Evidence-Based Practice Change: Implementation of a Collaborative Practice Model for Diabetes
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Background: The prevalence of type II diabetes mellitus (T2DM) in the United States is high, especially in underserved populations. Many patients with T2DM do not receive the optimal interprofessional collaborative care that has been shown to improve outcomes. A model of care that incorporates these evidence-based recommendations is integral to improving the quality of diabetes care. A growing body of literature identifies the use of a provider-clinical pharmacist collaborative practice (P-CPCP) model of care as an effective, innovative, and evidence-based practice that will improve patient outcomes.
Purpose: In response to an identified need to improve T2DM patient care in an urban community health clinic (CHC), the purpose of this project was to implement a P-CPCP model of care. The expected outcomes included (a) increase the number of patients with T2DM that are referred to a clinical pharmacist; (b) improve provider satisfaction with the collaborative process; and (c) implement the P-CPCP model of care across all CHC agency clinics in the network to ensure the delivery of high-quality, evidence-based patient care.
Design and Analysis: A quality improvement (QI) design was used and incorporated a rapid improvement cycle of plan-do-study-act (PDSA). After identification of a gap in care and analysis of the evidence, the QI project was created. A provider education module was presented and followed by a chart audit of electronic medical records (EMR) of patients with T2DM. These charts were examined to determine pre- and post-implementation usage of the model. Provider satisfaction and perceived effectiveness of the P-CPCP model was assessed using a brief electronic survey. Descriptive statistics and a cross tabulation analysis are presented to show the effectiveness of the model for increasing the number of referrals to the clinical pharmacist and the number of patients seen by the clinical pharmacist in both pre and post groups, as well as to describe the most used pharmacist interventions and provider perceptions of the model.
Results: The P-CPCP model increased utilization of the clinical pharmacist in diabetes care. Following implementation of the model referrals increased by 210%. The provider survey demonstrated an increase in provider satisfaction with collaboration, the usefulness of the model, and sustainability of the model. Of the pharmacist interventions, medication reconciliation education (MRE) was perceived as the most frequently used.
Conclusions: This doctor of nursing practice (DNP) project reflects evidence-based practice methods on interprofessional collaboration and provides new insight into the implementation of a collaborative practice model and the role of the clinical pharmacist as a valued member of the collaborative team. Consistent use of the P-CPCP model of care improved provider satisfaction with the collaborative process, increased the number of patients referred to the clinical pharmacist, and led to the standardization of diabetes management at a CHC.
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