Posted By Ruth Nutting,
Tuesday, July 22, 2014
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|It is my prediction that the majority, if not all, of you reading this have or are experiencing hierarchical, fragmented health care. Going to the doctor is like getting an appointment with a higher power. You wait for your appointment, perhaps months, in order to see your doctor for a coveted 10 minutes. During these coveted 10 minutes, you wait for the doctor’s decree…most often, a list of endless referrals. Then begins the journey, throughout the town or state, to these various providers; all the while, you are signing endless releases of health information, in hopes that communication will flow from provider to provider. |
For some populations, the days of traveling to multiple appointments and hoping for communication to flow between various providers are long gone. As the collaborative model increases in health care, more and more patients, specifically patients from under-served populations, are experiencing collaborative care, often found in a Patient-Centered Medical Home (PCMH). Although various in nature, most collaborative models of care focus on the belief that family professionals (e.g. physicians, nursing staff, behavioral medicine specialists, social workers, etc.) need to deconstruct traditional patterns of hierarchy so that families are engaged as active, empowered participants in the services they receive.
What can occur through collaborative care is mind-blowing. I say this from first-hand experience, not a as a patient but as a provider of behavioral medicine in a PCMH. At our clinic, we provide Shared Medical Appointments (SMA) to patients with Type II Diabetes. During these appointments, physicians, nursing staff, behavioral medicine specialists, pharmacists, and a diabetes educator collaborate in providing care to a group of 6-8 patients. The level of collaboration, which leads to resourcefulness and efficacy, is impacting, but what is most beautiful is the spirit and unity of the participating patients.
| These patients come together, some for over a year and others for the very first time, and welcome one another with open arms. Together, they share personal highs and lows; they encourage one another to reach goals, whether it is lowering A1Cs, weight loss, or smoking cessation, and support one another in bettering their quality of life (e.g. getting involved in various volunteer services, scheduling group walks outside of the SMA). These patients are inspiring and what they offer one another cannot be offered by a provider.|
I highlight this one initiative of collaborative care to demonstrate the possibilities and empowerment that collaborative care settings can offer. If these patients were seen by a typical primary care physician they would not experience biopsychosocial healing or the empowerment from others who face the same struggles. Instead, these patients would potentially feel isolated and discouraged, as they faced various appointments without a support system, and were responsible for continuous communication between providers.
|Collaborative care models focus on deconstructing traditional patterns of hierarchy |
But what about patients who are not of an under-served population? These patients continue to receive the majority of their health-related care from primary-care physicians who do not practice collaboratively. As a result, these patients often receive fragmented care and most likely are not having their psychological, social, and spiritual needs attended to. Without these needs receiving attention patients are not being treated continuously or holistically and health disparities are likely to remain or increase.
To further clarify, fragmented health care can often increase health disparities, as patients fall through “the gaps” of communication and care. Collaborative health care focuses on closing these gaps. Therefore, it is crucial that the collaborative model of health care be available to all populations in order for health disparities to decrease in the United States. It is my hope that with the increase of research highlighting the benefits of collaborative care more health-related institutions will incorporate this model so that all populations experience a decrease in health disparities and an increase in well-being.Ruth Nutting is in the process of obtaining her PhD in Human Development with a concentration in Marriage and Family Therapy from Virginia Polytechnic Institute and State University. Currently she is interning as a Behavioral Medicine Specialist in the Internal Medicine Residency program at University of Nebraska Medical Center-Midtown Clinic. In this position she consults with providers and patients in regards to psycho-social concerns, provides ongoing psychotherapy to patients, supervises master’s MedFT interns, and participates in Shared Medical Appointment related research, among various other tasks. In 2012, she earned her MA in Applied Psychology with a concentration in Marriage and Family Therapy from Antioch University New England. Her research interests are related to the area of coping and resilience in relation to young adult couple systems in which one partner has a chronic illness.
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