Dementia is a complex medical condition with profound effects on the patient and family. Alternative models of care beyond the traditional, single profession medical model could provide a more comprehensive approach to address patients' needs. The purpose of this scoping review was to extract findings from published interprofessional practices (IPP) that serve patients with dementia and their caregivers to inform planning and implementation of collaborative care models for this population. A search of the scientific literature from 2011 to 2025 was conducted using PRISMA guidelines with the extension for scoping reviews. Search results yielded a total of 113 records for screening. Sixteen studies met criteria for review and subsequent data extraction. Findings demonstrated variability across IPP care models in terms of healthcare professions (range 2-10) and types of care models represented. Collaborative features reported in studies were consistent with the continuum of care model types; teamwork models, the most collaborative type, included shared purpose and decision making with high levels of communication, whereas networking models, the least collaborative type, showed low levels of these features. All care models included some form of psychosocial support. Studies incorporated varied outcome measures of patients, caregivers, and team members, and research designs were classified under weaker levels of evidence. Results from this review highlight the development of different types of IPP care models to address the complex needs of patients with dementia, and underscore a need for well-designed research to conclusively demonstrate the effectiveness of collaborative care.
Children with life-limiting conditions and their families face profound existential and spiritual challenges throughout the paediatric palliative care (PPC) trajectory. While spiritual care (SC) is a recognised component of PPC, its continuity and quality across care settings remain underexplored. This study examined how SC can be organised and safeguarded across the PPC continuum, from the perspectives of parents, healthcare professionals, and spiritual care providers. An exploratory qualitative study was conducted using multidisciplinary peer consultation groups. Two groups met online in 2022-2023, discussing six PPC cases over seven sessions. Participants included spiritual care professionals, clinicians from hospital and home settings, and parents. Data sources included audio-recorded transcripts, structured case descriptions, and field notes. A modified QUAGOL approach was used for narrative-informed thematic analysis. Coding was supported with team discussions. Continuity of care (relational, informational, and managerial) informed interpretation as a sensitising framework. Two themes were identified: (1) challenges in ensuring continuity of spiritual care, including fragmented referrals, lack of coordination, and cultural disconnects; and (2) defining and delivering quality SC, emphasising relational consistency, cultural and linguistic fit, and interprofessional collaboration. Parents valued providers who "knew their story", while professionals stressed clearer referral pathways and role alignment. Gaps in coordination and information transfer constrained support across transitions.  Continuity of spiritual care in PPC is not merely a logistical task but a relational and interpretive process. Embedding SC into proactive care planning and interprofessional practice may improve coordination, enhance cultural responsiveness, and support families throughout the illness trajectory. • Spiritual care is an essential dimension of paediatric palliative care but is often fragmented across settings. Traditionally, SC has been hospital-centred. • Families frequently lack consistent support during transitions between hospital, home, and community care. • This study suggests that continuity in spiritual care relies on sustained relationships, cultural attunement, and clear coordination. • Embedding spiritual care in proactive planning may support consistency and family-centred support throughout the illness trajectory.
Primary care is essential for health care systems to promote health, prevent disease, and manage chronic conditions. However, a shortage of primary care physicians challenges the delivery of high-quality primary care services to the population, especially for those living with multimorbidity. To address this challenge, interprofessional primary teams consisting of primary care physicians, nurses, and allied health professionals (AHPs) have been rolled out in many jurisdictions. This approach allows physicians to focus on complex patient care, where less complex care can be delegated to nurses and AHPs. We conducted a scoping review of the literature on the scope of practice of nurses and AHPs in interprofessional primary care teams in Ontario, Canada. Nurse practitioners and registered nurses are heavily involved in providing direct patient care, whereas registered practical nurses are less involved. Pharmacists focus on medication management and patient education, dieticians focus on dietary assessments and nutrition education, and social workers focus on counselling and psychosocial assessments. Pharmacists and nurse practitioners often face challenges in defining their independent roles. Some physicians struggle with teamwork, whereas others appreciate multidisciplinary approaches. Effective integration of nurses and AHPs in a primary care setting would enable physicians to delegate several tasks and address primary care physician shortages in various jurisdictions. Clarifying the professional roles of AHPs in primary care would enhance interprofessional team functioning, helping to increase both the quality and quantity of primary care.
