Practitioners’ experiences of interprofessional collaboration in substance use services: A qualitative study

Widespread and sustained adoption of telemedicine in long-term residential care is emerging. Nursing home (NH) nurses play a key role in collaborating with remote physicians to manage residents' medical conditions through videoconferencing. Therefore, understanding of interprofessional collaboration and effective communication between nurses and physicians is critical to ensure quality of care and safety during teleconsultations. To explore NH nurses' and physicians' experiences of interprofessional collaboration and communication during teleconsultations. A qualitative descriptive design was adopted. Purposive sampling was conducted to recruit 22 physicians and nurses involved in NH teleconsultations. Semi-structured online interviews were conducted, and data were thematically analyzed. Three themes were identified: (1) Manner of communication in telemedicine, (2) sociocultural influences in collaborative practice, and (3) role expectations in telemedicine. Both nurses and physicians recognized the importance of building and maintaining trust as physicians heavily depended on nurses for provision of objective information for clinical decision-making. However, practice differences were observed between nurses and physicians during teleconsultations. Sociocultural influences such as power relations and language barriers also affected the nurse-physician relationship and interpersonal communication. Additionally, different performance expectations were identified between nurses and physicians. Interprofessional collaboration in teleconsultations is challenging because of lack of in-person assessment and dependence on nurses for clinical information. In addition, expectations and communication styles differ among healthcare professionals. This study called for interprofessional telemedicine training with incorporation of shared mental models to improve role clarity and communication. Given the international-dominated healthcare workforce in long-term care, the development of cultural competency could also be considered in telemedicine training to enhance nurse-physician collaborative practice. Telemedicine is increasingly adopted in long-term care settings, where multidisciplinary healthcare professionals from different health institutions are involved in resident care. Interprofessional collaboration should be incorporated into telehealth education for enhanced clinical practice in this care delivery model.

In this chapter, I show how I have applied the concept of objectivation to explore how frontline workers in the Norwegian Labor and Welfare Administration carry out and reflect on interprofessional collaboration in their work with youth. Institutional and political discourse on interprofessional collaboration motivates collaborative efforts across services. In this chapter, I describe the interaction between frontline workers’ experiences of interprofessional collaboration and the institutional conditions and procedures associated with interprofessional collaboration. I analyze nine semi-structured interviews with frontline workers in the Norwegian Labor and Welfare Administration. Applying objectivation as an analytical concept, I find that even though interprofessional collaboration occasionally can be useful and effective for the youth, the unquestioned understanding of interprofessional collaboration as positive also leads to the frontline workers subsuming the youths’ experiences.

Effective interprofessional collaboration is considered essential for optimum healthcare delivery. Studies have investigated interprofessional education (IPE) as a means for improving collaborative practice, and evidence suggests that the clinical setting offers opportunities for interprofessional learning (IPL). Little is known, however, about the aspects of clinical practice that students perceive as meaningful to their IPL. This study explores physiotherapy students' experiences of collaborative working, and identifies their perceptions of the skills used and factors affecting interprofessional interactions in the clinical setting. Twenty second-year physiotherapy students studying in London provided written critical incident reports describing good and poor interprofessional collaborative encounters in the clinical setting. The data were subjected to thematic content analysis. Students identified communication and interprofessional relationships as the main factors affecting collaboration and perceived teamwork in formal contexts (e.g., team meetings) as generally effective with positive outcomes for professionals and patients. Informal collaboration was perceived to be poor and attributed primarily to insufficient direct contact and communication. The wide range of described experiences and learning outcomes indicate that clinical placements provide potentially valuable IPL opportunities. Facilitating the development of informal (ad hoc) collaborative teamwork skills is proposed as an important consideration when planning and implementing IPE in this setting.

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Interprofessional collaboration (IPC) has been shown to improve patient safety and quality of care. Particularly, IPC assists health care providers to manage complex and chronic diseases. To this end, primary care centers around the world have begun practicing IPC; however, little is known about the patient’s experience of IPC in primary care (IPC-pc). The goals of this scoping review were to identify the studies exploring patients’ perspectives on IPC-pc and to reveal gaps in the literature for future research in order to inform policy and practice. A key word search strategy was conducted using PubMed to identify studies published from 1997 to 2017 on IPC-pc that included data collected from patients or their caregivers about patient experience or satisfaction. Seven studies met the inclusion criteria for the scoping review, and these studies were evaluated by interprofessional intervention, collaboration, and outcomes.

