If you’ve been feeling like there’s not enough of you to go around, you’re on to something. The truth is, there aren’t enough physicians to provide appropriate patient access, particularly in primary care. And experts say the problem is likely to get worse.
The good news is that there is a practical, readily available solution that can increase satisfaction across the board: interprofessional care teams.
What is an Interprofessional Care Team?
Most practices already have a squad of different disciplines working together: MDs, nurses, and front office staff, to name a few. But the interprofessional care team approach takes it to the next level: adding advanced practice providers (APPs) like nurse practitioners and physician assistants to the medical care team—and establishing protocols that ensure every member of the team is practicing to full scope of their licensure.
The second part of that statement is key; adding an APP or two to the staff without giving them space to exercise their full scope of practice is a recipe for disaster. “It’s less than satisfying for the APP and less than effective for the practice,” says Allison Dimsdale, DNP, NP-C, AACC, FAANP, Associate Vice President for Advanced Practice for the Private Diagnostic Clinic at Duke University Health System. It also prevents the MDs on the team from practicing at the top of their scope. Instead, identify each type of patient encounter and which team member is best suited for the task. “It’s about having the right provider for the right position at the right time to take care of the right patient,” says Dimsdale.
Where Do I Start?
Remember, this is all about access, so start with the patient. “Look at what the patient needs are,” says Dimsdale. “It looks different depending on the needs of the patient and the practice.” What are the snags in your schedule: New patients? Same day appointments? Medication reconciliation? What are those things you’d love to offer your patients if you had more time? Once you identify the top needs, evaluate them in terms of scope of practice. Which tasks require MD involvement? Which ones fall into an APP’s scope of licensure in your state? “APPs can manage 85%” of patient encounters in many cases, according to Dimsdale.
Who Does What?
There is no one answer to this question, but it’s important that your interprofessional team answer it conclusively before seeing patients. In specialty practices, roles may be more clear-cut. “If the MD is also a surgeon, they should be in the OR,” says Dimsdale. Having APPs handle pre- and post-op office visits allows the MD to do just that. In other settings, roles may be more flexible based on the needs of the patients and the practice. Some interprofessional team practices delineate roles by type of appointment: APPs handle all new patients or all disease management appointments. In other practices, APPs have their own patient panels. Of course, state licensure laws for APPs are a factor in these decisions. But within those parameters, there is still a lot of room for delivery models that improve patient access.
What Will Patients Think?
Research shows that patient reaction to interprofessional care teams is overwhelmingly positive. Patients report shorter wait times for appointments, higher satisfaction with quality of care, and improved understanding of their condition. And clinical outcomes are better, too: an interprofessional team approach has been shown to reduce emergency room visits and hospitalizations, and improve specific chronic disease markers like hemoglobin A1C levels.
On a micro level, patient acceptance of APPs has a lot to do with the way the concept is presented. Front desk staff are a critical part of this communication. “When a patient calls for an appointment, the way the front desk person presents the provider appointment options is key,” says Dimsdale. “You want to introduce the interprofessional team to the patient thoughtfully.” Make sure front desk staff understand the titles, licensure requirements, and educational backgrounds of everyone on the team and that they are prepared to explain them confidently.
It’s also important that all members of the team respect each other’s roles and project that confidence to patients. Just as you would when adding a new MD to a practice, consider ways to introduce a new APP team member to your patients, such as mailing an introductory letter with a photo.
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