Inter-professional education (IPE) is recognized as best-suited strategy to improve health professionals' collaborative competencies, leading to improved patient outcomes. However, assessment of attitude of healthcare professionals towards these competencies is also important for developing effective strategies for promoting inter-professional collaboration. The present study was designed to assess IPE collaborative (IPEC) competencies of healthcare professionals including physicians, nurses and pharmacists in Pakistan. A descriptive cross-sectional study design was used to assess IPEC competencies of 500 healthcare professionals i.e. (physicians, nurses, and pharmacists) working in tertiary care healthcare facilities located in 4 cities of Pakistan were selected using convenient sampling technique. A pre-validated tool IPEC self-assessment was used for data collection. After data collection, data was analyzed statistically. The mean scores of healthcare professionals regarding IPEC Competencies were calculated for total items in which mean score of nurses was highest (67.34 ± 0.52), followed by pharmacists (66.24 ± 0.58) and then doctors (65.88 ± 0.44). The results depicted higher IPEC competencies in all the health professionals. On both the domains i.e., inter-professional values and inter-professional interaction, nurses outscored both pharmacists and doctors with mean scores 34.46 ± 0.26 and 32.88 ± 0.28 respectively. The findings indicate that healthcare professionals in Pakistan generally demonstrate positive attitudes toward inter-professional collaborative competencies, with nurses showing comparatively higher scores across both inter-professional values and inter-professional interaction domains. Although the overall competency levels were encouraging, the variation across professional groups suggests the need for more targeted efforts to strengthen collaborative practice among all disciplines. Integrating structured IPE and training into clinical and academic settings may help bridge these gaps and further enhance teamwork, ultimately supporting better patient care outcomes.
Interprofessional primary care providers play a central role in delivering palliative care, although it remains challenging to implement. We evaluated a virtual interprofessional education program called CAPACITI, aiming to increase early identification of palliative care needs in the context of interprofessional primary care teams. A three-module two-arm version of CAPACITI was delivered in a randomized controlled trial, with teams assigned to either a self-directed or facilitated learning arm. Participants completed surveys before and after each module, including the Assessment of Interprofessional Team Collaboration Scale-II (AITCS-II). The pre-intervention survey also included the Organizational Readiness to Change Assessment (ORCA) measure. Descriptive statistics, paired t-tests, and generalized linear models were conducted. Of the 566 enrolled, 380 (67.1%) completed Module 1, 274 (48.4%) completed Module 2, 202 (35.7%) completed Module 3, and 192 (33.9%) completed all three modules. AITCS-II scores improved significantly (p < .001) following CAPACTI, with no difference between self-directed and facilitated groups for any module. Participants with lower ORCA scores at baseline experienced greatest improvement in team collaboration. CAPACITI demonstrates promise as an effective and scalable intervention to enhance interprofessional collaboration in palliative primary care. These findings support the integration of virtual team-based training as a strategy to strengthen collaborative care across primary care settings.
Aged care systems are under increasing pressures, demanding optimised interdisciplinary teams. Pharmacist roles are expanding into these teams, and successful integration requires an understanding of team member perspectives. This systematic review and meta-synthesis aimed to identify, analyse and present the published literature pertaining to healthcare professional perspectives of the roles of pharmacists working in residential aged care settings. A systematic search of literature published between 2000 and 2025, in English language only, was undertaken across Embase, Medline, CINAHL and Web of Science. Primary studies addressing the research aim were eligible for inclusion. The Mixed Methods Appraisal Tool was used to assess methodological quality of each paper; no papers were excluded based on quality. Two researchers independently reviewed and reached consensus agreement for all studies to include. Both researchers undertook a thematic synthesis of qualitative data to identify analytic themes. After removing duplicates, 1874 unique papers were identified through database searching and an additional two papers identified through citation searching. After screening, we included 39 papers for data extraction and analysis. Three overarching themes were identified. Theme 1: 'Supporting the role' describes how pharmacist roles in aged care are supported through building trust with the team, education and experience, access to information, specific attributes, organisational buy-in, favourable models of care, and role clarity. Theme 2: 'Medicines expertise activities' describes how pharmacists perform three key roles valued by healthcare staff: knowledge and communication brokers, filling existing gaps in care, and optimising quality use of medicines. Theme 3: 'Helping the team' illustrates health professionals' perception of three distinct outcomes of pharmacist input (ie enhanced confidence, improved workforce capacity and capability, and improved person-centred care). This meta-synthesis of the evidence regarding the perceptions of healthcare professionals on the role of pharmacists in aged care provides contextual information for individuals, organisations and policy-makers for future implementation. Pharmacists are perceived to improve stakeholder confidence, staff capacity and capability, and overall person-centred care. Embedded roles that foster interdisciplinary collaboration are preferred to irregular visiting roles. These embedded roles are enabled through a range of mechanisms that policymakers, organisations and individuals may leverage for successful implementation in future iterations.
