Intervention Program Based on a Model of Interprofessional Co-operation and Promotion of Self-Care for Type 2 Diabetes Clients

Key Implications for Decision Makers

  • In Canada, diabetes is a major health problem. According to Health Canada, almost 60,000 new cases are diagnosed each year. The literature advocates an approach centred on the individual that promotes managing his health through responsibility for self-care and partnership with the care team.
  • Services to people with diabetes affect everyone: individuals, managers, policy decision makers, workers and researchers.
  • Implementation of models fostering interprofessional co-operation is essential for field decision makers and policy decision makers. They therefore must rely on practical, documented experiences.
  • The research report discusses interprofessional co-operation between nurses and physicians treating type 2 diabetes clients.
  • The project is a concept from the workers in the field and meshes with the various missions (services, teaching and research) of the university-affiliated centre (UAC, CLSC component of CSSS-IUGS). It is based on broader mobilization among workers, managers and researchers around discussions of practices, client services and development of field tools emerging from needs in the field.
  • A field-based approach coupled intervention with research, documented practices, concerns and effects. The tools developed facilitate ongoing development of a model of interprofessional co-operation drawn up in an earlier pilot project.
  • The project factors in local and national concerns about systematic monitoring of client groups with chronic health problems, interprofessional co-operation and an interdisciplinary approach.
  • The interprofessional co-operation model implemented is based on co-operative models described in the scientific literature. It is flexible, reflects organizational conditions in the field and can be adjusted to other client groups and other professionals than those mentioned. It is supported by national thrusts for primary care and is consistent with leading practices of CSSS-IUGS (CLSC component).
  • The findings indicate, in part, the importance of participation by managers to support the introduction, implementation and assessment of a new practice (adoption by the management committee) and to demonstrate openness in management: reorganizing work teams, participating in meetings, discussing difficulties and securing funding.

Executive Summary

  • How can the organization of primary care be more effective in treating people with a chronic disease such as type 2 diabetes?
  • Should the role of professionals be reconsidered in conjunction with the rise in chronic diseases?
  • Can individual responsibility for one's health, through learning self-care, contribute to more efficient organization of primary healthcare services?
  • Will professional reorganization and better sharing of responsibilities among professionals foster improved service delivery and a general improvement in the health of the people involved?
  • How can sharing responsibilities in medical and nursing follow-up, as well as the resulting reorganization of duties, take shape within institutions and departments that meet the usual institutional standards?

These concerns voiced by managers and decision makers in a primary care intervention setting form the basis for deliberation by this evaluative and participatory study. The study's findings indicate that interprofessional co-operation and interventions to promote self-care represent relevant strategies in the organization of primary care services for people coping with chronic disease.

The study of interprofessional co-operation between nurses and physicians emerges from the determination and needs voiced by an intervention setting. It reflects the tone and concerns of this field. However, it also contains cross dimensions applicable to other settings or departments, including family medicine groups. Interprofessional co-operation takes form around an appropriate work structure (space layout and work schedules, pooling of tools, joint definition of communication methods); compliance with an intervention model defined and shared by professionals (intervention based on promoting self-care, agreements on follow-up objectives, joint implementation of the model); co-operation and use of various professional knowledge (mutual influence, joint case discussions); joint accountability for follow-up (joint intake, reconciling complementary roles, accepting the central role of nurses); and finally, essential co-operation among managers (support implementation of the model, display openness and flexibility in management, seek solutions to various ad hoc problems).

Promotion of self-care with people who have type 2 diabetes led to six strategies tested by teams of nurses and physicians: 1) contribute to the therapeutic link (listen, show interest, use appropriate language); 2) intervene from the basis of clients' concerns and views as well as their strengths (leave enough time to speak, name the strengths and place value on them, adapt the pace of the intervention to the individual); 3) encourage and support decision-making (invite the person to decide, adapt the intervention as required); 4) facilitate learning (foster understanding of the situation, assist with skills development, etc.); 5) assist with the establishment of support networks (find support resources, intervene with people in the support network); and 6) co-ordinate the organization of assistance (implement various methods that foster interactions among the people involved). The effects of the intervention program on people with diabetes show results that do not clearly support a conclusive finding. A larger number of subjects would have supported a more meaningful reading and scope for the findings. The research in this field must continue. This study documented a model of professional co-operation and promotion of self-care actually implemented by teams of nurses and physicians, resulting in an incomplete reading, admittedly, but one that contains sufficiently reliable indications to demonstrate the interest of continuing development of this type of model.