Interprofessional (IP) experiences are increasing in frequency and scope in health professions education, though little is known about the role of the co-curricular environment in fostering students’ attitudes towards IP collaboration. We examined if participants in IP co-curricular activities of substantive duration held attitudes toward IP learning and collaboration differently than students who did not participate in such activities. We distributed a questionnaire composed of the Readiness for Interprofessional Learning Scale (RIPLS) and the Interdisciplinary Education Perception Scale (IEPS) to the 2008, 2009, and 2010 graduates of an academic health center. Respondents indicated if they participated in any of the six substantive IP co-curricular activities offered by the institution. Respondents were grouped by participation in “one or more IP activity” or “no participation.” Independent sample T-tests were performed for each of the RIPLS and IEPS scales to assess differences between those groups. 997 (58.1%) of the graduates completed the survey; 52.9% of the respondents reporting participation in at least one IP activity. Of the seven scales from the two instruments, the mean scores of one scale were significantly different between the two groups: IEPS “perceived need for cooperation” (p Results indicate that students who have participated in a substantive IP co-curricular activity hold more positive attitudes toward the perceived need for cooperation. It is likely that as a result of their IP collaborative experiences, these students recognize the value and need for cooperation. It appears that important IP collaborative learning occurs within the IP co-curricular environment, and in turn, may translate into improved use of IP collaboration skills in practice.

BackgroundDespite numerous evidences for the positive effect of community pharmacists on health care, interprofessional collaboration of pharmacists and general practitioners is very often limited. Though highly trained, pharmacists remain an underutilised resource in primary health care in most western countries. This qualitative study aims at investigating pharmacists’ and general practitioners’ views on barriers to interprofessional collaboration in the German health care system.MethodsA total of 13 narrative in-depth interviews, and two focus group discussions with 12 pharmacists and general practitioners in Mecklenburg-Western Pomerania, a predominantly rural region of North-Eastern Germany, were conducted. The interviews aimed at exploring general practitioners’ and pharmacists’ attitudes, views and experiences of interprofessional collaboration. At a second stage, two focus group discussions were performed. Fieldwork was carried out by a multi-professional team. All interviews and focus group discussions were audio taped and transcribed verbatim. The constant comparative method of analysis from grounded theory was applied to the data.ResultsThere are three main findings: First, mutual trust and appreciation appear to be important factors influencing the quality of interprofessional collaboration. Second, in light of negative personal experiences, pharmacists call for a predefined, clear and straightforward way to communicate with physicians. Third, given the increasing challenge to treat a rising number of elderly patients with chronic conditions, general practitioners desire competent support of experienced pharmacists.ConclusionsOn the ground of methodological triangulation the findings of this study go beyond previous investigations and are able to provide specific recommendations for future interprofessional collaboration. First, interventions and initiatives should focus on increasing trust, e.g. by implementing multi-professional local quality circles. Second, governments and health authorities in most countries have been and still are reluctant in advancing political initiatives that bring together physicians and pharmacists. Proactive lobbying and empowerment of pharmacists are extremely important in this context. In addition, future physician and pharmaceutical training curricula should focus on comprehensive pharmacist-physician interaction at early stages within both professional educations and careers. Developing and fostering a culture of continued professional exchange and appreciation is one major challenge of future policy and research.

Refugee populations experience significant psychological stress in host countries. The COVID-19 pandemic worsened pre-existing vulnerabilities and also presented new vulnerabilities for substance use. The study was conducted to examine the pattern of substance use during and after the COVID-19 pandemic among youth residing in a rural refugee settlement camp in north-western Uganda. The study was conducted in a refugee settlement camp in north-western Uganda. We used an interpretative phenomenological analysis framework to explore substance use among young people. We conducted eight in-depth interviews and four focus group discussions among youths between the ages of 18-30 years. We identified two master themes: (1) trauma led us to substance use and (2) desire for belonging and identity kept us in substance use. Young people recounted stories of trauma which served to initiate and promote substance use among them. COVID-19 restrictions on social isolation, social distancing and military enforcement of the restrictions exacerbated previous experiences of trauma resulting in substance use. Refugees, who were already separated from their families in the host country, engaged in substance use following further parental and social isolation, loneliness and reduced support systems in refugee camps. The reduced financial support, unemployment, closure of businesses and schools provided additional motivation to engage in substance use among young people. Surviving the refugee camp heightened the need for belonging to a group. The desire to belong in, to fit in and to stand out in the group altogether served to provide further avenues for substance use among young refugee populations. Interventions for substance use among refugee youth, particularly during a pandemic, ought to consider the complex landscapes for refugees and their multiple layers of vulnerabilities. Peer pressures and group influence should be given special considerations while planning mitigation measures.

Interprofessional education for collaborative practice (IPECP) within pre-licensure health education supports development of collaborative healthcare teams. However, challenges to enacting collaboration exist within contemporary healthcare practice. This study explores the professional socialization experiences of recent medical graduates during early residency/practice to understand contributions of undergraduate IPECP for new medical professionals' development of an interprofessional identity and readiness for collaborative healthcare practice. Interpretive, narrative methodology was used to explore the early residency/practice experiences of recent medical graduates (n = 8). Participants were recruited from a longitudinal study of the IPECP experiences of students from five health programs. Interviews centred on personal, social and systemic factors that enable and challenge new graduates' interprofessional identity development. Narratives reveal that developing an interprofessional identity evolves through exposure to interprofessional settings and collaboration in practice. Mentorship from experienced professionals and exposure to collaborative teamwork were facilitators for interprofessional socialization. However, prevailing healthcare culture and settings dictate the level to which meaningful connection and collaboration can occur. The attitudes and behaviours of practicing healthcare professionals were found to reinforce professional hierarchies, stereotypes and a profession-specific identity for new graduates. IPECP experiences which address and deconstruct professional hierarchies and stereotypes are needed in education and practice settings to promote collaboration. Preparing new medical professionals to assume their role within interprofessional teams is contingent on the provision of 'real' collaborative experiences and interprofessional exposure. Findings support the development of IPECP programming in health education/practice that address barriers to collaborative practice and promotes interprofessional identity development.

