GITT 2.0 at HIGN
This section will describe the implementation of GITT 2.0 at the Hartford Institute for Geriatric Nursing as part of a 3-year HRSA grant (HRSA grant #UD7HP26049) with students from a Nurse Practitioner (NP) program, a Masters in Social Work (MSW) program, and a Doctor of Pharmacy (DPh) program. Students were matched with preceptors from the same disciplines in a home care agency. The team focused on decreasing medication regimen complexity and improving medication adherence among older, transitional care homebound patients. The results of this team-based, interprofessional project include enhanced patient/caregiver-centered outcomes, as well as decreased associated cost by identifying and mitigating medication redundancies, and enhancing care coordination.
Since the aging population frequently experiences multiple comorbid medical conditions and is often prescribed an overwhelming number of medications, the team thought that this would be an ideal focus for our interprofessional collaborative efforts. Consequently, focusing on decreasing medication complexity among the older adult population was determined to be the focus of this interprofessional collaborative effort, especially since we know that many professions play a pivotal role in medication adherence, and not just the individual prescribing the drugs. Qualitative evaluation from the program showed that healthcare professionals have more positive experiences delivering care utilizing a team-based approach. This finding supports improved attitudes and experiences among team members.
The overarching goals of our interprofessional collaborative initiative were to:
- Encourage a practice-education collaboration among nurse practitioners, social workers, and pharmacists, as well as students of each of the aforementioned professions
- Decrease medication complexity (and consequently increase adherence) among transitional care homebound older adults
- Decrease emergency room utilization
- Provide opportunities for the various professions to develop and enhance leadership capabilities
- Improve attitudes regarding interprofessional collaboration among each of the three aforementioned professions
- Building an initiative that was adaptable across all healthcare settings
Some of the lessons learned include:
- One potential shortcoming of the model was the lack of physician integration into the interprofessional team. It likely would have been helpful to include physicians, as the patients that the interprofessional team was providing care for were still under the ultimate care of the community-based physician.
- Leadership could not be designed for only one predetermined profession. Although this initiative was designed to be nurse-led, it became clear that actual leadership varied with the current clinical needs of the patient. It was this understanding that leveraged the integration of situational leadership into our model.