When does a need to collaborate arise? If one does not know what to do, but assumes someone else does, collaboration could be the answer. Also, people look for organized teamwork if time and resources for complicated and long-lasting situations must be allocated economically. In modern medicine, appropriate care for many clinical conditions requires well-coordinated teams of various health professions, and both Parkinson’s disease (PD) and diabetes are cases in point.
Generally, physicians, nurses, nutritionists, and (physical, occupational, or other) therapists know that care for PD and diabetes patients has many facets. Often, their ‘blind spot’ is how to collaborate in a way that skillfully focuses their efforts on the patient, making judicious use of available resources. Thus, purposeful interprofessional education (IPE) would benefit health professionals in a multidisciplinary approach to PD and diabetes. Besides building a less fragmented and more integrated knowledge base, IPE participants can be expected to value the roles of other health professionals more appropriately. This helps them establish a mindset of competency collaboration (in contrast to personal competition) to achieve a common goal.
To put IPE into action, a group of American specialists developed the Allied Team Training for Parkinson (ATTPTM) IPE program. This is a multi-day, peer-reviewed curriculum that encompasses principles of teamwork as well as medical and therapeutic aspects of ‘best practices’ in PD care, addressing nurses, medical doctors, and the entire range of therapists who can support the PD patient. After using and refining the program over a ten-year period, the authors now describe its educational outcomes. Cohen et al. found that the ATTP program, indeed, improves interprofessional collaboration. Moreover, besides self-ratings, objective assessments of PD knowledge were significantly higher in the ATTP trainee group compared with controls. Also, trainees’ understanding of other disciplines and their specific role in PD care was enhanced. In a follow-up inquiry, 63 percent of trainees reported a care practice change to better team collaboration and management, and 41 percent to better clinical treatment of PD, among other improvements.
In diabetes, effects of educational measures can quite straightforwardly be measured through changes in the patients’ laboratory values. Ching et al. report the consequences of a 10-week IPE program for health professionals in diabetes. In the groups of this program, half of participants were physicians, half were nurses; at course start, they were asked to identify and agree on challenging topics of diabetes care, e.g. hypertension or neuropathy. Besides joint interactive lectures, group members provided cases from their own practice for discussion and analysis.
Laboratory values such as cholesterol levels of more than 4000 patients markedly improved after treatment by the IPE participants, documenting its effects. Also, the diabetes proficiency of the practices participating in the program, when compared with ‘conventional’ practices, was higher in all three years of assessment. In follow-up interviews three years after finishing the IPE program, Ching et al. found evidence that nurses and physicians had changed their work-related attitudes, delivering concrete benefits to their patients.
As a previous1 study indicated, implementing a multidisciplinary, integrated care program alone seems to generate only small benefits for PD patients. IPE may offer more advantages because it appeals to the competencies and creativity of health professionals in devising care. The programs reported here show tangible positive outcomes of IPE programs that are tailored to the needs of patients with complex diseases. This should encourage establishing similar programs and rigorously assessing their impact on care.
Mirko von Elstermann
Read more: Cohen EV, Hagestuen R, González-Ramos G, Cohen HW, Bassich C, Book E, et al. Interprofessional education increases knowledge, promotes team building, and changes practice in the care of Parkinson’s disease.
Parkinsonism Relat Disord. Epub 2015 Nov 6. http://dx.doi.org/10.1016/j.parkreldis.2015.11.001
Ching D, Forte D, Aitchison E, Earle K. Are there long-term benefits of experiential, interprofessional education for non-specialists on clinical behaviours and outcomes in diabetes care? A cohort study. BMJ Open. 2016;6(1):e009083. http://dx.doi.org/10.1136/bmjopen-2015-009083
See also : van der Marck MA, Munneke M, Mulleners W, Hoogerwaard EM, Borm GF, Overeem S, et al. Integrated multidisciplinary care in Parkinson’s disease: a non-randomised, controlled trial (IMPACT). Lancet Neurol. 2013;12:947-56. http://dx.doi.org/10.1016/S1474-4422(13)70196-0