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6
support their respecting the
contributions of other professions, and
better prepare them for providing teambased patient care. These early IPE
experiences also increase the appeal of
collaborating with other professions,
reduce any negative stereotypical
attitudes toward these other
professions, and strengthen
communication skills.
The Health Professions Accreditors
Collaborative (HPAC), in association
with the National Center for
Interprofessional Practice and
Education (National Center), provided a
guidance document on developing
quality interprofessional education for
the health professions. They stated that
IPE plans should include four
characteristics: (a) a rationale; (b)
outcome-based goals; (c) a deliberate
design; and (d) assessment and
evaluation.
Case 7-7 (Questions
3, 4)
INTRODUCTION
Interprofessional practice and education (IPE) is a concerted effort to
prepare medical, pharmacy, nursing, physician assistant (PA), and
other health profession students to collaborate and deliver patient
care as part of a team.1 In the early 1970s, the Institute of Medicine
(IOM) report “Educating for the Health Team” addressed pharmacy
as a component of the team as well as medicine, nursing, and
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dentistry.2 However, there remains a concern that many practitioners,
including pharmacists, are commonly trained in programs that are
removed from other health care professionals. This educational
separation could potentially have a detrimental effect on the beliefs
and values that these practitioners may have on the contribution of
other providers to patient care.
3,4
In 2003, the IOM addressed this
matter in its report “Health Professions Education: A Bridge to
Quality.”5 The report stressed incorporating interprofessional
experiences into health care education and establishing core
competencies for IPE. The 2003 IOM report states “all health
professionals should be educated to deliver patient-centered care as
members of an interprofessional team, emphasizing evidence-based
practice, quality improvement approaches, and informatics.”5 These
IOM recommendations generated the momentum for health
professions to advance the need for IPE.
1,4
It is evident that with the
increasing prevalence of chronic diseases and the complexities of
delivering health care today, an interprofessional approach toward
patient care is important.3 In addition, new approaches to health care
have stimulated a movement toward team-centered health care,
such as the patient-centered medical home (PCMH) concept that
encourages interprofessional teamwork in providing primary care.
6
With the PCMH model, physicians share responsibility with nurses,
pharmacists, social workers, and others to manage complex patient
care cases. The PCMH model puts the patient at the center of
his/her health care and expands access and improves mechanisms
for patient–provider communication, including the use of technology
for patients to interact with their health care provider and have
access to other health care resources.
6
The evolution of an IPE model that incorporates collaborative
practice along with fundamental and continuing interprofessional
education is referred to as the new IPE.7 This is a way to create a
shared space between interprofessional education, interprofessional
practice, and collaborative practice to improve health care outcomes
while reducing cost.7 Thus, IPE is crucial in establishing integrated
interprofessional teams that provide patient- and family-centered
care to achieve what the Institute for Healthcare Improvement has
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termed the Triple Aim.8 In this model, the three dimensions of care
are to (a) improve the patient experience of care, (b) improve the
health of populations, and (c) reduce the per capita cost of health
care. More recently there has been an expansion to a fourth goal: (d)
of improving the work life of health care providers including clinicians
and staff.9 This “Quadruple Aim” recognizes “provider burnout” as an
impediment to effective health care that needs to be addressed.
Interprofessional patient care could potentially reduce individual
caregiver burden and enhance each team members’ sense of
contributing to shared outcomes.
CORE INTERPROFESSIONAL EDUCATION
COMPETENCIES
CASE 7-1
QUESTION 1: You are enrolled in an IPE seminar with pharmacy, nursing, PA,
and medical students. Each week you will be assigned cases to work on in
groups.
Your initial impression is that these exercises are primarily designed to help
foster teamwork, but are there any other areas that IPE helps develop as well?
The Interprofessional Practice and Education Collaborative (IPEC)
was formed in 2009 from six national associations of schools of
health professions (dentistry, medicine, nursing, osteopathic
medicine, pharmacy, and public health), to promote joint efforts to
advance interprofessional learning experiences with the goal of
helping prepare students to participate in team-based patient care.
An expert panel from its members produced a report in 2011 that
established Core Competencies for Interprofessional Collaborative
Practice.10 In 2016, IPEC published an update that organized and
broadened the competencies within the domain of interprofessional
collaboration to better achieve the Triple Aim with an emphasis on
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population health.11 A subsequent update is currently being
developed and is due to be released in early 2023.
12
The far-reaching impact of IPEC on health education since its
inception has been demonstrated by the addition of associations of
other health professions to its original core group including nutrition
and dietetics, PA, podiatry, respiratory care, physical therapy,
occupational therapy, psychology, speech-language and hearing,
chiropractic medicine, optometry, veterinary medicine, and health
library science.
13
The four IPEC competencies are (a) values and ethics for
interprofessional practice, (b) roles and responsibilities, (c)
interprofessional communication, and (d) teams and teamwork.
10,11
These competencies were identified to create a coordinated effort
across the different health care professions to incorporate key
content into their respective curricula and to guide curricular
development. The competencies also provide a foundation for
lifelong learning, as well as offer information to the different
professions’ educational program accrediting bodies that can be
used to set common accreditation standards.
