfortunately, interdisciplinary practices are difficult to implement Clinical information systems (CIS) are considered useful to support these practices  However, little is known about the impacts of CIS on interdisciplinary practices OBJECTIVES 1.To better understand the nature of interdisciplinary collaboration in the context of the use of a CIS in primary care 2.To develop a taxonomy of the dimensions encompassing interdisciplinary practices in PC 3.To determine the perceived impacts of a CIS (Da Vinci) implementation on interdisciplinary practices DESIGN  Qualitative longitudinal study using a Grounded Theory Approach SETTING  Two Family Medicine Groups in Quebec (Canada) where Da Vinci was introduced PARTICIPANTS  All family physicians, residents, nurses and pharmacists were invited to participate  31 participants (17 PC physicians, 6 residents, 5 nurses, 3 pharmacists) DATA COLLECTION AND ANALYSIS  Data collection: Triangulation - individual semi-structured interviews, documentation and observation  Recorded and transcribed verbatim  Analysis: Open, axial, selective coding. CONCLUSION A better understanding of the impacts of a CIS on interdisciplinary practices helps determine how to best encourage PC clinicians to develop efficient PC teams in order to improve quality of care for their patients with chronic diseases. Acknowledgements: CIHR, CCRGT and the Kaufmann Chair of Geriatric Medicine McGill University-Université de Montréal Research Goup on Frailty, Chronic Diseases and Aging PARTICIPANTSFMG 2 (N=10)FMG 1 (N=21)TOTAL (N=31) Family Physicians Clinic Staff 8 Users 6 Non users 2 9 Users 7 Non users 2 17 Residents 6 Users 6 Nurses 2 Users 3 Users 5 Pharmacists3 Users 3 DA VINCI CIS FUNCTIONALITIES Traditional CIS features  Problem list of all of a patient’s active chronic problems  Medication e-prescriber  Patient socio-demographic information  Patient past medical, surgical history and family history  Allergies, smoking status, alcohol use, drug use, level of physical activity  Encounter notes using the SOAP system (Subjective, Objective, Analysis, Plan)  Calculators (BMI; Framingham Cardiovascular Risk; Renal Function, etc.) Innovative CIS features that support interdisciplinary-team functioning and patient self-care  CASE classification (Convince, Action, Support, Empower) so team always shares knowledge about patient readiness for action for each chronic problem  Explicit patient-centered treatment-goal setting. Automated guideline-consistent goals proposed for each chronic problem, which can be altered to fit patient’s personal goals  Reasons for care gap when treatment goal is not achieved enabling team members to document why and keep the team informed  Tailored clinical guideline-based checklists of clinical tasks for timely integrated provision of preventive and chronic care for all chronic problems identified. These clinical tasks may be performed by a nurse, physician or pharmacist and appear as reminders for team members at the point of care  Decision-support tools, such as anticoagulation-adjustment protocol TEAM WORK PROCESSES Increased communication  Easier access to information  Timely communication Improved care coordination  Systematic follow-up  Management of patients’ trajectories Clear decision making process  Priority setting  But important decisions are still made on a face-to-face basis Sharing of responsibilities and tasks between healthcare professionals  CIS allow nurses and pharmacists to provide evidence about their role in PC teams  Physicians’ confidence in nurses’ competencies (e.g. decision support system structure nurses’ practices) Trust and quality of relationship are necessary predisposing factors TEAM COHESION Team identity Commonality of goals between the physician, the nurse and the patient TEAM PREFORMANCE Standardisation of practices Perceived ability to meet patients’ needs I Vedel, 1,2 L Lapointe, 1,2 MT Lussier, 3,4 A Turcotte, 3,4 C Richard, 4 J Goudreau, 3,4 L Lalonde. 3,4