Respectful patient care is a fundamental pillar of quality healthcare and is integral to the well-being and satisfaction of patients. However, there is a growing recognition of the disrespect and abusiveness of patients seeking care. Studies have reported that women's experiences of disrespectful and abusive care during childbirth significantly impacted their utilization of these services. This systematic review aims to provide a comprehensive evaluation of the practices of respectful and dignified maternity care in West Africa. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement checklist and was registered in PROSPERO. Research articles were systematically retrieved from four databases: PubMed, Scopus, EMBASE, and PsycINFO, and through manual searches of reference lists. A two-stage screening process was employed, followed by quality assessment using the Joanna Briggs Institute (JBI) critical appraisal checklist for cross-sectional studies. The review included 17 studies predominantly from Ghana and Nigeria, with one study spanning multiple countries. Most studies utilized qualitative methods and focused on women of reproductive age, practising midwives, and midwifery students. Findings revealed high levels of mistreatment during childbirth, including physical and verbal abuse, non-consented care, and dignity violations. Midwives showed varying levels of awareness and practice regarding respectful maternity care, with structural barriers within healthcare systems exacerbating mistreatment. Women reported experiencing disrespect and abuse, influenced by factors like age, marital status, and facility type. Midwifery students also identified issues of mistreatment and highlighted discrepancies between understanding the importance of respectful care and actual practice. We, however, did not find any literature addressing interprofessional respectful and dignified maternity care. The review reveals widespread mistreatment and disrespect during childbirth, including physical and verbal abuse, non-consented care, and dignity violations. Systemic barriers like staffing shortages and inadequate supplies exacerbate these issues, underscoring the pressing need for structural reforms in healthcare systems.
Interprofessional education (IPE) prepares healthcare professionals (HCP) for interprofessional collaborative practice (IPCP) by fostering knowledge, skills, values, and attitudes. Attitudes trigger approach or avoidance motivation, making engagement with IPCP more likely when HCPs hold positive attitudes. As research has struggled to consistently demonstrate a positive, long-term impact of IPE on healthcare students' attitudes, we investigated attitude development longitudinally in three undergraduate cohorts studying to become dieticians, midwives, nurses, or physiotherapists at a university of applied sciences in Switzerland. Specifically, we examined (1) whether related interprofessional attitude dimensions influenced each other over time, (2) how stable these dimensions were, (3) the impact of student characteristics, and (4) whether attitudes improved across time. We conducted a longitudinal study using structural equation modeling (SEM) to estimate cross-lagged panel models (CLPM) based on two out of three dimensions of the German version of the Interprofessional Attitudes Scale (G-IPAS): Teamwork, Roles, Responsibilities (TRR) and Community-Centeredness (CC). Of 879 undergraduate students who began their studies between 2018 and 2021, 234 provided data at least twice and were included in the final analyses. No cross-lagged effects were found between TRR and CC, however they showed moderate to moderate-to-strong stability across time. Student characteristics influenced attitudes: semester of study was positively associated with CC, male sex was negatively associated with CC, dietetics students reported more positive CC attitudes, and physiotherapy students reported more negative TRR attitudes. TRR attitude scores decreased significantly over time, while a change in CC could not be verified due to inadequate model fit. IPE did not produce the expected positive effect on interprofessional attitude development during undergraduate healthcare studies, in contrast to much previous research. The absence of reciprocal effects between attitude dimensions across time may indicate that they are serving different underlying psychological functions, with TRR being more utilitarian and CC being more value-oriented. Tailoring IPE curricula to the underlying psychological functions that interprofessional attitudes serve in different learner groups may enhance their effectiveness, thereby fostering positive and durable attitudinal change.