10,11,14
In the first competency, IPEC considers interprofessional values
and ethics as important elements in establishing a professional and
interprofessional identity. These values and ethics are patient
centered and grounded in a shared purpose to provide
compassionate patient care. Working in teams adds value to
patient/family and community outcomes that promote overall health
and disease prevention beyond just the more traditional treatment of
disease. In addition to being patient centered, competency in this
area helps develop trusting relationships with patients, families, and
other members of the health care team. There is also an expectation
that one maintains competency in one’s own profession relative to
his/her area of practice.
10,11
The second competency addresses the importance that IPEC
places on one’s understanding of how professional roles and
responsibilities complement each other in providing patient care to
advance the health care needs of patients and populations. It is this
diversity of expertise that is the foundation of an effective health care
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team. Coordination of care occurs more effectively when each
profession knows what the other can contribute to patient care.
11
Pharmacists should be able to effectively articulate to other team
members what they can contribute in executing a treatment plan,
especially when it comes to preventing and identifying any drugrelated problems. Sharing roles has also been shown to enhance
patient outcomes and reduce costs.3 For example, a nurse, social
worker, and pharmacist can collaborate to develop a discharge plan
that reduces the potential for hospital readmission by addressing
such issues as community resources that may be available for
assistance, medication adherence, patient education, and health
care provider follow-up.3 The IPEC documents note that one should
also understand the limitations of one’s abilities, knowledge, and
skills and engage in continuous interprofessional development to
improve team performance.
10,11
IPEC places communication as the third key competency. The
expert panel states that one should communicate with patients,
families, and both health care and non–health care professionals in a
responsive and responsible manner. Characteristics such as being
available, being well-informed, showing interest, and being receptive
are key aspects of this communication area as well. Listening and
encouraging the input of other members are also important attributes
for this competency. Presenting information in a manner that
patients, families, and other team members can understand helps
enhance the safety and effectiveness of interprofessional care.
10,11
CASE 7-2
QUESTION 1: You are a pharmacy student on your Advanced Pharmacy Practice
Experience (APPE) rotation in internal medicine participating in medical rounds
with a medical team that includes a very intimidating attending physician. Your
team is evaluating a patient presenting with an upper respiratory tract infection.
You note from the medical record that the patient is on warfarin. The attending
physician directs the medical resident to order an antibiotic that you know may
interact with warfarin and possibly increase the risk of bleeding.
How should you communicate your concerns to the attending?
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Communication can be negatively impacted by demographic and
professional differences that may exist between health care
professionals (eg, older attending physician and younger
pharmacist). To address this issue, the IPEC report encourages all
team members to be willing to speak up in a respectful way if they
have a patient-related concern. You should politely and very clearly
explain to the attending what your concern is and provide evidencebased literature to support the nature and severity of the interaction.
Despite the attending’s intimidating demeanor, failure to
communicate the problem could result in harm to the patient. Being
able to provide and receive feedback with confidence helps promote
team-based care.
10,11
The fourth competency of IPEC, teams and teamwork, means
working together for common patient care goals. Working in teams
not only relates to shared problem-solving but also being able to
constructively manage any disagreements that arise with other
health care professionals as well as patients and family. Conflicts
may occur when power is confused with expertise based on
professional background. Staying focused on patient outcome and
addressing any potential conflict openly through shared problemsolving and utilizing effective communication skills can help establish
a more effective team. Besides, the report indicates that working in
teams also means giving up some professional autonomy. Health
care teams function best when the knowledge and expertise of the
different professions on the team are integrated to make better
patient care decisions.
10,11
As a consequence of this shift toward teamwork, most health care
profession–accrediting organizations, including pharmacy, nursing,
and medicine, now incorporate interprofessional collaboration and
teamwork as part of their standards.14 In fact, the Health Professions
Accreditors Collaborative (HPAC), consisting of many of the
accrediting bodies of professions that are part of IPEC, was founded
in 2014 in part to help facilitate the incorporation of intentional IPE
throughout the curricula of its member bodies.15 The basic principle
of IPE is that if students from different health care professions learn
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together, they will be better positioned to work together in teams to
provide optimal patient care.
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CASE 7-3
QUESTION 1: A.Z. is a 66-year-old female, mother of six, widowed, non–English-
speaking Muslim refugee with limited medical literacy, who comes to urgent
care with a 3-day history of cough and fever. You are an ambulatory care
pharmacist working with the medical team responsible for the care of A.Z. that
includes a bilingual (English to Arabic) translator, nurse practitioner, nurse,
physician, PA, and social worker. Her medical history includes type 2 diabetes
mellitus, hypertension, hyperlipidemia, posttraumatic stress disorder (PTSD),
and anxiety. She takes metformin 1000 mg twice a day, simvastatin 20 mg daily,
lisinopril/hydrochlorothiazide (HCTZ) 10 mg/12.5 mg daily, and clonazepam 0.5
mg three times a day as needed. A.Z. is accompanied by her eldest son who
translates for her and guides the medical decision-making process. A.Z. and her
children practice traditional folk remedies such as black seed oil for respiratory
problems and honey for diabetes. A review of A.Z.’s vital signs and laboratory
work indicates that her blood pressure is 166/88 mm Hg, preprandial blood
glucose is 210 mg/dL, and total cholesterol is 220 mg/dL.
