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OBJECTIVE: To measure clinical and qualitative outcomes in patients with diabetes mellitus transitioning from intensive insulin therapy using multiple daily injections (MDI) to continuous subcutaneous insulin infusion (CSII) initiated and managed by clinical pharmacists under a collaborative practice agreement in a primary care setting without an endocrinologist. RESEARCH DESIGN AND METHODS: This study was a retrospective and cross-sectional analysis of data from an electronic medical record (EMR) and patient survey at a large primary care private practice. Patients with type 1 or type 2 diabetes who were ≥18 years old, started on CSII between 2007 and 2010, and had at least one follow-up visit post-CSII were analyzed. Mean HbA1c results were stratified across 3-month intervals post-CSII initiation and compared to pre-CSII levels. Body mass index (BMI), the number of diabetes-related clinic visits with the primary care physician (PCP), and non-insulin diabetes medication use was compared pre- and post-CSII initiation. Paper-based questionnaires were used to assess patient satisfaction with CSII vs MDI and pharmacist-led services. RESULTS: Twenty-five patients were included in the analysis. HbA1c decreased from 8.69 to 7.52% pre and post-CSII, respectively (p < 0.001). HbA1c also decreased across all 3-month intervals post-CSII. BMI decreased from 33.0 to 32.3 kg/m(2) pre- and post-CSII, respectively (p = 0.085). Fewer diabetes-related PCP visits were completed post-CSII (5.09 vs 3.78 visits/year, p = 0.009), and less non-insulin diabetes medications were prescribed post-CSII (p < 0.001). Patients felt more comfortable controlling glycemic excursions and resultant insulin adjustments with CSII compared to MDI (p < 0.001). CONCLUSIONS: Pharmacist-led CSII services appear to improve diabetes control in patients requiring intensive insulin therapy. Patients report greater comfort using CSII and strong confidence in the abilities of the pharmacist. Physician-pharmacist collaboration in the management of intensive insulin therapy in the primary care setting should be further explored.

The federal program of deinstitutionalizing psychiatric facilities has resulted in a well documented, ever-increasing mentally ill population in the nation's prisons and jails. Historically, the criminal justice system has maintained a laissez-faire attitude toward the mentally ill, and only became involved with the mentally ill when a crime had been committed. As such, the President's Mental Health and Criminal Justice Consensus Project was developed to explore ways that the two systems could work together to address the growing problem of the mentally ill offender. However, challenges arise because the criminal justice system has typically been viewed as a loosely coupled, fragmented system that is unwilling or unable to address the social issue of the mentally ill offender. The concept of coupling between agencies has serious ramifications for the ability of agencies to successfully collaborate. Theoretical foundations for collaboration between mental health and criminal justice agencies lie partly in labeling theory and the drive to avoid the negative stigmatization of the mentally ill by the formal criminal justice system. A second theoretical foundation is found in developmental theories, which seek to explain the development of organizational knowledge and skills, in handling mentally ill offenders, through interaction between the mental health and criminal justice systems. In this study, it is asserted that agencies that are appropriately coupled and have experience with collaboration will perceive greater benefits from the collaborative exchange. Furthermore, this leads to the main hypothesis of the current study that agency coupling and collaborative experience will increase the perception of benefits of collaboration and support of collaborative efforts that deal with mentally ill offenders. To assess the main hypothesis of the current study, a modified Dillman methodology was utilized. The research population consisted of a complete enumeration of the 20 Florida State's Attorneys Offices, the 66 County Sheriffs, the 54 Probation Office Managers, and the 313 municipal law enforcement agencies for a total study population of 453 possible respondents, of which 49% responded. Overall, the findings of the current study illustrate a willingness of agencies to couple with outside agencies to address the phenomenon of the mentally ill offender. The results provide theoretical support for the need to reduce the negative stigma of a mentally ill individual being additionally labeled a criminal offender. The results additionally bolster the belief that the knowledge and skills to do this can best be accomplished through interaction with outside agencies.

