Interdisciplinary Care: From a health policy perspective, one of the most significant changes occurring within our nation's healthcare system is the increasing emphasis upon interdisciplinary or interprofessional team-based care. Within the framework of the President's Patient Protection and Affordable Care Act (ACA) this is perhaps most evident within the envisioned Accountable Care Organization (ACO) and Patient-Centered Medical Home provisions of the law. Reimbursement models must change but as Katherine Nordal proclaimed at this spring's exciting State Leadership Conference (SLC): "We need to shake off the negative attitudes some of our colleagues have about what's happening in health care. This world is changing. And health care is moving ahead – with or without psychology."
A recent Institute of Medicine (IOM) report noted: "Much has changed over the past decade, necessitating new thinking. Innovators at that time stressed the importance of 'patient-centered care,' while today they think of patients as partners in health promotion and health care delivery. Patients are integral members of the care team, not solely patients to be treated, and the team is recognized as comprising a variety of health professionals. This changed thinking is the culmination of many social, economic, and technological factors that are transforming the world and forcing the fields of both health care and education to rethink long-established organizational models."
"One of the most exciting developments along this line at the Uniformed Services University of the Health Sciences (USUHS) (DoD) has been the recent collaborative effort by the leadership of the clinical psychology program and the Doctor of Nursing Practice Psychiatric Mental Health Nurse Practitioner program to jointly utilize the university's simulation laboratory with its professional actors. This team-based approach of treating 'patients (actors)' in the educational setting provides improved learning across all spectrums. The faculty and students from both disciplines report improved knowledge and feedback following the 'patient' encounters. Additionally, the collaborative effort models better utilization of resources since both programs are utilizing the actors simultaneously. These sessions have generated a considerable amount of interprofessional dialogue and better understanding of the respective roles and responsibilities of each profession. Future plans are being made for the programs to continue these training sessions in the upcoming therapeutic modalities course and psychopharmacology courses. Ultimately, this team-effort is helping to better prepare the students to safely and efficiently care for actual patients in today's health care delivery system" (Eric Pauli, Graduate School of Nursing faculty).
"At USUHS doctoral students in nursing and psychology can partake in a Friday afternoon public policy seminar with various guest speakers. Speakers have included high level APA staff, former and current military leaders, two former Secretaries of the Department of Veterans Affairs, executive staff from pharmacy and nursing professional organizations, and various health policy influencers such as the Institute of Medicine (IOM). These speakers share stories that convey the true art of policy making with a focus on building positive and lasting relationships across all health disciplines and in local, state, and federal government. Students regularly remark on common themes across speakers and frequently visit the class beyond their formal semester. Further, students in nursing and psychology build lasting professional relationships based on class discussions and off-site field visits to places such as the World Bank, APA, and Congressional offices" (Joanna Sells, psychology Ph.D. student).
Exciting Opportunities for Those with Vision: At the most recent meeting of the HRSA Advisory Committee on Interdisciplinary, Community-Based Linkages, we reviewed the HHS December, 2010 report Multiple Chronic Conditions: A Strategic Framework, which expressly mentions psychology and nursing. This strategic framework to improve the health status of individuals with multiple chronic conditions emphasizes the importance of preventing their occurrence. An enhanced focus on prevention and public health is seen as essential to ensuring optimum health and quality of life. The report seeks to catalyze change within the context of how chronic illnesses are addressed – from a focus on individual chronic diseases to one that uses a multiple chronic conditions approach. This cultural change, or paradigm shift, and the subsequent implementation of these strategies will provide the foundation for realizing the vision of optimum health and quality of life for individuals with multiple chronic conditions.
More than one in four Americans have multiple (two or more) concurrent chronic conditions (MCC); for example, arthritis, asthma, chronic respiratory conditions, diabetes, heart disease, HIV, and hypertension. In addition, these include substance use and addition disorders, mental illnesses, cognitive impairment disorders, and developmental disabilities. The prevalence of MCC among individuals increases with age and is substantial among older adults, even though many are under the age of 65. As the number of chronic conditions in an individual increases, the risks of mortality, poor functional status, unnecessary hospitalizations, adverse drug events, duplicative tests, and conflicting medical advice increases. The resource implications for addressing MCC are immense – 66% of total health care spending is directed toward care for the approximately 27% of Americans with MCC. "The poor health outcomes of individuals with serious mental illnesses and other behavioral health problems warrants special attention because of the co-occurrences of those conditions with other chronic conditions." More than 50 efforts across HHS were found which are directed primarily to the health care needs of individuals with two or more chronic health conditions.
Health care, public health, and social services professionals and family caregivers practice in a vacuum of published data regarding care for those with multiple chronic conditions. As the IOM report noted, health care, public health, and social services professionals are dependent on and influenced by training programs that prepare them for the environments in which they will practice. Evidence suggests that many health care professional trainees feel uncomfortable with key chronic care competencies. Addressing these gaps, as well as the need for improving providers' cultural competencies, will ensure that the current and next generations of providers are proficient in caring for individuals with MCC and in interacting with family caregivers. Specifically, HHS recommended developing and fostering training within both traditional and nontraditional professional settings (e.g., medicine, nursing, social work, psychology/counseling, clinical pharmacy, chaplaincy, vocational rehabilitation, community health workers) that emphasizes increased competency in palliative and patient-centered approaches. As psychology expands its training modules to include federally qualified community health centers (FCHCs) and the evolving ACA accountable care organizations and patient-centered medical homes (both of which might well become extensions of larger hospitals and HMOs) the clinical opportunities to work with patients with MCC and thereby demonstrate "value-add" will significantly increase. As Katherine Nordal noted at SLC: "This world is changing. And health care is moving ahead – with or without psychology." "It means exploring new techniques… to find new ways to stimulate the love of learning and the capacity for creation." Aloha,
Pat DeLeon, former APA President – HPA – June, 2015