Germany's longstanding separation of healthcare sectors - most prominently between outpatient and inpatient care - creates risks of fragmented service delivery, disrupted information flows, and ultimately suboptimal outcomes for patients. This position paper examines how cross-sectoral and integrated strategies can effectively mitigate or overcome this fragmentation. During a Berlin Forum of the Association of the Scientific Medical Societies in Germany (AWMF) (6 December 2024), experts presented best-practice models and discussed legal, structural, financial, and regional dimensions of integrated care. The insights from these discussions were synthesized into AWMF's recommendations. Integrated care represents a critical lever for improving the efficiency and quality of the German healthcare system. Promising examples exist across surgical, medical, psychiatric, and regionalized care settings. Key recommendations address the following topics: harmonized financing and remuneration system, regional population-based healthcare networks, interoperable information exchange across healthcare sectors, shared decision-making on care options. Health services research - and especially implementation research - plays an indispensable role in guiding and evaluating these reforms. The AWMF further emphasizes the need for integrated education and postgraduate training, particularly within structured residency networks, and offers AWMF as an important interdisciplinary and interprofessional platform for promoting cross-sectoral care. Broad implementation of integrated care, combined with robust and evidence-based monitoring of implementation, is essential for meeting the challenges posed by demographic change and increasing demands on healthcare delivery. Die bisherige Trennung der Versorgungssektoren in Deutschland – insbesondere zwischen ambulanter und stationärer Versorgung – birgt die Gefahr von unzureichend effizienten Behandlungsabläufen, Informationsverlusten und folglich einer suboptimalen Patientenversorgung. Dieses Positionspapier evaluiert, wie sektorenübergreifende Ansätze diese Fragmentierung verbessern und überwinden können. Im Rahmen eines Berliner Forums der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) (6. Dezember 2024) wurden Beispiele guter Praxis sowie rechtliche, strukturelle und regionale Aspekte der sektorenübergreifenden Versorgung durch Expertinnen und Experten vorgestellt und diskutiert. Die Ergebnisse flossen in ein Positionspapier ein, das Empfehlungen der AWMF formuliert. Die sektorenübergreifende Versorgung ist ein zentraler Ansatzpunkt zur Verbesserung der Effizienz und Qualität des deutschen Gesundheitssystems. Beispiele guter Praxis sind ermutigend. Die Empfehlungen der AWMF betreffen die folgenden Themenbereiche: Harmonisierung der Finanzierungs- und Vergütungssysteme, Etablierung regionaler Gesundheitsnetzwerke, interoperabler Informationsaustausch über alle Sektoren, partizipative Entscheidungsfindung zu Behandlungsalternativen. Die Versorgungsforschung spielt dabei eine zentrale Rolle. Die AWMF empfiehlt zudem eine sektorenübergreifende Aus- und Weiterbildung z.B. in Weiterbildungsverbünden und bietet die Nutzung der AWMF als strategische Plattform für interdisziplinäre und interprofessionelle Weiterentwicklung sektorenübergreifender Versorgung an. Eine Ausweitung der sektorenübergreifenden Versorgung mit evidenzbasiertem Monitoring der Implementierungsschritte ist essenziell, um den Herausforderungen des demografischen Wandels und den steigenden Anforderungen an die Gesundheitsversorgung zu begegnen.
Suicide attempts can lead to life-threatening conditions that require intensive care. In such situations, patients often experience existential fear when cared for in highly technological and unfamiliar environments such as the intensive care unit. The circumstances surrounding the suicide attempt, together with their critical condition, may further influence their ability to cope and shape their experience of care. Understanding these experiences is important to ensure that the therapeutic relationship supports the recovery process. Interprofessional collaboration and communication are essential for coordinated, recovery-oriented care. To map the existing evidence on how patients, family members and healthcare personnel experience care in intensive care units following a suicide attempt, to identify key themes, knowledge gaps and implications for clinical practice and future research. This scoping review was conducted using the Arksey and O'Malley methodology and the PRISMA-ScR list. Six databases were systematically searched using predefined keywords. All English-language studies addressing the review aim were included. The search yielded 1107 articles. After screening, 13 were assessed in full, and five met the inclusion criteria. These studies, published between 1985 and 2011, comprised four surveys and one qualitative interview study. Findings indicate that patients felt misunderstood, families lacked information and support, and personnel experienced emotional strain. Attitudes varied widely, and healthcare personnel expressed a need for further education and reflective practice in suicide care. Only five relevant studies were identified, all published between 1985 and 2011, with just one including patient or family perspectives. This limited and dated research highlights a clear gap in research on intensive care following suicide attempts and precludes firm conclusions about care experience. With these constraints, the findings tentatively suggest the importance of compassionate, holistic and collaborative approaches to care, as well as the potential value of personnel's support and training and policies that attend to the mental health needs of suicidal patients and their families. The findings may suggest the potential relevance of a holistic approach to caring for patients after a suicide in ICU practice, where physical, psychological, social and emotional aspects of care are considered in supporting recovery and well-being.
