Team Care for 21st Century Family Medicine

[Guest guest]

Interesting angle about Team Care.

Can't quite decide if this goes against the IMP model or could be incorporated into the IMP model (if one wasn't solo-solo).

No connections to the Trade Marked concept -- it was mentioned on another list and I thought it was interesting.

I know a Family Doc in Colorado who sort of does this.

Has 3 nurses -- they do the majority of the history taking -- he comes in and does the exam and makes recommendations on Dx and Tx.

The the nurses do the discharge counseling, coordination of care, etc.

He can easily see 30+ patients per day with this model and most of the documentation is done by the nurses.

Not saying it's for everyone, just an interesting way.

Locke, MD

http://www.familyteamcare.org/what_is_team_care.html

Liberating the Family PhysicianTMThe Handbook of Team Care for 21st Century Family Medicine.

The definition of team care is a physician using 1-2 well-trained assistants to help him/her execute a patient visit. This is in contrast to traditional care in which the physician does 95% of the patient visit. Under team care the physician does 20-50% of the patient visit. The heart of this innovation of team care is the developing of an assistant who is capable of taking and documenting a complete patient history for the visit. To be comprehensive, a complete history can be very time consuming—usually the longest part of the visit. However, it is extremely important to understand that even though this part is often lengthy, this step involves no decisions. This is a crucial point. Since this step consists of only the collection of data, it is not essential that a physician participate. Standard protocols, experience, and good patient care indicate that most patient visits can be broken down into four discrete components:Part l: Data gathering and communication of the data. Part 2: Analysis of data and pertinent physical exam. Part 3: Decision making and development of a plan. Part 4: Implementation of the plan and patient education. Although some of these components do not necessarily require a physician, tradition has generally placed all four of them within the purview of the physician. The basis for the team care is that a well-trained assistant can readily perform the information gathering and communication function (part 1) and implement a plan and provide effective patient education (part 4). In this model, the physician would then be able to focus on analysis of the data and the physical exam (part 2) as well as carry out the required decision making and development of a treatment plan (part 3). In terms of time, parts 1 and 4 are often the longest in duration, whereas, parts 2 and 3 can be generally accomplished more quickly. With a well-trained RN or LPN now doing part 1 and part 4, data can be collected and recorded with less pressure and time restrictions. By removing the physician from the parts of the visit not requiring his/her expertise, the physician has more time to do what only the physician can do. This allows the physician to see more patients without sacrificing quality of care or patient satisfaction. These are the foundation principles of team care. Its efficacy lies not in a complex approach, but in a disciplined, clearly outlined process wherein well-trained assistants take on a more active role in the patent visit. The result is a change in the patient/caregiver dynamic that enables the physician to see more patients with a higher level of attention.