An Introduction to IMPACT

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An Introduction to IMPACT

• Sunnybrook Health Sciences Centre
• GiiC
• Knowledge-to-Practice Workshop
• Presenters Susan Riddle Jasmine Arellano

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What it is

• Interprofessional Model of Practice for Aging and
  Complex Treatment
• A comprehensive model of
• Assessment
• Care
• Mentorship and training
• Planning

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What it is

• An interdisciplinary team works with patient,
  caregiver(s), and referring practitioner
• Typical appointment covers a diverse range of
  medical, functional and psycho-social issues
• Goal unpack the patients condition
• Takes 2-3 hours
• Complements family practitioners care

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What it is

• Room to personalize process according to context
• Builds on unique characteristics of the patient
  being assessed
• Builds on unique characteristics of the team in
  place

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IMPACT HCPs

• The team comprises
• Family physician
• Family physician resident
• Pharmacist
• Occupational therapist
• Physiotherapist
• Community nurse
• Social worker
• Dietician

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Patient on Screen
Doctor
Resident 1
Resident 2
HCP learner
Physio
OT
Researchers
Dietician
Pharmacist
Social Worker
Community Nurse
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The IMPACT patient

• Inclusion criteria
• aged 65
• 5 or more long term medications
• 3 or more chronic disease requiring monitoring
  and treatment OR 2 chronic diseases when one is
  frequently unstable
• minimum of 1 functional ADL limitation
• not home-bound or institutionalized
• patient and/or caregiver is willing and able to
  deliberate with a team
• patient and/or caregiver are motivated to take
  action to improve patients health status and
  patient is emotionally/cognitively/socially
  equipped to do so

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The IMPACT protocol
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Patient Selection Invitation

• Selection based on inclusion criteria
• Invitation extended to patient/caregiver

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Group Discussion 1

• Referring practitioner provides background info
• Brief history
• Recent events
• Current issues/concerns
• Patients support systems
• Rationale for bringing patient to IMPACT

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Patient Welcome Initial Patient Interview

• Patient and caregiver greeted
• Patient and caregiver interviewed, team observes
  and gathers data on
• Current concerns, current function patient and
  family goals and perspectives
• Interviewer summarizes patient and family
  concerns

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Group Discussion 2

• Interviewer debriefs team and priorities for
  visit are identified
• Issues and concerns
• Which HCPs will see patient and caregiver
• Additional information needed?

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HCP assessments

• Relevant HCPs perform assessments of patient,
  caregiver
• Social worker
• Occupational therapist
• Physical therapist
• Nurse
• Dietitian
• Pharmacist

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Team Deliberation

• HCPs discuss situation in light of findings of
  team members assessments
• Investigation/treatment options discussed
• Care plan begins to take shape
• What does the patient/caregiver want?
• What can the patient achieve?

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Documentation and Debrief

• Dialogue with patient/ caregiver to ensure their
  needs and expectations have been met
• Patient plan of care negotiated with input from
  patient and caregiver/family
• Resources and patient to-do list provided
• Patient medical records completed

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Patient Follow-up

• Follow-up visit with FP and care plan review
• Community visits from IMPACT team members
• Ongoing team communication

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Highlights of the IMPACT experience

• Very different from patients typical encounters
  with their family physician
• Group discussion, shared observation
• Final recommendations arrived at through a
  collaborative and interprofessional process
• Effectiveness
• Real-time problem solving
• Addressing patient and caregiver priorities
• Avoids multiple referrals

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Highlights of the IMPACT experience

• Shared knowledge and perspectives
• Sharing of expertise, knowledge
• Different professional and personal approaches
• Opportunity to draw on expertise of entire team
• Interprofessional collaborative knowledge
  construction
• Observation
• Can see interactions
• Referring FP sees patient in a new light

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IMPACT SuccessesAppeal to patients and caregivers

• Patients feel better able to express themselves
  with longer appointments
• ...so within the first 10-15 minutes, mom has a
  comfort level that she never had before and is
  more forthcoming than ever. Family member
• Patients feel that they are being listened to
• IMPACT is a huge improvement. Theyre hearing
  the patient, finally they are, they have the
  time. Family member

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Appeal to patients and caregivers

• Patients felt important and supported by the care
  team
• Well, it was just wonderful. I felt taken care
  of I felt um, I hate to say this, special
  Patient

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Thank you!

• Questions?

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• "Frail older patients unlike younger persons in
  the health care system or even well elders
  require complex care. Most frail older patients
  have multiple chronic illnesses. Optimum care
  cannot be achieved by following the paradigm of
  ongoing traditional health care, which emphasizes
  disease and cure. Because no one health care
  professional can possibly have all of the
  specialized skills required to implement such a
  model of health care delivery, interdisciplinary
  team care has evolved.
• Dyer et al. Frail Older Patient Care by
  Interdisciplinary Teams. Gerontology Geriatrics
  Education 200424(2) 51-62.