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Background: Team-based care models (TBC) have demonstrated effectiveness to improve health outcomes for vulnerable diabetes patients but have proven difficult to implement in low income settings. Organizational conditions have been identified as influential on the implementation of TBC. This scoping review aims to answer the question: What is known from the scientific literature about how organizational conditions enable or inhibit TBC for diabetic patients in primary care settings, particularly settings that serve low-income patients? Methods: A scoping review study design was selected to identify key concepts and research gaps in the literature related to the impact of organizational conditions on TBC. Twenty-six articles were finally selected and included in this review. This scoping review was carried out following a directed content analysis approach. Results: While it is assumed that trained health professionals from diverse disciplines working in a common setting will sort it out and work as a team, co-location, and health professions education alone do not improve patient outcomes for diabetic patients. Health system, organization, and/or team level factors affect the way in which members of a care team, including patients and caregivers, collaborate to improve health outcomes. Organizational factors span across seven categories: governance and policies, structure and process, workplace culture, resources, team skills and knowledge, financial implications, and technology. These organizational factors are cited throughout the literature as important to TBC, however, research on the organizational conditions that enable and inhibit TBC for diabetic patients is extremely limited. Dispersed organizational factors are cited throughout the literature, but only one study specifically assesses the effect of organizational factors on TBC. Thematic analysis was used to categorize organizational factors in the literature about TBC and diabetes and a framework for analysis and definitions for key terms is presented. Conclusions: The review identified significant gaps in the literature relating to the study of organizational conditions that enable or inhibit TBC for low-income patients with diabetes. Efforts need to be carried out to establish unifying terminology and frameworks across the field to help explain the relationship between organizational conditions and TBC for diabetes. Gaps in the literature include research be based on organizational theories, research carried out in low-income settings and low and middle income countries, research explaining the difference between the organizational conditions that impact the implementation of TBC vs. maintaining or sustaining TBC and the interaction between organizational factors at the micro, meso and macro level and their impact on TBC. Few studies include information on patient outcomes, and fewer include information on low income settings. Further research is necessary on the impact of organizational conditions on TBC and diabetic patient outcomes.

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Interprofessional Education Collaborative (IPEC) core competencies are widely accepted as a guide to prepare healthcare professionals. Two competency domains, values/ethics and roles and responsibilities, have specific relevance when investigating the effectiveness of a transcultural interprofessional experience. Participants were University of South Alabama students from the Colleges of Allied Health Professions, Medicine, and Nursing, who volunteered for a 7-day service learning experience in Trinidad. A convergent mixed methods research design was used. Students completed two Likert scale surveys, the Interprofessional Education Collaborative Competency Survey (IPECC) and the Transcultural Self-Efficacy Tool- Multidisciplinary Healthcare Provider Version (TSET-MHP), prior to and following the experience. A Wilcoxon Sign Test was used to analyze quantitative data. Qualitative data, guided by the Critical Incident Technique, was obtained from diary entries during the trip and a selected member focus group post-trip. There was a significant improvement in all three cultural competency domains of the TSET-MHP (p < .001). The most frequently reported IPEC sub-competencies were the ability to work in cooperation with those who receive, provide, and support care; and the ability to engage diverse healthcare providers to complement one's own professional expertise. Based on participant report, an international interprofessional clinical experience appears to be effective in enhancing health care competencies.

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CONTEXTO: A abordagem de portadores de doença renal crônica (DRC) em tratamento conservador, por meio de equipes interdisciplinares, pode melhorar a qualidade de vida desses pacientes. OBJETIVOS: Avaliar os efeitos da abordagem interdisciplinar na qualidade de vida de pacientes com DRC em tratamento conservador. MÉTODOS: Setenta e cinco pacientes, acompanhados por equipe interdisciplinar (n = 50) ou por atendimento médico tradicional (n = 25), foram avaliados no início e após um ano de acompanhamento. A qualidade de vida foi avaliada pelo Medical Outcomes Study Questionaire 36 - Item Short Form Health Survey (SF-36), e a análise de parâmetros clínicos e laboratoriais foi obtida com base nos registros dos prontuários médicos. RESULTADOS: Após 1 ano de acompanhamento, os pacientes assistidos por equipe interdisciplinar apresentaram melhora nos seguintes parâmetros do SF-36: capacidade funcional, aspectos físicos, estado geral de saúde, vitalidade e aspectos emocionais; já no grupo-controle esses parâmetros permaneceram inalterados. Além disso, pacientes do grupo interdisciplinar mostraram significativa redução do peso corporal e aumento da hemoglobina e do cálcio plasmáticos. CONCLUSÕES: A abordagem interdisciplinar contribuiu para a melhora da qualidade de vida e para o controle clínico de portadores de DRC em tratamento conservador.

BACKGROUND: Multidisciplinary team-based care (MDC) of patients with chronic kidney disease (CKD) before the beginning of the renal replacement therapy may improve their quality of life. OBJECTIVES: This study aimed to assess the impact of MDC on the quality of life patients with CKD not yet on dialysis. METHODS: Seventy five patients treated by MDC (n = 50) or by standard medical care (n = 25) were evaluated at the beginning and after one year of follow-up. Quality of life was assessed by the Medical Outcomes Study Questionnaire 36 - Item Short Form Health Survey (SF-36). Clinical and laboratory parameters were obtained from the patients' charts. RESULTS: After 1-year of follow-up, the patients in MDC improved the following dimensions of the SF-36: functional capacity, physical features, general health, vitality and mood. On the other hand, the control group did not improve any dimension in quality of life. At the end of the study, the patients followed by the MDC lost body weight and showed statistically significant increases in hemoglobin and calcium plasma levels, when compared to control group. DISCUSSION: Our results showed that, compared to the standard medical care, the MDC contributed to achieve a better quality of life and clinical control in patients with CKD not yet on dialysis.

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