The World Health Organization (WHO, 2010) defines interprofessional collaborative practice (IPCP) as happening "when multiple health workers from different professional backgrounds work together with patients, families, carers, and communities to deliver the highest quality of care." To successfully implement, IPCP requires: 1) supportive management practices (e.g., providing adequate time, training space and a nurturing collaboration), 2) champions, 3) embracing culture change, 4) revising existing policies, and 5) eliminating barriers.
The American Physical Therapy Association (APTA, 2019) is committed to the integration of IPCP, and home healthcare clinicians are optimally positioned to be leaders in this area. Evidence suggests significant improvements in patient outcomes, patient satisfaction, and increased healthcare worker commitment and confidence in patient-centered care when a culture of IPCP is practiced.
There are three key components to the development and sustainability of an IPCP program in home healthcare (Figure). They include: 1) Knowledge and integration of the four core competencies of interprofessional education; 2) Interprofessional shared decision-making; and 3) Interprofessional professionalism.
The four core competencies of the Interprofessional Education Collaborative include: 1) Values and ethics, 2) Roles and responsibilities, 3) Interprofessional communication, and 4) Teams and teamwork. Shared decision-making is ideal for situations that bring the patient, carers, and the healthcare team together to create the plan of care. According to Dogba et al. (2020), interprofessional collaboration in home care is critical in establishing shared understandings of seniors' complex health needs and providing comprehensive, patient-centric care.
The interprofessional shared decision-making approach is very applicable to home care, where multiple members of the team collaborate with older adults to discuss options, evaluate risks, and make decisions based on best options and patient preferences. Clinicians require training in shared decision-making if it is to be successful. This training needs to incorporate role clarification for team members, interprofessional conflict resolution, shared leadership, and embracing team dynamics.
Interprofessional professionalism is defined as "consistent demonstration of core values evidenced by professionals working together, aspiring to and wisely applying. principles of altruism, excellence, caring, ethics, respect, communication, and accountability to achieve optimal health and wellness in individuals and communities" (Interprofessional Education Collaborative [IPC], 2016). The APTA is a founding member of the IPC, endorsing this initiative and its vision.
A palliative home care setting was utilized by Shaw et al. (2016) to analyze participants' accounts and provide recommendations regarding two strategies for interprofessional team building. The first strategy involves providing time, opportunities to collaborate, and a supportive environment for the team to learn about roles and responsibilities of the palliative care team. The second key strategy was to eliminate professional hierarchies through empowering providers to share power among team members, building trust and partnerships to improve team-based care.
As physical therapists, it is incumbent upon us to lead the way to bring IPCP to our organizations. Be proactive in helping to create educational opportunities for colleagues and exhibit the behaviors of IPCP in every encounter of care so we can create a practice revolution!
Lower Wealth Linked With Faster Physical and Mental Aging
NIH: People with lower household wealth have a higher risk of many diseases, including heart disease, diabetes, depression, and shorter lifespans. Some lifestyle factors may play a role. For example, people with lower incomes have higher rates of smoking. However, other factors-including chronic stress and reduced access to resources-also likely contribute.
Less is known about how socioeconomic status influences the general aging process. To look more closely at this question, Drs. Andrew Steptoe and Paola Zaninotto from University College London followed more than 5,000 adults, aged 52 and older, for 8 years beginning in 2004. The team broke the study participants into four groups based on household wealth. The researchers measured 19 different outcomes in six domains: physical capabilities, hearing and vision, inflammation and organ health, cognitive functioning, emotional well-being, and social engagement. They then compared changes in these health domains over time between the four groups.
Differences in health between the groups were seen in all the domains over time. All four measures of physical capability declined more in the groups with less wealth. For example, people in the lowest wealth group had a 38% greater reduction in walking speed over 8 years compared to those with the highest wealth. Almost 16% of people in the lowest wealth group reported developing problems with vision over the course of the study, compared to about 10% of people in the wealthiest group. The groups with lower wealth showed higher levels of inflammation markers over time and greater decline in lung function.
People in all the groups showed a drop in cognitive function over the course of the study. However, larger reductions were seen in the group with the least wealth. People with less wealth also reported greater reductions in their enjoyment of life over time and more symptoms of depression. People with more wealth were more likely to keep up with social activities, including volunteering and maintaining friendships. The declines seen were independent of participants' age, gender, ethnicity, or education received, and whether or not they had grown up in poverty.
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