Occupational therapy (OT) and applied behavior analysis (ABA) practitioners often collaborate when working with children and young adults with disabilities (McGinnis, 2013). OT and ABA practitioners are primed to collaborate due to many areas of overlap among each respective scope of practice; however, there is limited research to guide best practice for this collaborative partnership (Welch & Polatajko, 2016). According to a review of OT and ABA literature, in addition to the literature of other community-based, social services, and health care professions, there are four major barriers to interprofessional collaboration (IPC): (1) biases, (2) differing cultures, values, and professional languages, (3) overlaps in scopes of practice, and (4) poor communication and relationship-building skills (Kim et al., 2016; Peck & Norman, 1999; Rice et al., 2010). Due to a limited amount of accessible OT and ABA training interventions on collaboration, there is a need for an online, interactive, educational training to present evidence-based and theoretically-sound solutions for the barriers to collaboration. The proposed program is called Supporting Interprofessional Partnerships: An Educational Training for Collaboration Between Occupational Therapy and Applied Behavior Analysis Practitioners. The program’s educational content targets: (1) the definition, benefits, and barriers to IPC, (2) context-based information on ABA’s culture, values, professional language, and scope of practice, and (3) strategies to improve collaboration with ABA providers. Supporting Interprofessional Partnerships explores the working relationship between OT and ABA to improve collaboration as well as client, family, provider, and organizational outcomes.

INTRODUCTION: Interprofessional education (IPE) is the organized integration of health care disciplines. IPE provides an environment for students and faculty from multiple disciplines to learn collaboration and communication skills for future clinical practice. In the 1970s, United States health institutions began focusing on team-based health care and IPE. IPE was viewed as a solution to the growing burden of health care costs and the increasing ratio of diseases to available resources. IPE was formed around four competencies--Ethics, Communication, Teamwork, and Roles and Responsibilities--to provide students with the necessary tools to work efficiently in health care teams upon entering the workforce. FOCUS AND GOALS: USF Health currently has five major pre-professional disciplines on its campus--medicine, physical therapy, pharmacy, nursing, and public health. An IPE initiative began in 2010 in order to eventually integrate portions of all disciplines and their curricula. The central question of this thesis is, "Has there been a change within the student and faculty populations of USF Health in terms of IPE awareness and opinion since before the IPE initiative began in 2010?" This thesis aims to evaluate the changes in both student and faculty perspectives across several health disciplines at USF Health when compared to previously recorded perspectives from 2010. This information will be recorded to provide a guide for improving the current IPE initiative at USF Health. METHODS: Using data from a 2010 survey, the researchers created an updated survey and released it to the students and faculty of all five disciplines. The results provided a comparison for the original 2010 data. A general literature review was used to supplement the collected survey results and guide the analysis and discussion of data. Results: The qualitative data from the original student (n=29) and faculty (n=58) surveys was quantified and compared against the data from the updated student (n=83) and faculty (n=16) surveys. Several consistent themes were found in responses from selected questions. The following themes were found within the literature: student and faculty perspectives of IPE, barriers and opportunities to IPE, and implementation methods. CONCLUSION: The study found that changes in opinion occurred between both student and faculty participants. Both students and faculty showed an increase in IPE awareness and alluded to several barriers that were also found within the literature. This study will serve as a continued method of evaluating IPE at USF health in order to maintain a continued improvement of IPE implementation amongst all colleges. LIMITATIONS: The initial student data set was significantly smaller than the new student data set and represented a different distribution of disciplines. This may account for some of the changes observed between both groups and should be considered in any future analysis of this data. Because the data presented in this thesis project is a preliminary sample of the future, complete survey results, a follow-up analysis of the complete data will be required to draw any comprehensive conclusions from this study.

Syftet med studien var att undersöka socialsekreterares erfarenheter av interprofessionell samverkan med professioner från andra verksamheter. Informationen samlades in genom semistrukturerade intervjuer med sju socialsekreterare vid olika verksamheter inom en svensk region. Empirin analyserades med stöd av ett samverkansperspektiv, begreppen makt och handlingsutrymme samt tidigare forskning. Studiens dataanalys resulterade i tre teman; Samverkans betydelse, Försvårande faktorer, samt Förutsättningar för lyckad samverkan. En slutsats som dras är att resultatet till stor del bekräftar tidigare forskning om vad som kan påverka resultatet av interprofessionell samverkan, vilket innebär att en mängd olika faktorer samspelar för att påverka resultatet. / The aim was to study social workers experiences of interprofessional collaboration with professions from other organizations. The information was collected through semi-structured interviews with seven social workers working in different organizations in a Swedish county. The empirical data was analyzed using a collaborational perspective, the concepts professional authority and discretion as well as previous research. The data-analysis resulted in three themes; The Importance of Collaboration, Aggravating Circumstances, and Conditions for Successful Cooperation. One conclusion we make is that the shown results mostly confirm previous reasearch about what affects the result of interprofessional collaboration. This means that different factors contribute to the result.