Interprofessional education (IPE) evaluation often relies on attitudes and satisfaction rather than case-anchored judgments about expertise distribution. We developed the Scope of Practice Evaluation, Knowledge Domain (SCOPE-K) to measure learners' self-referential expertise-mapping judgments; whether a clinical question falls within their own profession's knowledge domain. Undergraduate medical, nursing, and pharmacy students (N = 126) completed SCOPE-K before and after an interprofessional simulation. For each of eight, profession-linked clinical questions, participants rated relevance to their own profession on a four-point scale and completed a profession-attribution ranking task. Analyses examined internal consistency, internal structure, expert-referenced concordance against an 11-member panel, and own-versus-other profession comparisons. Among students with complete pre-post data (N = 99), McDonald's ω was .87 pre-simulation and .91 post-simulation (bootstrap CI for the difference including zero). Exploratory factor analysis indicated a two-factor pattern with a strong inter-factor correlation (|Φ| = .69), broadly consistent with an underlying unidimensional construct. Benchmark coherence was substantial (Kendall's W = .72). In the subset with complete relevance and ranking data (N = 62), student - expert concordance increased from r- s = .38 to .60 (p = .024) and profession-attribution ranking concordance from τ̄ = .35 to .59 (p = .017). Students rated own-profession items higher than other-profession items at both time points, with the difference narrowing post-simulation. SCOPE-K shows promising initial psychometric properties as a novel, scenario-based measure of learners' self-referential expertise-mapping judgments within simulation-based IPE. The pattern of improved expert-referenced concordance, improved ranking concordance, and stronger association with profession-attribution performance provides encouraging initial validity evidence. SCOPE-K offers a distinct complement to attitudinal and behavioral assessment approaches by targeting a cognitive component of interprofessional learning that existing instruments do not directly elicit. Further validation with expanded item sampling, response-process evidence, and multi-center cohorts is warranted before SCOPE-K is used as a program-level IPE evaluation measure.
Embedded in Spanish neighborhoods and towns, there are hundreds of thousands of self-employed healthcare professionals who provide services within the private sector. In the absence of an official term, they are referred to here as "self-employed community healthcare professionals", as they practice within a community setting with a high degree of proximity to patients, participate to varying extents in health promotion activities, and operate independently from large organizations. Healthcare provision, whether public or private, has an impact on patients. It would therefore be reasonable for a regulated exchange of information to exist, allowing, when necessary and in accordance with the legal framework, collaboration for their benefit. In this context, it is important to better understand the reality of healthcare services delivered by self-employed professionals and the extent to which coordination with public healthcare exists, if any. Although the available knowledge about these services is limited, in most cases there is a low degree of coordination and/or collaboration with other healthcare professionals, both public and private. Despite the millions of interventions carried out, very few are captured within the electronic health record of the Spanish National Health System, resulting in two parallel and largely disconnected systems coexisting within the same territory, with minimal coordination as patients move between them. Pilot initiatives and statements from some professional groups suggest the need to integrate communication and collaboration systems to optimize patient care.
Commitment to professional ethical principles is one of the fundamental pillars in improving the quality of nursing care and preserving patients' human dignity. Given the key role of nurses in direct interaction with patients, examining the extent of adherence to nursing ethics in clinical settings is of great importance. Considering the significance of ethics in nursing practice, this study was conducted to assess the level of adherence to nursing ethical principles among nurses at Imam Khomeini Hospital in Saqqez in 2024. This descriptive-analytical study was performed on 118 nurses working at Imam Khomeini Hospital in Saqqez in 2024, selected through simple random sampling. The data collection tools included a demographic information questionnaire and a standard questionnaire assessing nurses' adherence to professional ethical codes. Data were analyzed using SPSS version 27 with descriptive and inferential statistics. The findings showed that 61.86% of the nurses had a moderate level of ethical performance. The highest adherence to professional ethical codes was observed in the domain of "nurses and professional commitments" (58.79 ± 1.01), while the lowest was in the domain of "nurse and colleague" (8.18 ± 0.95). The results of this study indicated that the level of adherence to professional ethics among nurses at Imam Khomeini Hospital in Saqqez is mostly moderate. This can be considered a warning sign regarding the quality of nursing care and patient satisfaction. Despite relatively favorable performance in the area of professional commitment, weaknesses in interpersonal communication, especially in the nurse-colleague domain, require special attention. It is therefore recommended that continuous training and retraining programs in professional ethics be developed and implemented to improve nurses' ethical awareness and skills, enhance interprofessional interactions, and promote ethical-based care.
