Evidence-Based Practice Change: Implementation of a Collaborative Practice Model for Diabetes

11.00
Hdl Handle:
http://hdl.handle.net/10755/622571
Category:
Full-text
Format:
Text-based Document
Type:
DNP Capstone Project
Level of Evidence:
Other
Research Approach:
Translational Research/Evidence-based Practice
Title:
Evidence-Based Practice Change: Implementation of a Collaborative Practice Model for Diabetes
Author(s):
Edwards, Emma L.
Additional Author Information:
Emma L. Edwards, MSN, FNP-C, email: emmaleds@gmail.com
Advisors:
Watkins, Katherine Dolan
Degree:
DNP
Degree Year:
2017
Grantor:
Northern Arizona University
Abstract:

Background: The prevalence of type II diabetes mellitus (T2DM) in the United States is high, especially in underserved populations. Many patients with T2DM do not receive the optimal interprofessional collaborative care that has been shown to improve outcomes. A model of care that incorporates these evidence-based recommendations is integral to improving the quality of diabetes care. A growing body of literature identifies the use of a provider-clinical pharmacist collaborative practice (P-CPCP) model of care as an effective, innovative, and evidence-based practice that will improve patient outcomes.

Purpose: In response to an identified need to improve T2DM patient care in an urban community health clinic (CHC), the purpose of this project was to implement a P-CPCP model of care. The expected outcomes included (a) increase the number of patients with T2DM that are referred to a clinical pharmacist; (b) improve provider satisfaction with the collaborative process; and (c) implement the P-CPCP model of care across all CHC agency clinics in the network to ensure the delivery of high-quality, evidence-based patient care.

Design and Analysis: A quality improvement (QI) design was used and incorporated a rapid improvement cycle of plan-do-study-act (PDSA). After identification of a gap in care and analysis of the evidence, the QI project was created. A provider education module was presented and followed by a chart audit of electronic medical records (EMR) of patients with T2DM. These charts were examined to determine pre- and post-implementation usage of the model. Provider satisfaction and perceived effectiveness of the P-CPCP model was assessed using a brief electronic survey. Descriptive statistics and a cross tabulation analysis are presented to show the effectiveness of the model for increasing the number of referrals to the clinical pharmacist and the number of patients seen by the clinical pharmacist in both pre and post groups, as well as to describe the most used pharmacist interventions and provider perceptions of the model.

Results: The P-CPCP model increased utilization of the clinical pharmacist in diabetes care. Following implementation of the model referrals increased by 210%. The provider survey demonstrated an increase in provider satisfaction with collaboration, the usefulness of the model, and sustainability of the model. Of the pharmacist interventions, medication reconciliation education (MRE) was perceived as the most frequently used.

Conclusions: This doctor of nursing practice (DNP) project reflects evidence-based practice methods on interprofessional collaboration and provides new insight into the implementation of a collaborative practice model and the role of the clinical pharmacist as a valued member of the collaborative team. Consistent use of the P-CPCP model of care improved provider satisfaction with the collaborative process, increased the number of patients referred to the clinical pharmacist, and led to the standardization of diabetes management at a CHC.

Keywords:
Pharmacist; Evidence-based practice; Patient Care Team; Collaborative Practice; Model of care; Provider satisfaction; Interprofessional practice; diabetes
CINAHL Headings:
Professional Practice, Evidence-Based; Quality Improvement; Diabetes Mellitus; Multidisciplinary Care Team; Collaboration; Patient Care; Patient Care--Methods; Patient Satisfaction; Interprofessional Relations; Pharmacists
Note:
This work has been approved through a faculty review process prior to its posting in the Virginia Henderson Global Nursing e-Repository.
Repository Posting Date:
2017-09-12T16:14:49Z
Date of Publication:
2017-09-12

