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Monday Apr 27, 2015

Team-based Training Key to Providing Team-based Care

One of the core components in transforming a practice is team-based care, and this concept is a focus of many conversations when I visit our chapters across the country.  

My employer, the Quillen College of Medicine at East Tennessee State University (ETSU), also has embraced this concept. And the outstanding group of interprofessional educators I work with are constantly looking for ways to enhance not only the way we provide team-based care, but also how we address the all-important process of teaching team-based care. Truly, to embrace, understand and implement team-based care, we have to have team-based education.

Photo courtesy American Pharmacists Association

Here I am speaking at the American Pharmacists Association's annual meeting. I gave a presentation about team-based care with Brian Cross, Pharm.D., who is vice chair of the Department of Pharmacy Practice in the Bill Gatton College of Pharmacy at East Tennessee State University.

During my time as an AAFP officer, I have been honored to speak to the boards of several organizations that represent our colleagues who play critical roles in providing team-based care, including the Association of Family Practice Physician Assistants, the American Academy of Physician Assistants, the American Association of Nurse Practitioners and the American Pharmacists Association (APhA). At each of these meetings, I have had a chance to thank each group for helping improve the care of our patients, and to consider ways to work through challenges to find creative ways of providing education.

There are many others who play important roles in team-based care, including social workers, behavioral health specialists and our county health departments, but today I want to focus on how we work -- and train -- with pharmacists.

Recently, I had the opportunity to work with my friend and colleague, Brian Cross, Pharm.D., who is vice chair of the Department of Pharmacy Practice in the Bill Gatton College of Pharmacy at ETSU, on a presentation about team-based care(www.medscape.com) (login required) during the APhA's annual meeting.

We also co-teach several sessions with our medical students, pharmacy students and residents at ETSU. We start with a patient case that relates to considering and implementing evidence-based approaches to caring for patients with cardiovascular disease. We break our audience into small groups of junior medical students and second-year pharmacy students who then work through questions about patients to seek the best evidence about possible treatments and put them into practice. Then the groups defend their decisions in our discussions.  

This particular educational activity is critical because during the same rotation, students, family medicine residents and the pharmacy team work together to coordinate post-hospitalization care in our transitions clinic. Students and residents take what they have learned from this and other sessions and apply it to patient care, and the results have led to dramatic improvements. For example, this clinic has helped reduce our readmission rate from 25 percent to 13 percent.

Almost every patient seen in this clinic has benefited from the true medication reconciliation that can occur when these students review the clinic medication list, the hospital list, the pharmacy list and what the patient brings into the appointment.

In addition, we have other opportunities in which our pharmacists and their team see our patients in the anticoagulation clinic. They don't work in isolation. Instead, they work directly with our residents and medical students. In addition, our social worker leads a group of medical students, pharmacy students and sometimes a resident to make home visits with our patients.

These examples demonstrate ways that learners from different professions are able to put theoretical educational processes from the classroom into direct actions that impact care.  

Even if a school or community isn't blessed with a college of pharmacy, those of us in education still can reach out to our local pharmacies and find ways to involve some of their learners or employees in our educational process, which will help create better relationships. One of the keys to team-based care is having this kind of relationship-building at every level. And it is not just between health care professional and patient. It also is between each member of the team.  

If you are not involved in academics, there is value in having discussions with the team members who work not only under your roof, but also with local pharmacists or health departments. Each member of this community-based team can talk about the kinds of patient care issues they see and how each might be able to contribute to improving care. Much of this can be done without specific contracts or organizational memos. The core principle is improving the care of our patients by working together.  

It's worth noting that the Patient-Centered Primary Care Collaborative (PCPCC) published a report(www.pcpcc.org) in December that looks at how seven different programs use interprofessional health training to deliver patient-centered care. The PCPCC also is offering a five-part podcast series(www.pcpcc.org) on this concept.

Meanwhile, the Robert Wood Johnson Foundation offers a free resource(www.improvingprimarycare.org) related to improving care through team work. And the National Center for Interprofessional Practice and Education offers articles, presentations and other tools(nexusipe.org) in its resource exchange.

Finally, the Academy will be offering a session Sept. 29 and Sept. 30 at the 2015 AAFP Family Medicine Experience  (FMX) in Denver titled "Capitalizing on Team-Based Care to Improve Quality and Office Efficiency." Thomas Bodenheimer, M.D.(www.annfammed.org), and Berdi Safford, M.D., will be among the FMX panelists. 

I am hopeful that some of these ideas resonate with you. None of us takes care of patients in isolation, so the first question to ask and answer is, "Who are the members of our teams?" The second step is to get everyone together and think about how we can impact education and patient care. Thanks for being a part of this critical process.

Reid Blackwelder, M.D., is Board chair of the AAFP.

Posted at 01:20PM Apr 27, 2015 by Reid Blackwelder, M.D.

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