Transdisciplinary Health Care Education: Training Team Players

A health care team is like a sports team, except for instead of points we are dealing with people's lives. Like any great team, it is essential to know the roles and responsibilities of each of the players and to have trust in one another. It is vital to have that team learn together, and practice together so that when the game truly matters they can each play their best with trust and understanding leading to more positive outcomes.

—Dr. Kyu Rhee, Health and Human Resources—Chief Public Health Officer

Transdisciplinary Health Care

Transdisciplinary health care involves reaching into the spaces between the disciplines to create positive health outcomes through collaboration. This model of care effectively integrates clinicians such as physicians, nurses, social workers, physical therapists, complementary and alternative medicine practitioners, physician assistants, community health workers, and other health care providers to create a team that provides comprehensive preventative primary care. Transdisciplinary care advocates call for broadening our notion of primary care to include a multi-player team working together to alleviate the burdens borne by patients with multiple co-morbidities and extenuating social circumstances.^1,2 Transdisciplinary health care improves the quality of patient education and support delivered to a patient, which has been proven to improve health outcomes. To date, however, there have been limited large-scale studies showing the efficacy of transdisciplinary health care education.^3,4,5

Transdisciplinary health care is especially crucial in underserved populations since these patients not only carry the largest burden of chronic disease, but are also subject to social, economic, and environmental determinants of health that contribute to worse outcomes than other groups. Moreover, underserved populations also have limited access to care. Thus, to overcome the health problems of medically underserved patients, clinicians must learn the principles of transdisciplinary care from the outset of their training; in doing so, they can learn how to use a support network to provide comprehensive, preventative primary care while addressing social and environment determinants of health that their patients will face.

The Traditional View of Primary Care

The preventative care side of primary care is broad and covers a spectrum of specialties and disciplines. Frequently, people in each specialty work separately from those in others. Many practitioners feel frustrated by having to work in a fragmented system of care delivery. In such a system, depending on a single clinician to change health care outcomes—as one might have done when care was more localized—is not realistic. A patient-centered medical home is one that fosters relationships and coordination of care for preventative services as well as chronic care management.

The current shortage of practitioners in primary care is likely to become more pronounced as federal health reform improves coverage for the uninsured. Students across health disciplines presently tend to enter specialty fields rather than primary care.⁶ This coupled with the projected increase of 50 million new patients in addition to the current 46 million uninsured has resulted in a huge primary care workforce demand and a steadily diminishing supply especially for underserved populations.⁷ Lacking preventive care, many underserved patients also lack health care knowledge and medication. A new Harvard study has demonstrated that lack of insurance is linked to 45,000 deaths annually, or one death every twelve minutes. The report emphasizes that much of this disparity is due to lack of care for treatable chronic diseases and the increased quality of care available to those with access to care.⁸

It is estimated that to meet patient primary care physician demands, the workforce must expand by 40,000 physicians, but less than 20% of medical students show interest in primary care.⁶ Moreover, practicing primary care physicians experience burn-out due the high volume demands needed to keep a practice financially viable, which furthers the workforce deficit. Fifteen-minute office visits and increasing paperwork demands hardly allow physicians time to address medical issues while providing adequate preventive care education and counseling. This environment lowers job satisfaction.⁹

The primary care workforce is also dwindling among care providers such as nurse practitioners...