ABCs of Interprofessional Education in a teaching PCMH FQHC STFM Annual Conference ~ May 1, 2016 A. Ildiko Martonffy, MD Meghan Fondow, PhD Nora Groeschel, PharmD, RPh Mary Vasquez, APSW Jessica O'Brien, MD

Objectives Describe the fundamental importance of shared vision and a unified mission when utilizing an interprofessional education model in a clinical setting List the ABCs of interprofessional education presented in this model (Access, Buy-in, Co-ownership with Clear roles) and describe how they could be achieved in your own clinic setting Compare and contrast the current status of interprofessional education in your practice site with your ideal model and list one action step that will move your practice site toward your ideal

Background: Benefits Increased comfort with providing team-based care o Building the multidisciplinary mindset Improved interprofessional communication and collaboration Enhanced patient safety

Barriers Limited communication ~ access or practice style Unclear boundaries Poor understanding of roles

Our set up

BHC Team Behavioral Health Consultant (BHC) o A team of mental health providers integrated within primary care using the Primary Care Behavioral Health model o Work in collaboration with medical providers, nurses, support staff, clinic manager, and pharmacy Role as Consultant o Warm hand-offs o Curbside consults o Member of care team

Pharmacist team - overview History of Clinic Pharmacist Role o Started in 1982 – responsibilities have varied o Involvement from School of Pharmacy faculty and UW Health Ambulatory Pharmacy Department Current model o Responsibilities: Refill requests Prior Authorizations Consultant to prescribers and support staff o Paid for by the Department of Family medicine Pharmacy is in the SAME building as clinic

Pharmacists team - impact Potential areas for impact: o Adherence o Options for patient specific factors: Dexterity needed for devices, especially medications in pen devices Visual concerns for glucometer/insulin vial use Lung function required for certain inhalers o Knowledge of options for compounded or specialty medications o Comprehensive profile review o Clinic staff education New medications or guidelines Interpreting messages from pharmacies Efficient completion of prior authorizations

Pharmacist team - challenges Health system might not have ambulatory department Pharmacy may not be in close proximity to clinic Pharmacy workloads vary Funding might not exist for RPh involvement Outcomes of RPh interventions can be difficult to track Vision for RPh role in clinic differs between RPh and clinic staff

Pharmacist team – implementation Identify area(s) for improvement within current model Reach out o Health system pharmacy department (Inpatient) May have pharmacy resident to pilot a program Capacity or interest might already exist might have capacity and/or interest o Small chains and independent pharmacies Greater focus on patient care and outcomes May have greater capacity within current model Payers in the area may offer reimbursement for patient care activities Pharmacy may already have programs in place Adopt team mentality and communicate with RPh – important to have 2 way communication

Framework for Success Access Buy-in Co-ownership and Clear Roles

Problem Solving

White Hat White Hat What do we know about the status of interprofessional education in our practice settings? What do we need to find out? How will we get the information we need?

Yellow Hat Yellow Hat What are the potential benefits? What are some logical reasons this may work in our own institutions? Who might my allies be?

Black Hat Black Hat What are some cautions to consider? Barriers? Risks?

Red Hat Red Hat Will this work for me? What’s my intuition? How will others at my institution feel about this? Who would champion this?

Blue Hat Blue Hat What thinking and planning is needed to formulate next steps? Who are my stakeholders in this and how can I approach them?

Green Hat Green Hat What are some ideas, alternatives, or possibilities for how this might look at my institution?

Group discussion What is one step you can take now to move your practice toward your ideal model?

Questions?

References Reeves S, Zwarenstein M, Goldman J, Barr H, et al. Interprofessional education: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.:CD002213