Yes / Objectives The New Medicines Service (NMS) is provided by community pharmacists in England to support patient adherence after the initiation of a new treatment. It is provided as part of the National Health Service (NHS) pharmacy contractual framework and involves a three-stage process: patient engagement, intervention and follow-up. The study aims to explore community pharmacists’ experiences and perceptions of NMS within one area of the United Kingdom. Methods In-depth semi-structured telephone interviews were conducted with 14 community pharmacists. Interviews were audio-recorded, independently transcribed and thematically analysed. Key findings Pharmacists gave a mixed response to the operationalisation, ranging from positive opportunities for improving adherence and enhancement of practice to difficulties in terms of its administration. Pharmacists generallywelcomed opportunities to utilise their professional expertise to achieve better patient engagement and for pharmacy practice to develop as a patient resource. There was a perceived need for better publicity about the service. Different levels of collaborative working were reported. Some pharmacists were working closely with local general practices most were not. Collaboration with nurses in the management of long-term conditions was rarely reported but desired by pharmacists. Where relationships with general practitioners (GPs) and nurses were established, NMS was an opportunity for further collaboration; however, others reported a lack of feedback and recognition of their role. Conclusions Community pharmacists perceived the NMS service as beneficial to patients by providing additional advice and reassurance, but perceptions of its operationalisation were mixed.Overall, our findings indicate that NMS provides an opportunity for patient benefit and the development of contemporary pharmacy practice, but better collaboration with GPs and practice nurses could enhance the service.

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The need to incorporate interprofessional education (IPE) as part of any healthcare profession curricula is growing in an approach to prepare a collaborative practice-ready workforce. Pharmacy students should be equipped with the necessary competencies and skills needed for them to practise interprofessionally, commensurate with the expanding and evolving role of the pharmacist. Thus, the Qatar University College of Pharmacy has decided to incorporate IPE initiatives formally into the pharmacy curriculum in collaboration with other healthcare institutions in Qatar to meet the accreditation standards set by the Canadian Council for Accreditation of Pharmacy Programs (CCAPP) and fulfil the recommendations set in the World Health Organization (WHO) framework. To implement effective IPE strategies, it is important to consider the prior attitudes and expectations of various stakeholders in the process -- particularly students, faculty, and practising pharmacists. The overall aim of this PhD research is to explore the pharmacy perspectives of IPE and collaborative practice from a Middle Eastern context. The research started with a comprehensive systematic review of the literature focusing on the perspectives of pharmacy students, pharmacy faculty, and practising pharmacists on IPE and collaborative practice. Five themes have been identified from the systematic review: inconsistency in reporting IPE research, professional image of the pharmacist, lack of longitudinal follow-up, lack of IPE research on faculty, and lack of mixed method studies. This was followed by three sequential explanatory mixed method designs, to explore the perception of faculty, students, and practising pharmacists, individually. This was undertaken to gain an in depth understanding of the strengths and challenges of each group that can affect the implementation and perspectives toward IPE and collaborative practice. Two data collection methods were used: quantitative surveys and qualitative focus groups. Quantitative data were imported into SPSS® version 22 and analysed using both descriptive and inferential statistics. Qualitative data from the focus groups were analysed using thematic analysis. For the quantitative surveys, the overall response rate was 117 out of 334 (35%) for pharmacy faculty in the Middle East, 102/132 (77%) for pharmacy students in Qatar and 178/285 (63%) for practising pharmacists in Qatar. This was followed by seven focus groups with a total of 51 participants. Findings, from both the survey and focus groups, support that students, faculty and practising pharmacists are ready to engage in IPE and collaborative practice. The findings further identified positive attitudes that reinforce the need to incorporate IPE into healthcare curricula. They perceive anticipated benefits to them as professionals and to the patients. However, a large number of challenges have been highlighted, including the existence of a hierarchical culture, pharmacists’ role and image, a weak sense of professional identity among pharmacists, their marginalised contribution, resistance from the healthcare teams to the evolving role of the pharmacists, and the heterogeneous background of healthcare professionals. Promisingly, the education and healthcare system in Qatar is undergoing significant changes with some positive influences noted within education and practice settings. This is the first study investigating pharmacy perspectives of IPE in Qatar, the Middle East, and worldwide. The findings from this research generated a body of knowledge regarding the pharmacy perspectives of IPE and provided a better understanding of what shapes this perspective from a Middle Eastern context. The research presents a new model based on collective input, efforts, and readiness in five key stages: academic institution, faculty, student, practice, and environment. The model moves beyond focusing on the individual stages separately and expands to consider the complexity of linking and aligning the stages together. Coordinated efforts, between the stages, focused on a more comprehensive and holistic implementation, is essential for successful implementation of IPE and collaborative practice.