Collaborative care

Ignatavicius D.D. and M.L. Workman (2002). Medical Surgical Nursing Critical Thinking for Collaborative Care. W.B. Saunders, Philadelphia. 

Collaborative care has many definitions. It does not refer to split care, which usually implies that the physician treats the biological part of the patient by prescribing medication, and the therapist does the rest. Although split care may be attractive in terms of cost and ease for the provider, it is inadequate care. Patients need their therapist and physician to communicate, particularly in the creation and maintenance of a treatment plan. 

As clinicians, we were beginning to understand that a collaborative care model addresses gaps and fragmentation in the health care delivery system. It means that we do not have to know every fact about every system that might affect the patient s care. Instead of viewing ourselves as the sole deliverers of treatment, we have become the purveyors of possibilities in a system that extends beyond our own personal limitations, in addition to offering the patient our clinical expertise. 

All treatment options are equally plausible, regardless of whether we can deliver the treatment ourselves. We might provide the treatment, or we might serve as a conduit of information and resources so that our patient can receive the best possible care. When psychotropic medications are used, we consider their impact beyond the patient s biological system. In a collaborative care model, it has become our job to understand the impact that psychotropic medications could have on the... 

It has become clear that training in collaborative care and the development of supportive systems are essential initiatives if future patients are going to receive optimal care. We have realized that we have to train our students not only in traditional practice and technique but also in the principles of collaborative care. We also have to play a part in building support for collaborative care models within health care systems. 

Despite our immersion in the collaborative care movement, we were doing training as usual in our family therapy master s program. That is, we were training future therapists to work independently, using the tools... 

We began experimenting with collaborative care models of patient care and thinking about how to train students in their use. The four of us—two psychiatrists and two family therapists—began to share patient care. That is, we began to provide joint clinical supervision to family medicine residents and family therapy interns, and we began to teach each other s students. ... 

This book is the result of our collective search for better ways to care for patients with mental health problems. Its purpose is to provide the information a non-MD therapist needs to know about psychotropic medication and collaborative care. It is intended for nonprescribing clinicians who work in mental health. We wrote it with two objectives in mind to give readers a basic sense of pharmacotherapy for various mental health disorders, and, more important, to provide a conceptual framework, a mind-set, and specific approaches for working in a collaborative care environment with medical professionals who do prescribe psychotropics. 

We assume that you are pressed for time, that the physicians you work with are pressed for time, and that the payors (including employers and insurance companies) want the patient to get better as quickly as possible. The physicians you work with might have little knowledge or interest in your contribution to the shared treatment—namely, the therapy. They may even have little time or interest in working or communicating with you. Although it is helpful if both professionals share a commitment to collaborative care, it is not essential. 

An action plan for building collaboration For example, we discuss what a therapist might consider when deciding to refer a patient to a generalist physician or a psychiatrist. The basics tenets of collaborative care are discussed (beyond collaborating about the patient s psychotropic medication). Whether you are currently in a private practice or in a hospital-based interdisciplinary team, this section provides tools to enhance collaboration. 

The following is a list of groups supporting collaborative efforts among health care professionals. We anticipate, with the continued development of the collaborative care movement, that this list will grow over time. 

Untitzer, J., Katon, W, Callahan, C. M. (2002). Collaborative care management of late-life depression in the primary care setting A randomized controlled trial. Journal of the American Medical Association, 288, 2836-2845. 

Ryan, M. In Collaborative Care Agreements to Facilitate Pharmaceutical Care. International Pharmaceutical Abstracts, 32nd American Society of Health-System Pharmacists Midyear Clinical Meeting, Atlanta, Georgia, Dec. 7-11, 1997 American Society of Health-System Pharmacists Washington, DC, 1997, 3412273, 2164. 

The Concord Collaborative Care Model has produced measurable improvements in morbidity and mortality. Cardiac staff members who participated in a survey on quality of work life reported that the Collaborative Communications Cycle consistently helped them make better therapeutic decisions. According to staff members, a key motivator has been the reactions of patients and family members. Patient satisfaction has increased as family members have reported feeling comforted and empowered by the process. 

In summary, the connective tissue disorders frequently involve the lung with a variety of disorders that impact clinical symptoms and outcome. Knowledge of these disorders will assist in optimal clinical outcomes. The impact of the pulmonary specialist is more appreciated when clinical care is provided in a comprehensive approach. Therefore, successful centers that deal with the CTDs foster collaborative care for these complicated disorders. 

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