Helene Hjalmarson NHPRC 2013

A longitudinal case of secondary
prevention for patients with
osteoporosis
*Developing
interprofessional
collaboration
Hjalmarson, Åhgren, & Strandmark 2013
Journal of Interprofessional Care, (27) 161-170

2013-06-18
Promoting Health in everyday settings / 7th
Nordic Research conference in Health
promotion, Hjalmarson., Åhgren., Strandmark
*
Osteoporosis implies an increased risk for fractures attributable to low bonemass
microarchitectual deterioration of bone tissue resulting in bone fragility
In Scandinavia every third women (70-75 years) suffering osteoporosis
The risk for Swedish women having a low trauma fracture after the age of 50, is 50%
Detection of osteoporosis is less than 30 % in patients with low-trauma fractures (Sweden
less than 23%)
Collaboration concerning
fracture prevention needs
to be strengthened
(Ström et al. 2011, Besette et
al. 2008)

2013-06-18
*
*Explore the development of interprofessional
collaboration, over almost a 4-year period,
aiming to improve secondary prevention of
osteoporosis
*Keywords: Bottom-up approach, case study,
interprofessional collaboration, osteoporosis, secondary
prevention

2013-06-18
*
There is limitied knowledge about the impact of
interprofessional learning practice (Zwarenstein & Reeves 2008)
and a need to conceptualize the links between
interprofessional collaboration and the interplay between
inputs, process and outcomes (Reeves et al. 2011, Dámour et al
2005)
There is a special need to clarifying research about how
interprofessional collaboration and integrated care can
be developed between the orthopedic speciality and
primary health care (Jaglag et al. 2010.; Feldstein et al. 2008)

2013-06-18
*
Orthopedic department
Rehabilitation
department
8 Primary Health
Care units
3 Division directors
6 Department directors
23 key
stakeholders -
”owners of the
process
A systematic approach for health promotion planning inspired by the idea
to incorporating community empowerment into top –down driven structures
(Laverack & La Bonte 2000)

2013-06-18
*
Structure Process Outputs Outcomes
Professional
Management
Patient
Developing
Interprofessional
Collaboration
Integrating seondary
prevention activities
of osteoporosis

2013-06-18
*

2013-06-18
*
*A leadership style that supported interdependency.
*Continous sharing of clinical experiences and
increasing the professional´s space for freedom of
actions with focus on patient-centred integrated
care.
”In contrast to what is traditionally done, we did not
begin by coordinating our health care program
policies based on top-down deciscions instead, we
begun by trying to find forms for collaboration”
(Physiotherapist in year 2)

2013-06-18
*
*”One major factor determining the success of
the process has been and remains the ongoing
feedback we get, the fact that we regularly
receive confirmation about what is happening
in the process, since we become blinded to it
ourselves” (Occupational therapist, workshop in year 3)

2013-06-18
*
Feedback generated
* Ability to identify collective actions
* Knowledge about the benefits of collaboration
* A sense of collective efficacy
* Trust and shared responsibility between professionals
* Interactions skills for instance developed discursive power

2013-06-18
*
*Practicing new approaches by incorperating
empowerment aspects in patient
communications (MI, Learning circles, shcedule
time for reflection…)
*New organizational innovations: assessment
instruments, patient information,
communication guides, flow charts, physical
profile, new routines for follow-ups…

2013-06-18
Hjalmarson,Åhgren,Strandmark (2013)
Journal of Interprofessional Care

2013-06-18
*
*”Working like this is very inspiring, as seeing
patients at the hospital and knowing they will
be followed up at the primary care unit. Today
we have a strong chain of care, and we can
feel it” (Nurse in year 3)
* The detection of osteoporosis increased from less than 30%
before 2007 to 83% in 2009/2010
* 86% of patients diagnosed with osteoporosis were followed up
with a telephone call
* Almost 90% had a post-fracture follow-up with their general
practitioner
* Almost 50% achieved lifestyle changes like increased physical
activity, calcium intake or quit using tobacco…

2013-06-18
*
* A balance between bottom-up and top-down structures triggered
improvements in the development of interprofessional collaboration
furthermore shows a way to manage knowledge translation of EBM in
osteoporosis
* The results demostrate some possibilites to better understand some
interprofessional issues generating inputs, outputs with outcomes and thus
reveal parts of ”the black box” -
* The findings show interprofessional collaboration to be a successful way of
facilitating clinical innovations to reduce care gaps and improve secondary
prevention activities
* Leaders may consider: accepting complexity, focusing on communication
based on interprofessional experiences, measuring collective performance
and highlight the importance of feedback

2013-06-18
Thank You!
helene@kau.se

Helene Hjalmarson NHPRC 2013

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