The interdisciplinary health care team in the 21st century: It’s not just about doctors anymore
A report released in October 2010 by the U.S. Institute of Medicine called for an increased level of cooperation between various health care disciplines in the U.S. health care system, including increased use of nurse practitioners in primary care delivery. In response, the editor-in-chief of the Journal of Family Practice, himself a physician, recently issued an editorial calling on his profession to welcome nurse practitioners into increased primary care roles, a marked shift from the medical profession’s traditional resistance to nurse practitioners (Susman, 2010). And with health care costs skyrocketing in the midst of acute shortages of both nurses and primary-care physicians, Americans are increasingly looking for alternatives to the traditional physician-driven health care model.
With calls for interdisciplinary health care now coming from high levels, a movement to develop widespread interprofessional education and training (IE&T) has arisen to meet the future demand for this new care paradigm. A recent conference administered jointly by the Josiah H. Macy Foundation and the Carnegie Foundation for the Advancement of Teaching (2010) focused on the need for more interprofessional health care training, saying “if nursing, medical, and other health professions students learn jointly in clinical settings, as graduates they will improve patient outcomes by working more collaboratively, communicating better with each other, and fostering a health care delivery system that assures quality and patient safety.”
“Just like it’s easier to raise a child with the support of family and community than as a single parent, health care quality is better when it’s delivered by a team,” says Jane Mohler, RN, MPH, PhD, an associate professor at the University of Arizona Colleges of Medicine, Pharmacy, Public Health and Nursing, and a current FNP student at University of Phoenix. “As models of care become more focused on team care, interprofessional education and training is taking off nationally in a big way,” she says.
What exactly is “team care” in the health care setting? According to Mohler, it’s a combination of more cost-effective allocations of care resources, combined with better communication and more patient-centered decisionmaking. “Who is the person that costs the least amount of money, yet is still competent to do the work? That’s where the team comes in,” she explains. “In a team setting, you can have a nurse practitioner treat simple cases like strep throat, a paraprofessional educate the public on COPD, freeing up the physicians for the more complex cases. All the medical disciplines are moving toward working in teams.”
The United States is also somewhat late to the party when it comes to team-based health care—interdisciplinary health care models have already been standard in Europe, Canada and Japan for generations. “Other countries have been doing things this way for years,” says Mohler. “Our health care payment system in the U.S. is set up to favor physicians and hospitals, and that’s not the best way to deliver care. We spend the most money and yet have the worst outcomes.”
According to Mohler, interprofessional health care will help move more care out of hospitals and back into the community. One way to accomplish this is via increased use of nurses and nurse practitioners for primary caregiving in the outpatient setting, as well as the use of laypeople called promotora—trained paraprofessionals who can conduct educational programs in the community on common public health issues like obesity, COPD, pre- and post-natal care, and the like. “So much of health care is essentially self-care,” Mohler explains. “Promoturas can help teach people how to take better care of themselves.” Mohler currently heads an interprofessional education and training center at the University of Arizona that uses a combination of campus-based and telemedicine-based training to develop teams of physicians, nurses, pharmacists and other allied health disciplines who are trained to work as a cohesive unit.
“The various professions don’t always communicate well,” says Erich Widemark, PhD, RN, FNP-BC, who currently serves as director of nursing at University of Phoenix’s main Campus. “Nurses and nurse practitioners in particular are well-positioned to streamline team-based care communications, because we’re in contact with all the other disciplines—the pharmacist, the physical therapist, the physician. We’re the gatekeepers.”
Widemark goes on to say that if all the various health professions do their training together, seamless cooperation is far more likely to happen in the real world. “If you take a class with someone, you tend to bond with that person on an equitable level,” says Widemark. “It’s another way to foster collaboration through shared learning experiences. I’m far more likely to have a good working relationship with the doctor or pharmacist I went to school with than somebody I’ve never met.”
Although the United States still has a ways to go when it comes to training its health care workforce to work in teams, the IE&T movement is already making an impact in real-world care settings. “With IE&T, our outcomes will be better, and our care will be of higher quality and at a lower cost,” says Jane Mohler. “It’s a whole new health care world.”
References
Institute of Medicine, and Robert Wood Johnson Foundation Initiative on the Future of Nursing. (2010). The Future of Nursing: Leading Change, Advancing Health. Washington, DC: Institute of Medicine Press.
Susman, J., MD. (2010). It’s time to collaborate—not compete—with NPs. Journal of Family Practice, 59 (12), p. 672.
Josiah H. Macy Foundation, and the Carnegie Foundation for Advancement in Teaching. (2010). Conference Summary. Educating Nurses and Physicians: Toward New Horizons Advancing Inter-professional Education in Academic Health Centers, June 16-18, 2010, Palo Alto, CA. New York: Carnegie Foundation.