As Japan's population ages, home-based care has become increasingly important for older adults with cancer. Many patients experience functional decline, multimorbidity, and psychosocial challenges, making continuity of care across medical and long-term care services essential. However, coordination between hospital-based and community-based providers remains fragmented. This study aimed to explore the perspectives of healthcare and long-term care providers to identify key elements for effective coordination in home-based care for older adults with cancer. We conducted semi-structured interviews with healthcare and long-term care providers from designated cancer care hospitals, home-visit medical institutions, and long-term care agencies. Institutions were purposively selected based on prior reports or expert recognition of structured coordination practices, and additional participants were recruited through snowball sampling. Interviews were conducted online between September 2024 and January 2025. Transcripts were analyzed using conventional content analysis, and themes were synthesized to capture essential components of coordination. Seventy-seven participants from 48 institutions were enrolled. Six key elements were identified for effective coordination: (1) system infrastructure, (2) information exchange, (3) communication, (4) timeliness, (5) human resource development, and (6) information dissemination. Institutions with structured referral protocols, designated coordinators, and information and communication technology platforms demonstrated smoother transitions from hospital-based treatment to home-based care. Timely, patient-centered information sharing was emphasized as more important than technology. Beyond medical details, functional status, psychosocial information, and patient goals were considered essential. Real-time, bidirectional communication ensured goal alignment across care settings. Early initiation of coordination-ideally during treatment or even at diagnosis-was considered critical for advanced care planning and symptom management. Cross-training, interprofessional workshops, and multidisciplinary conferences were perceived as effective strategies to increase hospital providers' awareness of community resources, foster mutual understanding, and strengthen workforce capacity. Proactive education and outreach were considered essential to addressing the limited understanding of home-based care systems among patients and caregivers. Six key elements, including structural, procedural, and educational components, were identified as essential to strengthening transitional and longitudinal care. Effective coordination in home-based care for older adults with cancer requires appropriate tools or systems along with proactive, timely, and multidimensional engagement across medical and long-term care sectors.
Use of in-home video telehealth rapidly expanded in response to the COVID-19 pandemic, including at Veterans Affairs (VA), a forerunner in telehealth. Despite this uptick, differences in use by patient age and rurality created a digital divide that persists to this day. While clinicians frequently cite patients' older age and lack of technical skills as barriers to in-home video telehealth, it remains unclear how clinicians decide whether to offer video visits to patients and to what extent these beliefs may hinder offering video visits to older adults. Gathering perspectives from clinician users of in-home video telehealth may illuminate opportunities to ensure continued access to care through solutions such as telehealth. This study aimed to examine clinician decision-making around the offer of in-home video telehealth to understand how interprofessional clinicians determine to whom they offer in-home video telehealth and what factors (organizational, personal, or attitudinal) influence their decision. We conducted a qualitative study by using semistructured interviews. Participants were interprofessional clinicians (N=16) employed by 11 different VA hospitals and included 1 clinical pharmacist, 6 medical doctors, 2 nurse practitioners, 1 occupational therapist, 3 psychologists, 1 physical therapist, 1 speech-language pathologist, and 1 social worker. All the participants had at least some experience using in-home video telehealth from locations across VA (the largest integrated health care system in the United States) and were interviewed over a 6-month period. Interviews focused on clinicians' use of video telehealth and the decision-making process involved in offering in-home video telehealth. We used directed content analysis with a rapid analytic approach, given the time-pressured nature of our project. This study revealed that clinician decision-making around offering in-home video visits is complex and influenced by several domains, namely, (1) clinician factors, including experience with video and perceived benefits of video; (2) appointment factors, including the visit's clinical goal; (3) clinician-reported patient factors, including age and willingness to try video; (4) patient social context, including caregiver availability; (5) geographical factors, such as availability of reliable high-speed internet and patient distance from the medical center; and (6) health system factors, including technical support and clinician ability to work from home. Access to in-home video telehealth may be facilitated by clinician familiarity and confidence with telehealth technology, strategies to improve patients' technical skills, and support for caregivers. Infrastructure also plays an important role, including device availability, broadband reliability, and clear protocols for matching services to video visits. Findings highlight the importance of clinician competency in telehealth, patient and caregiver digital readiness, and a supportive technology infrastructure to equitable in-home video care. In addition, improved guidance for specific clinical services and awareness of potential biases may enable consistent, accessible telehealth delivery for older adults and medically complex populations.