To determine whether best practice recommendations are being followed by primary care physicians (PCPs) by examining the integration of oral health-related practices in their management of patients with diabetes. A cross-sectional study design was used to examine PCPs' knowledge of the bidirectional link between diabetes and periodontal disease (PD), their adherence to international best practice recommendations, and their experience of interprofessional collaboration with dentists via an online survey. In total, 79 of 173 PCPs completed the online survey. Almost 90 percent of PCPs neither inform patients with diabetes about the link with PD nor advise dental care. Approximately, one-third of PCPs (32 percent) felt confident facilitating access to dentists. However, 93 percent of PCPs do not refer patients with diabetes to dentists as part of diabetes management. PCPs tend not to inform their patients with diabetes of the bidirectional link with PD, or provide advice or referral to attend dental care as part of diabetes management.

Introduction to the special issue on "Statistical approaches and methodological issues in longitudinal analysis of substance use and related behaviors"

Background Substance use disorder profoundly affects not only the individuals with the condition but also their family members, particularly children. The impact on children can be long-lasting, influencing their development and well-being throughout their lives. The study explored the determinants of perceived shame in young adults with paternal substance use disorder in Pakistan. Method Eight young adults aged 20–30 with paternal substance use disorder were selected through a purposive sampling technique for this study. A phenomenological research design, with interpretative phenomenological analysis, was used to gain an in-depth and comprehensive perspective. Semi-structured interviews were conducted with the participants. Result Two master themes with respective two sub-themes along with 40 codes were identified i.e., personal distress (psychological problems and existential crises) and social and relational issues (social problems and interpersonal turmoil). Conclusion Shame is the dominant factor that young adults with paternal substance use face. The study highlighted that these young adults face many personal, social, and relational issues that intensify their feelings of shame. This study may assist mental health professionals in developing effective strategies to decrease the feeling of shame in young adults affected by paternal substance use disorder.

Aim Getting professional help in early-mid adolescence can reduce or eliminate harm related to substance use and risky situations. Research was conducted over eighty years ago that increased our understanding of cognitive development in the adolescent period (the concrete stage of development) of life. However, there is a need for a greater understanding of the Fundamental Attribution Error for substance use problems and risky behaviors. The current study identifies developmental and cultural factors that would facilitate or prevent adolescents from seeking support for problems. Method Eighty (80) eleven to thirteen-year-olds were recruited from a middle school in Washington State. A qualitative interpretative design using interpretative phenomenological analysis (IPA) was used incorporating semi-structured, computer-generated interviews. Results Several overlapping themes that reflected barriers or enablers to seeking help were identified: approachability, confidentiality and trustworthiness, and perceived expertise. Help-seeking was facilitated when adolescents believed that the help source would be honest, would keep the information confidential; interpret the information accurately; were viewed as trustworthy; and possessed expertise in the field of substance use and risky behaviors. Conclusions These findings highlight perceptions that may influence help-seeking for substance use problems and risky behaviors. Mothers were reported to be the most significant supports in life, followed by fathers, then friends and siblings. These supports need further investigation. Further research is needed to determine if help-seeking can be facilitated by improving parent and peer knowledge of risky behaviors and promoting the expertise of health professionals. Additional research is needed into the impact of Adverse Childhood Experiences (ACEs) and the Fundamental Attribution Error.

Aims There has been a rise in the number of women who engage in risky use of substances. Although research explaining the difference between substance use practices of men and women exist, research understanding substance usage and recovery in women has not been conducted in Pakistan. Hence, the aim of the present study was to understand the experience of women who engage in risky use of substances, specifically the reasons they seek recovery. Design For this purpose, semi-structured interviews in the native language of the participants (i.e. Urdu) were conducted with five participants. The average time of the initial interview conducted was 32 min. A Purposive Sampling technique was used within the social constructivism framework. The interviews were transcribed in Urdu and translated into English by the primary researcher. The results were analyzed using Interpretative Phenomenological Analysis (IPA). The themes were first elicited manually and then further analyzed using the software Taguette. Participants The study was conducted on five participants recruited from a private sector rehabilitation centre. Results There were four themes elicited related to the reasons women seek recovery: wanting to care for their children, desiring a greater sense of self-worth, religion, and concerns for the impact on their family of origin. Findings Family, religion, children, and perception about self were leading factors that motivated women to seek recovery. Previous research has not investigated these factors, but this study has highlighted the importance of these factors in women’s recovery journey. Conclusion A single theme cannot be highlighted as the main factor for recovery. Instead, understanding the themes as a whole including the context is important to understand the process of recovery. The results of this study can help in raising awareness among the society and designing therapy protocols for women that take into account their reasons for moving toward recovery.