Full metadata record

DC FieldValue Language
dc.contributor.advisorWatkins, Katherine Dolanen
dc.contributor.authorEdwards, Emma L.en
dc.date.accessioned2017-09-12T16:14:49Z-
dc.date.available2017-09-12T16:14:49Z-
dc.date.issued2017-09-12-
dc.identifier.urihttp://hdl.handle.net/10755/622571-
dc.description.abstract<p><strong>Background:</strong> The prevalence of type II diabetes mellitus (T2DM) in the United States is high, especially in underserved populations. Many patients with T2DM do not receive the optimal interprofessional collaborative care that has been shown to improve outcomes. A model of care that incorporates these evidence-based recommendations is integral to improving the quality of diabetes care. A growing body of literature identifies the use of a provider-clinical pharmacist collaborative practice (P-CPCP) model of care as an effective, innovative, and evidence-based practice that will improve patient outcomes.</p> <p><strong>Purpose: </strong>In response to an identified need to improve T2DM patient care in an urban community health clinic (CHC), the purpose of this project was to implement a P-CPCP model of care. The expected outcomes included (a) increase the number of patients with T2DM that are referred to a clinical pharmacist; (b) improve provider satisfaction with the collaborative process; and (c) implement the P-CPCP model of care across all CHC agency clinics in the network to ensure the delivery of high-quality, evidence-based patient care.</p> <p><strong>Design and Analysis: </strong>A quality improvement (QI) design was used and incorporated a rapid improvement cycle of plan-do-study-act (PDSA). After identification of a gap in care and analysis of the evidence, the QI project was created. A provider education module was presented and followed by a chart audit of electronic medical records (EMR) of patients with T2DM. These charts were examined to determine pre- and post-implementation usage of the model. Provider satisfaction and perceived effectiveness of the P-CPCP model was assessed using a brief electronic survey. Descriptive statistics and a cross tabulation analysis are presented to show the effectiveness of the model for increasing the number of referrals to the clinical pharmacist and the number of patients seen by the clinical pharmacist in both pre and post groups, as well as to describe the most used pharmacist interventions and provider perceptions of the model.</p> <p><strong>Results:</strong> The P-CPCP model increased utilization of the clinical pharmacist in diabetes care. Following implementation of the model referrals increased by 210%. The provider survey demonstrated an increase in provider satisfaction with collaboration, the usefulness of the model, and sustainability of the model. Of the pharmacist interventions, medication reconciliation education (MRE) was perceived as the most frequently used.</p> <p><strong>Conclusions:</strong> This doctor of nursing practice (DNP) project reflects evidence-based practice methods on interprofessional collaboration and provides new insight into the implementation of a collaborative practice model and the role of the clinical pharmacist as a valued member of the collaborative team. Consistent use of the P-CPCP model of care improved provider satisfaction with the collaborative process, increased the number of patients referred to the clinical pharmacist, and led to the standardization of diabetes management at a CHC.</p>en
dc.formatText-based Documenten
dc.language.isoenen
dc.subjectPharmacisten
dc.subjectEvidence-based practiceen
dc.subjectPatient Care Teamen
dc.subjectCollaborative Practiceen
dc.subjectModel of careen
dc.subjectProvider satisfactionen
dc.subjectInterprofessional practiceen
dc.subjectdiabetesen
dc.titleEvidence-Based Practice Change: Implementation of a Collaborative Practice Model for Diabetesen
dc.typeDNP Capstone Projecten
thesis.degree.grantorNorthern Arizona Universityen
thesis.degree.levelDNPen
dc.description.noteThis work has been approved through a faculty review process prior to its posting in the Virginia Henderson Global Nursing e-Repository.-
dc.primary-author.detailsEmma L. Edwards, MSN, FNP-C, email: emmaleds@gmail.comen
thesis.degree.year2017en
dc.type.categoryFull-texten
dc.evidence.levelOtheren
dc.research.approachTranslational Research/Evidence-based Practiceen
dc.subject.cinahlProfessional Practice, Evidence-Baseden
dc.subject.cinahlQuality Improvementen
dc.subject.cinahlDiabetes Mellitusen
dc.subject.cinahlMultidisciplinary Care Teamen
dc.subject.cinahlCollaborationen
dc.subject.cinahlPatient Careen
dc.subject.cinahlPatient Care--Methodsen
dc.subject.cinahlPatient Satisfactionen
dc.subject.cinahlInterprofessional Relationsen
dc.subject.cinahlPharmacistsen
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