Integrating Multidisciplinary Teams into Daily Practice Steven Elrod

Integrating Multidisciplinary Teams into Daily Practice Steven Elrod, Pharm. D, BCACP; J. Miguel Lee, MD; Erica Dennehy MSW, LICSW, SUDP

Objectives • Describe interprofessional cultural initiatives • Review how a hybrid curriculum impacts didactic schedule • Develop implementation strategies for a behaviorist and pharmacist into a medical residency

Enhance Population Health Improve Patient Outcomes Trip le A im f or P opu lati on He al th Interprofessional Learning Framework Reduce Cost

Medical School Interprofessional Education West, C et al. J Interprof Educ Pract 2016 Sept; 4: 41 -49

Medical School Interprofessional Education West, C et al. J Interprof Educ Pract 2016 Sept; 4: 41 -49

Parsell, G and Bligh J. Medical Education, 1999. 33(2), 95 -100 J

Perception of Interprofessional Education Visser C, et al BMC Medical Education (2017) 17: 77

Perception of Interprofessional Education • Readiness • Interaction based • Facilitators • Acquainted and work experience • Barriers • Miscommunication and gaps in role perception Visser C, et al BMC Medical Education (2017) 17: 77

Visser C, et al BMC Medical Education (2017) 17: 77

Culture. Process. Individual. Buy in Curriculum design and delivery Interview process Involvement at all levels Professionalism Mutual respect Residents’ self identified needs Team based care Recognizes gaps

Where We Started

Where We Are Now

What We Learned • Conventional doesn’t work everywhere • Buy in is essential • Everybody has their place • Residency graduation • MAs, PSRs, admin all invited!

Timeline of Interprofessional Education CCC/PEC- ACGME Milestones Self Assessment Behaviorist and Pharmacist as Advisors Shadow Residents in Clinic Residents shadow Behaviorist and Pharmacist in clinic Interprofessional lecture on “Your Legacy and Professionalism” Layered learning lectures throughout residency

Ways to Involve Pharm and BH Faculty Topic Pharmacist Behaviorist Interview season ✔ ✔ Suboxone clinic ✔ ✔ Hepatitis C clinic ✔ Advising ✔ Wellness ✔ ✔ Didactics ✔ ✔ Shadow sessions ✔ ✔ Scholarly activity ✔ Nursing home preceptor/Home visit ✔ ✔ Program Evaluation Committee ✔ ✔ Clinical Competency Committee ✔ ✔

Resident Self Identified Needs

Assessment Intervention Management Personal § § § § Anxiety Mood Disorders Psychosis Abuse/Mandated Reporting Substance Use Disorders Developmental Stages Weight Loss Sleep/ Insomnia Diabetes Management Primary Prevention (Hypertension/Hyperlipidemia) Conducting a family meeting Chronic Pain Personality Disorder Wellness (self awareness, well being) Biostatistics

Individual Curriculum Topics Substance Use Disorders Diabetes/Insulin Mgmt Asthma/COPD Osteoporosis Primary Prevention High Risk Medications (opioids, benzodiazepines) Biostatistics Suicide ? Trauma informed Care Personality Disorders Wellness End of Life Care Communication Abuse/Mandated Reported

Brain Storm on Topics of Collaboration • Professionalism • Wellness • Psychiatric topics (Children and Adults) • • Mood Disorders Anxiety ADHD Insomnia • Chronic pain • Diabetes • Suicide • Smoking Cessation • Considerations in End of Life Care • Dementia

Our Didactic Schedule • 1230 – 1330 on Tuesdays and/or Fridays • During interview season (Oct-Dec) didactics are on Friday • In addition to 3 hour workshops residents go to every other Wednesday with our core program

Our Didactic Schedule Topic Number of Lectures Behavioral Health 8 Pharmacology 8 Population Health 4 Wellness 6 Support Group Monthly Practice Management ? ? Case Conference 4 Journal Club 4

Team Based Care • Suboxone case • Who is included? • Depression/Anxiety case • Who is included • Sharing care • Increasing access for patients

Our Schedules • Faculty Pharmacist Schedule Monday Tuesday Wednesday Thursday Friday Clinic Admin Clinic Admin • Faculty Behaviorist Schedule Monday Tuesday Wednesday Thursday Friday Clinic Clinic Admin Clinic

Medical and Pharmacy Residency Interview Process • This is where we start setting the expectation • Applicants meet MD, Pharm. D, and BH • This is for medical and pharmacy residency interviews • Setting the expectation of team based care/collaborative work environment • Standardized questions vs free response interview portion

Advising and Advisors • Started with all faculty members, including Pharm. D and BH, as advisors • Each of us had a resident from each class • Changed to Miguel (PD) advising all 3 rd years; Steven (Pharm. D) advising all 2 nd years; Rein (APD) advising all first years • Erica (BH) advised as needed during times of stress or needed some brief counseling • Residents are completely aware that if they need advising from a particular faculty, we will meet that need

Professionalism • Created lecture together • How is everyone involved in professionalism? • Holding each other accountable

• Burnout questionnaire 80 70 60 50 40 30 20 10 0 7/31 -8/27/2. . . 9/25 -10/22/. . . 11/20 -12/17. . . 2/12 -3/11/2. . . 4/9 -5/6/2018 7/3 -7/29/20. . . 7/30 -8/26/2. . . 8/27 -9/23/2. . . 9/24 -10/21/. . . 10/22 -11/18. . . 12/17 -1/13/. . . 3/11 -4/7/20. . . 5/6 -6/2/2019 • Idea generation Rotation 60 50 40 30 20 10 0 • Taking turns leading Steven Elrod, Pharm. D MBI & WEMWBS Rotation 7/31 -8/27/2017 9/25 -10/22/2017 11/20 -12/17/20. . . 2/12 -3/11/2018 4/9 -5/6/2018 6/4 -7/1/2018 7/3 -7/29/2018 7/30 -8/26/2018 8/27 -9/23/2018 9/24 -10/21/2018 10/22 -11/18/20. . . 12/17 -1/13/2019 2/11 -3/10/2019 Score • Quarterly 7/31 -8/27/2017 8/28 -9/24/2017 10/23 -11/19/2. . . 12/18 -1/14/20. . . 2/12 -3/11/2018 4/9 -5/6/2018 6/4 -7/1/2018 7/3 -7/29/2018 7/30 -8/26/2018 8/27 -9/23/2018 10/22 -11/18/2. . . 12/17 -1/13/20. . . 3/11 -4/7/2019 60 50 40 30 20 10 0 Score Wellness Miguel Lee, MD MBI & WEMWBS MBI - Burnout MBI Depersonalization MBI - Personal Achievement Erica Dennehy, LICSW MBI & WEMWBS MBI - Burnout MBI Depersonalization MBI - Personal Achievement

Creation of Faculty • ACGME has started to catch up • Advocating within our own system • Being recognized as faculty not just on paper but receiving full benefits that come with that role as well

Integrating Multidisciplinary Teams into Daily Practice Steven Elrod, Pharm. D, BCACP; J. Miguel Lee, MD; Erica Dennehy MSW, LICSW, SUDP