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Building Interprofessional Collaborative Practices Through a Support Program for Patients With Type 2 Diabetes in
Noura Bawab1, Joanna Moullin, Sébastien Jotterand
1Dr. Bawab: Research fellow, Center for Primary Care and Public Health (Unisanté), Department of ambulatory care, University of Lausanne, Lausanne, Switzerland; and Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland; and School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland; Dr. Moullin: Senior Research Fellow, Faculty of Health Sciences, School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, Australia; Mr. Jotterand: General practitioner, Médecins de famille et de l'enfance Suisse, Zürich, Switzerland; and Sispha SA, Ofac, Lausanne, Switzerland. Mr. Rossier: Pharmacist, Sispha SA, Ofac, Lausanne, Switzerland. Prof. Schneider: Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland, and Medication adherence and Interprofessionality lab, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland; Dr. Perraudin: Health economist, Center for Primary Care and Public Health (Unisanté), Department of ambulatory care, University of Lausanne, Lausanne, Switzerland; and Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland; and School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
Introduction:
The building of interprofessional collaborative practices throughout the implementation process of a patient support program (Siscare) in primary care for patients with type 2 diabetes was assessed. Siscare included regular patient-pharmacist motivational-based interviews; medication adherence, patient-reported, and clinical outcomes monitoring; and physician-pharmacist interactions.
Method:
This investigation was a prospective, multicenter, observational, mixed-methods cohort study. Interprofessionality was operationalized through four progressive levels of interrelationship practices between the health care professionals. The target number of patients per pharmacy was 10 among 20 pharmacies.
Results:
The project started with the recognition of Siscare by stakeholders, the creation of an interprofessional steering committee, and the adoption of Siscare by 41 pharmacies among 47 pharmacies in April 2016. Nineteen pharmacies presented Siscare at 43 meetings attended by 115 physicians. Twenty-seven pharmacies included 212 patients; however, no physician prescribed Siscare. Collaboration primarily occurred through the unidirectional transmission of information from the pharmacist to the physician (level 1: 70% of pharmacists transmitted interview reports to physicians), bidirectional exchange of information sometimes occurred (level 2: 42% received physician responses), and concerted measures of treatment objectives took place occasionally (level 3). Twenty-nine of 33 physicians surveyed were in favor of this collaboration.
Discussion:
Despite multiple implementation strategies, physician resistance and lack of motivation to participate exists, but Siscare was well received by pharmacists, patients, and physicians. Barriers to collaborative practice (financial and IT) need to be further explored. Interprofessional collaboration is a clear need to improve type 2 diabetes adherence and outcomes.
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