Hospitals can form condition-based units (CBUs) to support value-based healthcare (VBHC). Interprofessional collaboration is key to the success of CBUs, but insights into its quality are lacking. We aimed to examine professionals' perceived quality of interprofessional collaboration in CBUs, and factors influencing it. A single-center mixed-methods study was conducted within four CBUs in a Dutch top-clinical hospital: (1) geriatric trauma, (2) prostate cancer, (3) colon cancer and (4) breast cancer. A relational coordination (RC) survey was used to examine professionals' perceived collaboration quality, followed by semi-structured interviews to explore influencing factors. Varying RC scores were observed between professionals with different professions and disciplines within CBUs (geriatric trauma: 1.9-5.0; prostate cancer: 2.9-4.8; colon cancer: 2.1-4.8; breast cancer: 1.1-4.9), with higher scores among professionals involved in similar parts of related care pathways. Interview findings suggest that this variation is explained by four factors: (1) streamlined communication, (2) active engagement, (3) mutual recognition and (4) workflow efficacy. This exploratory study introduces a novel approach to studying professionals' perceived collaboration quality in CBUs through relational dynamics. The results suggest that traditional hospital structures can hinder interprofessional collaboration in CBUs by limiting physical interactions and shared administrative systems. Future studies with larger samples are needed to confirm these findings, and to provide recommendations for improving interprofessional collaboration in CBUs in order to unlock their potential in improving patient care.
Interprofessional learning (IPL) is required for health profession students to develop appropriate collaborative competencies. In 2024, in response to accreditation recommendations and evolving best practices, the Royal College of Surgeons in Ireland (RCSI), University of Medicine & Health Sciences undertook a comprehensive redesign of its original IPL strategy. Guided by Kotter's eight-step model for organizational change, an interprofessional leadership team of academic staff, student, and patient partners reviewed and updated their approach to IPL. This new strategy integrates formal, informal, and workplace-based learning opportunities for all students, with learning outcomes aligned to the 2023 IPEC core competencies. An IPL logo was collaboratively designed to signpost all interprofessional activities and communicate the new vision. There is now an increased focus on workplace learning and embedding IPL into both curricula and co-curricula domains of the learning environment, with faculty development organized by a centralized team. Early success includes patient participation in all strategic decisions, appointment of a Deputy Dean interprofessional leadership role, new workplace learning activities, and elevating the vision of IPL at a local and national level through conference presentations, workshops, and with student engagement initiatives. This report outlines our process, rationale, and early outcomes, with the aim of demonstrating the merit of using an organizational management process when seeking curriculum transformation within a large education institution. This approach reinforces the recognized importance of leadership, stakeholder engagement, and sustained institutional support in fostering a cultural recognition and valuing of IPL.
