For the past couple of weeks, we’ve talked about some of the models of healthcare delivery that use collaborative approaches to patient care, where patients are referred to the most appropriate provider to treat their condition. Interprofessional healthcare teams bring expertise from a variety of disciplines so that patients receive comprehensive services customized to their needs. This model of healthcare is truly patient-centred.
While most Canadians probably prefer more streamlined, collaborative healthcare, we have to remember that systems change slowly. To complicate matters, if collaborative care models are not explored during education and training, these practices can be difficult for some practitioners to integrate later in their careers. Therefore, it is optimal to introduce collaborative healthcare models into academic programs so that students receive the education and experience required for clinical decision-making and providing appropriate referrals.
In their first report, From Innovation to Action in Health Care, the Health Care Innovation Working Group recommended that Canada’s “Premiers direct Ministers to consider adapting the elements and key success factors” of five innovative healthcare models in Canada that could significantly improve patient outcomes. St. Michael’s Academic Family Health Team, associated with St. Michael’s Hospital, was listed as one of the Centers of Excellence.
The team delivers services from physicians, nurses, chiropractors, nurse practitioners, social workers, dieticians, and pharmacists to a diverse urban Toronto population. Through a partnership with Ryerson University, a clinical psychologist (supervising 12 psychology residents per year) was added, and through a partnership with Toronto Public Health, a dentist and dental hygienist joined the team, as well as dental students who were recently included amongst the Team’s department learners. Addiction services have since been embedded into the clinic as well as part of a unique primary care mental health program. The embedded training programs produce an environment conducive to knowledge-sharing and innovative practices amongst learners and clinicians.The St. Michael’s Academic Family Health Team is a prime example of an interdisciplinary healthcare setting where professionals and students collaborate to provide team-based care, including chiropractic, to urban, inner city patients. Within the Family Health Team, fourth-year interns and chiropractic residents from the Canadian Memorial Chiropractic College (CMCC) work with professionals from 10 different healthcare disciplines to provide comprehensive clinical care. This has resulted in improved access to musculoskeletal services within the primary care setting at the hospital. More so, interns and residents benefit from working in a truly collaborative setting, facilitated by shared Grand Rounds and Electronic Health Records, as well as learning from and co-managing patients with their peers from a variety of other professions.
Interestingly, the chiropractic services are offered in concert with the other healthcare providers and are evidence informed, targeting the management of patients suffering from musculoskeletal (MSK) conditions. The chiropractors and interns perform a comprehensive assessment, diagnosis and treatment plan for patients that may include spinal and joint manipulation, mobilization, soft tissue therapies, modalities, active rehabilitation, lifestyle counseling and exercise plans among others.
“We’ve also recently brought on a health promoter to help with navigation of financial systems and the team is discussing a pilot project to include a legal clinic,” said Dr. Deborah Kopansky-Giles, DC, CMCC clinical supervisor. “Our hope was to enhance the way healthcare is delivered with patients at the centre and non-hierarchical health teams, building on the strength of practitioner-patient relationships while embracing technology and developing new models of care delivery. Working with community services and through establishing partnerships, access to care and the quality of care has been significantly improved through maximizing the use of human health resources in terms of scope, skills and expertise. For example, if a patient is seeing me for one problem and I also notice a complex problem with food, I can engage a dietician to help co-manage this patient. In this way, we have gone outside of what people would usually see in traditional health services. It is very unique.”
CMCC Clinician Dr. Igor Steiman says that the chiropractic interns are exposed to many interprofessional interactions including shadowing and group clinical presentations. The learning programs were designed so students from all disciplines could learn together, learning shared curriculum content at the same time as learning from and about each other’s professional roles and scopes.
“People see that it does work,” said Dr. Steiman, “Research suggests that interdisciplinary care is better for patients and providers, it is also better for the budget.” He also remarked that every year he meets primary care physicians who went through the family practice residency and, as a result, understand that chiropractic is an integral part of treating MSK conditions.
Switzerland has enjoyed multidisciplinary education since 2008 when the first cohort of students began the six-year Master of Chiropractic Medicine program at University of Zürich. The students in the program learn alongside medical students for four years before breaking away to focus exclusively on chiropractic clinical training. For this reason, Swiss medical doctors are more likely to view chiropractors as colleagues and have high rates of referring patients with MSK conditions to chiropractic treatment.
St. Michael’s family health team may be of the most extensive interprofessional healthcare educational models in Canada. The hospital’s past Chief of Family Medicine, Dr. Philip Berger, lauded the clinic’s ability to teach future healthcare providers to collaborate on care as they learn together “rather than in silos, and that patients benefit from the multidisciplinary approach and improved communications”.
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