How can we address each of the IPEC core competencies regarding this
case?
Values and Ethics
CASE 7-3, QUESTION 2: To respect A.Z. and her family’s cultural beliefs while
delivering high-quality and effective health care, what aspect of the care plan
can be customized to ensure this patient receives care that reflects the patient’s
values?
Patients of different cultures and religions may experience
conflicts regarding their values or morals when interacting with
members of the health care team. Health care providers’ awareness
of and sensitivity to such issues can benefit patients and increase
the quality of care they receive. It is important to understand the
religious implications, culture, family perspectives, health practices,
and beliefs of people of the Islamic faith. It is also important to
validate the patient’s use of home remedies and work together to
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incorporate as many cultural practices as possible. Creating and
maintaining clinical relationships based on trust and good
communication is essential. Protecting the patient’s freedom of
belief, and maintenance of life and intellect while preserving honor
and integrity is paramount in the Islamic faith.
16
The team should be cohesive in its approach to maintain a climate
of mutual respect and shared values between team members as well
as with patients and their families.
Roles and Responsibilities
CASE 7-3, QUESTION 3: You use your knowledge of your own role and those of
other professions to appropriately assess and address A.Z.’s health care needs
and the needs of her family to promote health and well-being. How does the
pharmacist’s approach differ from that of the other team members?
The pharmacist can explain to the family the medication regimen
prescribed for the patient and discuss the rationale for treatment
while being mindful of her cultural background. Prescription records
can be reviewed for evidence of validating adherence. The
pharmacist could research and provide information to the rest of the
team on the herbal remedies that A.Z. is using. These home
remedies can be explored for potential interaction with the
prescribed medication (eg, how is the cultural use of “honey for
diabetes” potentially affecting her treatment and could its judicious
use be incorporated into her treatment regimen). The pharmacist’s
knowledge of dietary supplements could also be helpful in
suggesting alternative treatments that may be culturally acceptable
to the patient and family.
The nurse practitioner or PA could initiate, manage, and
coordinate A.Z.’s health care needs with the interdisciplinary team.
Tasks will include, but not be limited to, prescribing medication,
assessing efficacy of current medication and treatment plan,
educating the patient and family about current treatment modalities,
health promotion, and harm reduction. The primary care provider
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(physician, PA, or nurse practitioner) can consider a referral to a
mental health professional for counseling and mental health
treatment as indicated. Other team health care members such as the
social worker could assess how the patient’s PTSD and the role of
the family dynamics could be affecting her health and treatment. A
nutritionist could be helpful in assessing and addressing her dietary
requirements in the context of her cultural orientation.
Communication
CASE 7-3, QUESTION 4: A.Z.’s son tells you in confidence that his mother does
not take any of her medications because the family uses home remedies.
Should you communicate this information to the rest of the team and, if so, how
would you do it?
It would be important to discuss with the son the need to share
any vital information that could affect his mother’s health and wellbeing with the team. Explain to the son that his mother is an integral
part of the team and is, in fact, its center. As such, she will not be
ostracized by the team; rather, her actions and beliefs will be taken
into consideration and become a part of the team plan.
Communicating with the patient and her son about the role of
medications is a necessary part of the teaching process. Being open
to patient/family questions or concerns is crucial. Complete and open
communication with the rest of the interprofessional team is essential
for quality and consistency of care.
17
Teams and Teamwork
CASE 7-3, QUESTION 5: The pharmacist, translator, mental health care nurse
practitioner, nurse, physician, PA, and social worker meet with A.Z. and her
children as part of care planning, delivery of care, and discharge. What
teamwork skills are necessary to deliver patient-centered care that is safe,
timely, efficient, effective, and equitable?
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Teamwork skills include communication, problem-solving,
listening, self-awareness, and collaboration. These are essential for
providing quality health care. Effective team skills can improve
patient outcomes, prevent errors, improve efficiency, and increase
patient satisfaction. It is important to establish at the onset of care
how patients and families want to be involved in their care. Engaging
them in designing their plan of care increases their understanding of
tests, procedures, and anticipated care outcomes, ensuring a
successful discharge. Each member of the team contributes, within
the confines of their own specialty, the needed skills to optimize the
patient’s health and clinical care.
18
This unified approach achieved through the blending of multiple
disciplines, with the patient and family at its center, is the key to a
successful interprofessional team.
The end game of IPE is to establish and support fully functioning
interprofessional teams that collaborate to promote the Quadruple
Aim9 to optimize effective, compassionate, and cost-effective
patient/community care while validating caregiver knowledge, skills,
and teamwork. The IPEC core competencies can be seen not only
as goals of preprofessional training but also as a grounding in the
learning continuum of team members throughout the practice
trajectory (Fig. 7-1).
11
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