Trauma is a leading global cause of preventable morbidity and mortality, with South Asia bearing a disproportionate burden due to fragmented trauma systems and resource limitations. Effective trauma care depends on coordinated personnel, infrastructure, clinical processes, and interprofessional collaboration (IPC). To map existing evidence on barriers to adult trauma care delivery in South Asia and to examine how IPC is implemented through educational, practice-based, and organisational interventions. A scoping review was conducted following the Arksey and O'Malley framework and reported in accordance with PRISMA-ScR guidelines. Four electronic databases (PubMed, Scopus, Embase, and Web of Science) and Google Scholar were searched for English-language studies published between 2005 and 2025. Eligible studies examined IPC, teamwork, or system-level challenges in adult trauma care across civilian healthcare settings. Data were charted and reported descriptively with multiple categories across system, provider, and patient levels. Twenty-one studies were included from South Asia, with most evidence originating from India, highlighting important regional research disparities. Most were conducted in tertiary emergency departments or trauma centres and employed observational or quasi-experimental designs. Interventions were classified as IP education (n = 10), IP practice (n = 8), and IP organisation (n = 1); two studies provided contextual system analyses without direct interventions. Educational and practice-based interventions consistently improved provider knowledge, confidence, communication, and process reliability. However, organisational-level interventions were scarce, and patient-level outcomes such as mortality and functional recovery were infrequently reported limiting assessment of the true clinical effectiveness of IPC interventions. Recurrent barriers included underdeveloped prehospital systems, inconsistent trauma team activation, protocol variability, workforce turnover, and limited trauma registry coverage. The evidence base on IPC in South Asia trauma care is dominated by education and practice-level interventions, with limited evaluation of system-level redesign. While IPC interventions improve teamwork and care processes, their impact on patient outcomes remains inadequately measured. Sustainable progress will require trauma registries, standardized protocols, governance reform, and multicountry patient-outcome-driven research. Policymakers should prioritize integrated trauma governance, registry systems, and regional quality assurance to translate IPC gains into measurable improvements in trauma mortality, morbidity, and recovery.
People with cognitive impairment face several challenges during hospitalisation. Insufficient attention to person-centred care often means that individual needs are not recognised, which can lead to complications and adverse outcomes such as falls and a decrease in the nutritional status. To promote person-centred care on hospital wards, nurses acting as change agents possessing both clinical expertise and leadership skills are a key factor. We aimed to develop a complex person-centred care intervention for people with cognitive impairment delivered by Expanded Practice Nurses in acute care hospitals and to derive tailored implementation strategies. This study used a multi-method-design. We performed two systematic reviews aiming to synthesise existing evidence on advanced nursing roles and factors influencing role implementation. To explore the setting and target groups, we conducted two surveys on the scope of practice of Expanded Practice Nurses and on attitudes of health care professionals towards advanced nursing roles in Germany. The results guided two expert workshops to model the intervention and prioritise implementation strategies using participatory principles. We created a logic model to depict underlying processes and contextual factors of the developed complex intervention. Fourteen intervention components form the complex intervention and reflect the tasks of the Expanded Practice Nurse within the interprofessional team. We defined nine components directly related to patients, five system-related tasks to promote person-centred care at an organisational level, and described opportunities for adapting the role to different contexts. Implementation strategies target qualifying the Expanded Practice Nurse, engaging the interprofessional team and people with cognitive impairment, as well as familiarising with local relationships and structures. The comprehensive intervention development results in a detailed role description as well as implementation strategies allowing adaptation to different acute care contexts, especially in countries in an early stage of development of Advanced Practice Nursing. The developed nursing role is a key to promote person-centred care in the interprofessional team. By developing a person-centred culture on the wards, individual needs of people with cognitive impairment can be identified and addressed in time, which can lead to a reduction in complications and an improved hospital experience for patients.
The WHO has proposed interprofessional collaboration (IPC) as a promising health care reform to adapt to future healthcare challenges. Among these challenges are a shortage of healthcare professionals, patients becoming more complex due to multimorbidity, and increased use of emergency department services, which could become a bottleneck. Studies investigating the effect of IPC on patient outcomes show mixed results. One promising collaborative practice is the Intensive Collaboration Ward (ICW): which has previously shown promising patient-related outcomes during hospital stay such as shorter length of hospital stay and fewer medical consultations. This retrospective cohort study, studies the effects after hospital stay, and included patients from two previous studies on the ICW and acquired new follow-up data on one ICW group and two control groups. The primary outcome was the number of emergency department visits within six months of discharge. The secondary outcome was the number of outpatient clinic visits within six months of discharge. Outcomes were analysed using a negative binomial regression. A total of 490 patients were included, 200 in the ICW group, 51 in control group A and 239 in control group B. Patients in the ICW group had significantly less emergency department (0.16 (95%-CI 0.10-0.25) vs 0.41 (95%-CI 0.27-0.63)) and outpatient clinic visits (0.82 (95%-CI 0.62-1.07) vs 1.67 (95%-CI 1.27-2.20) compared to the control group. This study provides further evidence of the potential positive impact of IPC on future healthcare challenges, namely reducing the emergency department use and outpatient clinic visits.