Optimizing strategies to improve interprofessional practice for veterans, part 1

Abstract

Introduction

Interprofessional patient care is a well-recognized path that health care systems are striving toward. The Veteran’s Affairs (VA) system initiated interprofessional practice (IPP) models with their Geriatric Evaluation and Management (GEM) programs. GEM programs incorporate a range of specialties, including but not limited to, medicine, nursing, social work, physical therapy and pharmacy, to collaboratively evaluate veterans. Despite being a valuable resource, they are now faced with significant cut-backs, including closures. The primary goal of this project was to assess how the GEM model could be optimized at the Pittsburgh, Pennsylvania VA to allow for the sustainability of this important IPP assessment. Part 1 of the study evaluated the IPP process using program, patient, and family surveys. Part 2 examined how well the geriatrician matched patients to specialists in the GEM model. This paper describes Part 1 of our study.

Methods

Three strategies were used: 1) a national GEM program survey; 2) a veteran/family satisfaction survey; and 3) an absentee assessment.

Results

Twenty-six of 92 programs responded to the GEM IPP survey. Six strategies were shared to optimize IPP models throughout the country. Of the 34 satisfaction surveys, 80% stated the GEM clinic was beneficial, 79% stated their concerns were addressed, and 100% would recommend GEM to their friends. Of the 24 absentee assessments, the top three reasons for missing the appointments were transportation, medical illnesses, and not knowing/remembering about the appointment. Absentee rate diminished from 41% to 19% after instituting a reminder phone call policy.

Discussion

Maintaining the sustainability of IPP programs is crucial for the health of our veterans. This project uncovered tools to improve the GEM IPP model for our veterans that can be incorporated nationally. Despite the lengthy nature of IPP models, patients and families appreciated the thoroughness, requested transportation and food, and responded well to reminder phone calls. A keen eye on these issues and concomitant medical complexity needs to be observed when planning IPP models to ensure sustainability.

Keywords:

• interprofessional practice
• veterans
• geriatric evaluation and management

Acknowledgments

The primary author wishes to acknowledge coauthors Michelle I Rossi and Jennifer M Mentz for their unending support of this project – both were crucial to its success. The Albert Schweitzer Fellowship Program and the University of Pittsburgh Medical Center provided the time to conduct this project; the VA Hospital in Pittsburgh provided the patient panels. Lastly, the authors would like to sincerely thank the patients and their families for their patience in completing the forms, answering telephone calls, and providing their feedback. It is for them that we strive to improve geriatric care. Dr Bhattacharya received funding from the University of Pittsburgh Medical Center, the Veteran’s Affairs Pittsburgh Healthcare System, and the Albert Schweitzer Fellowship Program.

Author contributions

The authors had complete independence in the study concept and design, acquisition of subjects and/or data, analysis and interpretation of data, and preparation of manuscript. The sponsors did not have any role in the study design, methods, subject recruitment, data collections, analysis or preparation of the manuscript.

Disclosure

The authors report no conflicts of interest in this work.