Written By :
Janice Lee, PharmD Candidate 2015
Reviewed By :
Livia Macedo, Pharm.D.
Boorsma M, Frijters DH, Knol DL, Ribbe ME, Nijpels G, van Hout HP. Effects of multidisciplinary integrated care on quality of care in residential care facilities for elderly people: a cluster randomized trial. CMAJ. 2011 Aug 9;183(11):E724-32.
In 2011 the Canadian Medical Association Journal published the: Effects of Multidisciplinary integrated care on quality of care in residential care facilities for elderly people: a cluster randomized trial1. This study was able to cite the correlation between multidisciplinary team care and the improvement of standard care for elderly individuals in residential care facilities. A randomized controlled trial involving ten residential care facilities in the Netherlands were utilized. Five of the facilities provided multidisciplinary integrated care, and five provided usual care. The intervention consisted of geriatric assessment of functional every three months. The assessment was used by trained nurse-assistants to design the guide of individual care plan; discussion of the outcomes and care priorities with the family physician, resident and the patient’s family. There were multidisciplinary meetings with the nurse-assistant, family physician, psychologist and geriatrician to discuss residents with complex needs.1
Although this study showed improved quality of care with a multidisciplinary team, this data has several limitations. First, the patient population of the elderly is difficult to evaluate because individuals often have functional and cognitive impairments that increase over time1. Additionally, since most individuals in long-term care have various health ailments, the duration of the trial was only six months due to the high risk of drop out.
Second, the study was conducted in the Netherlands where the generalizability of results to be applicable to the United States does not necessarily apply. Long term care in the Netherlands is funded by mandatory state controlled insurance2. In contrast, long-term care in the U.S. such as residential facilities for the elderly is mostly self-financed by individuals. Thus, long-term health care in the U.S. is variable and contingent on financial cost3.
The applicability of conducting an ideal multidisciplinary team in the US health care system also remains questionable due to financial restrictions. Staffing a competent team to work together where the education level, experience and interprofessional skills of cooperation and good communication take time and depend on the individual’s themselves4. The cohesiveness of the health care team to make effective decisions depends on the infrastructure and the individual members of the team itself. Trust in professional competency and positive rapport takes time to develop in an interdisciplinary setting.
Additionally, the facility itself and the criteria of staff education and standards can differ from facility to facility. Various facilities have different policies in regards to their mix of staffing and their admittance policy for elderly individuals in need of care, as well as their discharge policies in relinquishment of care. Thus, the process of care in a multidisciplinary care team depends on cultivating a professional team in a cost-effective infrastructure.
Although this randomized control trial was major in respect to showing how multidisciplinary care can have improved outcomes, it remains to be seen whether this can be carried out on a financial and organizational level in the United States. Since many patients base their health care decisions on their financial limitations, managed care settings can be one way to resolve the heterogeneity of team members and account for the financial demands in implementing primary care4. Conducting future clinical trials in these managed care settings in the U.S. can be one way to develop evidence for the effectiveness of multidisciplinary team based care in primary settings.
1. Boorsma M, Frijters DH, Knol DL, Ribbe ME, Nijpels G, van Hout HP. Effects of multidisciplinary integrated care on quality of care in residential care facilities for elderly people: a cluster randomized trial. CMAJ. 2011 Aug 9;183(11):E724-32.
2. Schoen C, Osborn R, Doty M, Bishop M, Peugh J, Murukutia N. Toward higher-performance heath systems: adults’ health care experiences in seven countries, 2007. Health Aff (Millwood). 2007 Nov-Dec;26(6):w717-34.
3. Feder J, Komisar HL, Niefeld M. Long-term care in united states: an overview. Health Aff (Millwood). 2000 May-Jun;19(3):40-56.
4. Boul C, Reider L, Leff B, Frick K, Boyd C, Wolff J, Frey K, Karm L, Wegener S, Mroz T, Scharfstein D. The effect of guided care teams on the use of health services, results from a cluster-randomized controlled trial. Arch Intern Med. 2011 Mar 14;171(5):460-6.