The Multidisciplinary Team Approach to Healthcare

In an effort to provide effective and efficient care to patients with chronic health conditions, the U.S. healthcare system has done much to redesign its delivery system. Developing an approach to meet the high demands of patients and to best utilize resources has become necessary. The result is the common use of a multidisciplinary team (MDT) approach. This approach provides better care than an individual plan that traditionally has just involved doctor and patient.

When properly implemented, this multidisciplinary team approach provides positive measurable outcomes. With a diverse group of healthcare professionals, such as physicians, nurses, pharmacists, dieticians, health educators, social service and mental health providers there is more certainty that all of the needs of the patient will be met.  The most important member of the multidisciplinary team is the patient. He or she is at the center of the team. This approach is holistic health care that focuses on all aspects of a patient’s life that might impact treatment success (Drake, 2005).

Multidisciplinary teams, as the name implies, are teams of people from different disciplines that come together for a common purpose. The MDT approach is used in a variety of different setting including healthcare, education, mental health and criminal justice.  The concept is that it is best to address an issue or problem from all angles. For a patient in a healthcare setting this means a holistic approach focusing on a variety of life domains. The MDT is typically used in difficult, multifaceted cases and situation where a comprehensive response has the best chance of accomplishing the goals. Simple or uncomplicated cases may not require this approach.

The group of professionals that make up an MDT come from diverse disciplines.  They begin by providing a comprehensive assessment through their individual expertise and then, in consultation with one another. The team approach promotes coordination and communication and can offer the patient a “one stop” effort as opposed to many separate evaluations, interpretations and plans. Any differences in opinion or approach can be discussed and resolved as a group, among the professionals and with the patient. This avoids having the patient interpret and decide upon differing viewpoints alone

The MDT professionals can change from case to case depending of course on the diagnosis and social or personal situation of the patient. In general, the team will include medical professionals from various disciplines, homecare professionals if needed, social service and mental health professionals, nutrition and health educators. The benefits to the professionals is the opportunity to  enhance  skills and knowledge of individual team members by providing a forum for learning more about the strategies, resources, and approaches used by various disciplines.

It is a built in consultation component. It also provides the professionals with ongoing support which can be invaluable as they deal with many difficult situations and cases.  As a member on an MDT, the professionals work together to develop a plan of action, or a treatment plan and then combine their efforts towards initiating treatment.  The patient is involved in every aspect and is encouraged to involve family and supports as well, as this support can improve outcomes long term.

While the team approach has many benefits, it can also be complicated to coordinate schedules and response of busy health professionals, who may need to participate on MDT’s for any number of cases. It can be costly to spend time meeting, requiring highly paid and again busy health professionals to come together for a case discussion. Assuring that all professionals make the time to participate can be a challenge.

The team approach involves patient satisfaction, building a community support system, patient follow-up, all in addition to the coordinated medical services. The team can follow a patent from the hospital back to their home and can from diagnosis, through treatment. This model of treatment has become increasingly popular with a variety of chronic conditions including diabetes, heart disease, cancer and mental health treatment.

Research has shown that for patient with Type II diabetes, a multidisciplinary approach can actually lead to the improvement of glycemic control and improved quality of life. A 2004  National Institute for Clinical Excellence (NICE) guideline for type 1 diabetes in adults (2004) says,  that a range of  professional skills are  needed for the  best service delivery model. An MDT is specifically recommended and it is suggested that the team have professionals in education, nutrition, and medical and mental health care (Codispoti, 2004).

 In cases of breast cancer, the   MDT includes: oncologists; surgeons; nurses; nutritionists; counselors; and other cancer specialists. With the complexity of cancer care, these specialized healthcare professionals help to provide a continuum of care through diagnosis, treatment, and recovery.    There are many studies that have explored the collaboration among the oncology specialties and team members. Multidisciplinary approaches to breast cancer can help to ensure that women with early-stage breast cancer receive all the benefit of adjunctive treatments.

For patients with heart failure, a multidisciplinary approach can reduce costs by reducing hospitalization and improving the patient’s compliance with medical care and follow-up. The multidisciplinary response in studies that concluded this result, involved in part, a component for simply calling on patients after discharge from the hospital to review the treatment course and answer questions (McAlister, 2004). This type of outreach on the part of the health care industry can identify potential problems before they exacerbate a situation. Patients or family members can benefit greatly from support and reeducation on the disease, course of treatment and importance of compliance. A little support can make an enormous difference.

To fully understand the benefits of treatment and the team approach, it is important tot look at all variables. Research into patient outcomes requires a multidisciplinary approach involving review of both medical and nonmedical disciplines For example, a patient may have received excellent diagnosis and education on his or her illness, but be unable to follow-through due to mental health issues or family issues that sabotage treatment (Freeman, 2004).

The MDT that includes professionals from mental health and social services may identify these issues and address them with built in supports and referrals for services that can assist the patient and their family with the critical follow through. This may involve referrals to transportation services to assure that a patient is able to keep follow-up appointments, health benefit entitlement programs so the patient can afford the prescriptions ordered, or a referral for counseling to address the coexisting depression that may be causing the patient to have difficulty with follow through.

In behavioral health the multidisciplinary approach is well established. For patients with severe and persistent mental illness, the need to collaborate and coordinate among professionals is clear. The doctor prescribing the psychotropic medications, healthcare professionals treating the chronic conditions such as high blood pressure and diabetes, as well as mental health counselors and nutritionists are routinely involved in care. As many of these patients also have difficulties in other life areas, it is imperative that social services staff be involved to assure that the living environment is stable, which increases the likelihood of compliance (Dziegielewski, 2004).

The benefits of a multidisciplinary team for the patient are enormous. This approach assures the patient and family that the healthcare professionals are all talking to one another; everyone knows what everyone else is doing. This method means that the ill patients is not required to be responsible for sharing information that he or she may not fully understand. It takes the burden off of the patient and places it on the healthcare professionals, who are better able to deal with it and use the information correctly.

The MDT approach can be thought of as a circle, with the patient in the middle and the professionals, both medical and nonmedical, around him or her providing support and care (Dziegielewsk, 2004).  Ideally, the patient will also have family and social supports as part of the team as well. This approach is growing in popularity and use throughout healthcare setting.

It acknowledges the complexities of human beings and the need to treat illness from all possible avenues. It also acknowledges the vast improvements in healthcare, and the understanding of how medical, nonmedical, educational and social attention all improves the outcomes for patients. While attending to patients individually can have positive results, working together improves outcomes.

References

Codispoti, C., Douglas, MR., McCalister, T.,  The use of multidisciplinary team care to improve glycemic control and quality of life by the prevention of complications among diabetic patients., Oklahoma State Medical Association, May 2004, 97(5):201-4

Drake, Robert MD, Goldman, Howard MD,  Implementing Evidence-Base Practices in Routine Mental Health Service Settings  Psychiatric Services 52:179-182, February 2005

Dziegielewski, Sophia, PhD, LCSW  The Changing Face of Health Care Social Work, Professional Practice in Managed Behavioral Health Care, Second Edition , Oxford University Press, 2004

Freeman, Gill, Multidisciplinary team working across primary and secondary care, Diabetes and Primary Care, Winter 2004

McAlister, Finlay, Multidisciplinary strategies for the management of heart failure patients at high risk for admission, Journal of American Cardiology 2004; 44:810-819