My husband and I recently completed a crash course in diabetes management, following our three-year-old son's diagnosis of type 1 diabetes. During a three-day hospital stay, we met with physicians, diabetes educators, a dietitian and psychologist. His caregiver and preschool were included in the process to ensure his condition is properly monitored.
We left the hospital exhausted, albeit reassured that assistance was a mere phone call away. In the few weeks since his diagnosis, we've already met with his diabetes team, the first of ongoing quarterly meetings to help us achieve optimal outcomes for our son and his condition. And I can now dial the emergency line in my sleep.
The care team is a godsend, as we learn to navigate the highs and lows of diabetes management. And yet the team-based approach remains underutilized in health care today. The benefits are many: individualized care that improves outcomes, enhances patient satisfaction and lowers costs. But the challenges are equally profuse.
Team-based care is impeded by outdated reimbursement models, antiquated medical training that reinforces individual autonomy and workforce constraints, among other things.
"We have to be able to provide care in a better, coordinated way," says John Combes, M.D., senior vice president of the AHA and president and chief operating officer of the Center for Healthcare Governance. The development of new delivery models, including the patient-centered medical home, should help in that achievement.
Earlier this year, the AHA released "Workforce Roles in a Redesigned Primary Care Model," a report that examines the future primary care workforce. The vast majority of patients with chronic conditions are treated in the primary care setting. The report emphasizes the importance of team training among health care professionals and developing a culture to support patient-centered care. Another key is creating an environment that allows all members of the health care team to practice to the full scope of their respective licenses. In our case, we work closely with the nursing staff to make adjustments to our son's insulin dosages. Emphasis should be placed on self-care as well.
"In the long run, these moves will bring down the costs of care, extend the work force and be better for the patient," Combes says.
"Having an effective primary care infrastructure within a hospital system is incredibly important," says Peter McGough, M.D., chief medical officer for the University of Washington Medicine Neighborhood Clinics in Seattle. "Under the old primary care model, the physician does everything. That's the way our reimbursement system is structured."
To truly provide better care, primary care teams must bring in other providers beyond physician assistants and nurse practitioners, McGough says. Effective primary care teams should include access to psychologists, social workers, nutritionists and case managers.
"We are bringing other people in to support the physician and take better care of the patient," he says. "We are also looking at ways to extend care outside of the office."
Content by Health Forum, Sponsored by: VHA.
