When The Moon Is In The Seventh House. And Jupiter Aligns With Mars. As our nation's health care costs continue to rise faster than almost any other segment of our economy -- expenditures of $2.6 trillion in 2010, or over 10 times the $256 billion in 1980 -- the health care environment is undergoing unprecedented transformation. In many ways, "bending the cost curve" has become the rationale for instituting substantive changes which health policy experts, particularly those at the Institute of Medicine (IOM), have recommended for decades. A key element of President Obama's landmark
This past Summer, six major professional educational organizations released the report Core Competencies for Interprofessional Collaborative Practice. This visionary effort by the American Association of Colleges of Nursing, the American Association of Colleges of Osteopathic Medicine, the American Association of Colleges of Pharmacy, the American Dental Education Association, the Association of American Medical Colleges (AAMC), and the Association of Schools of Public Health lays out a strategic plan for implementing a number of recommendations made by the IOM over the past 40 years. The underlying objective is to ensure safe, high quality, accessible, patient-centered care. It will not be easy to establish a culture of interprofessional learning and genuine respect for the competence of others. There is a long history of "turf wars" under the banner of "patient safety." Nevertheless, it is important to appreciate that How care is delivered is steadily becoming appreciated as being as important as What care is delivered. Developing effective teams and redesigned systems is critical. These underlying concepts are reflected in PPACA's ACO and medical home provisions. On a personal level, having retired from the U.S. Senate staff after 38+ years, I look forward to working on these intriguing issues from a university perspective.
The underlying purpose of interprofessional learning is to prepare health professional students for deliberately working together with the common goal of building a safer and better health care system. To be successful, one must appreciate that educational institutions have a responsibility to both produce a health care workforce that is responsive to the nation's evolving health care needs and also to ensure that their graduates are able to practice to the full extent of their expertise. Practice and education can no long be viewed as separate entities. The optimal use of the workforce requires a cooperative effort in the form of teams sharing common goals and incorporating the patient, family, and/or community as active members. This is particularly important for addressing the complex needs of chronic conditions where the psychosocial-economic-cultural gradient of care is so significant. Examples of exciting interprofessional education exist but are rare. For example, the Accreditation Council on Graduate Medical Education multispecialty resident survey data showed that formal team training experiences with non-physicians was significantly related to greater resident satisfaction with learning and overall training experiences, as well as to less depression, anxiety, and sleepiness, and to fewer reports by residents of having made a serious medical error.
Core competencies are needed to: * Create a coordinated effort across the health professions to embed essential content in all health professions education curricula. * Guide professional and institutional curricular development of learning approaches and assessment strategies to achieve productive outcomes. * Provide the foundation for a learning continuum in interprofessional competency development across the professions and the lifelong learning trajectory. * Acknowledge that evaluation and research will strengthen the scholarship in this area. * Prompt dialogue to evaluate the "fit" between educationally identified core competencies and practice needs/demands. And, * Actively involve accreditation agencies and licensing and credentialing bodies in the process.
The report notes: "It may be more helpful to think in terms of competencies that are common or overlapping more than one health profession but not necessarily all health professions. This can be the source of interprofessional tensions, such as in the debate about overlapping competencies between primary care physicians and nurse practitioners. The overlap may be a strategy to extend the reach of a health profession whose practitioners are inaccessible for various reasons…. 'Complementary' competencies enhance the qualities of other professions in providing care…. "Collaborative' competencies are those that each profession needs to work together with others, such as other specialties within a profession, between professions, with patients and families, with non-professionals and volunteers, within and between organizations, within communities, and at a broader policy level."
Perhaps the heart of this transformation: "Provision of patient-centered care is the goal of interprofessional teamwork. The nature of the relationship between the patient and the team of health professionals is central to competency development for interprofessional collaborative practice. Without this kind of centeredness, interprofessional teamwork has little rationale." Mutual respect and trust are foundational to effective interprofessional relationships. Collaborative care honors the diversity that is reflected in the individual expertise each profession brings. All team members must place the interests of patients and populations at the center of health care delivery. Today, too many health professions students have little knowledge about or experience with interprofessional communication. Working in teams involves sharing one's expertise and being willing to relinquish some professional autonomy to work closely with others, including the patient and his/her family. "The challenges to bringing about transformational change in health professions education, which includes much stronger emphasis on 'learning together to work together,' are real and will require creativity and commitment to overcome. However, positive changes… indicate that many of the elements requiring change are 'unfreezing'…. Every indication is that the time is now indeed right for transformational changes and, collectively, we are ready for action." We would rhetorically ask: Should not those pursuing psychology's psychopharmacology (RxP) agenda rightfully see themselves as being on the forefront of their profession's evolution into the 21stcentury?
A Refreshing Vision: Reflecting upon the experiences of retired colleagues, Vickie Mays has insightfully proposed intergenerational collaboration: "I have seen some wonderful transformations in retirement. What I love is the executive group that sends retired executives to work free with community organizations. I wish there was a community service mandate at all high schools and universities as that is the time to have those executives get a sense of community. What would make psychology a transformed profession is if, like our law colleagues, we had to do pro bono work. I have thought on a couple of occasions of trying to move this through APA by having people indicate their willingness and then having APA put it on a website as a start. We at UCLA now have a volunteer center and it has made a big difference in the tackling of community needs. We bus the students into a school and in one day we renovate a school, rehab a facility, any number of things!" If such an approach were systematically implemented in federally qualified community health centers, we would expect that our senior and new career colleagues would work together to develop that necessary comfort level to effectively integrate psychological expertise with primary care needs.
Changing Times: * The Substance Abuse and Mental Health Services Administration (SAMHSA) recently announced the availability of $35.7 million for up to 32 Primary and Behavioral Health Care Integration grants for community behavioral health organizations to establish coordinated and integrated services through the collocation of primary and specialty care medical services. The goal is to improve the physical health status of adults with serious mental illnesses who have, or are at risk for, co-occurring physical health conditions and chronic diseases, with the objective of supporting the "triple aim" of improving their health, enhancing consumers' experience of care, and reducing the cost of care. * Pharmacy students are now eligible for the National Health Service Corps State Loan Repayment Program. Through program guidance, the Health Resources and Services Administration has provided states with the flexibility to include additional healthcare professionals, including pharmacists, in the state loan repayment program. Thirty-one states currently participate in this initiative. Only states that are seeking new or continued funding are eligible to include the expanded health professionals during this funding cycle. A state agency must be responsible for the grant management – health care reform is, indeed, local.
Federal Trade Commission (FTC): Under the Carter Administration, the FTC aggressively addressed the issue of competition in health care. Recently, under the Chairmanship of Jon Leibowitz, the FTC has again focused upon health care and particularly the findings of the IOM report The Future of Nursing: Leading Change, Advancing Health. In response to a request by a
"The FTC is charged under the FTC Act with preventing unfair methods of competition and unfair or deceptive acts or practices in or affecting commerce. Competition is at the core of
