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Team Care. Traditions and New Trends
INGEMAR F. PETERSSON ABSTRACT . Major changes have occurred in the care of patients with rheumatic diseases over the past decades. Most of these changes have focused on new pharmacological and surgical procedures and methods. However, for different reasons, few of these methods are available to many patients around the world, and thus other forms of care are still needed. For optimal benefit to patients, all aspects of care should be organized and coordinated through team care. This leads to new trends in team care development and research, based on well established traditions and accumulated knowledge. (J Rheumatol 2006;33:1895–6) Key Indexing Terms:
PATIENT CARE TEAM
From the Spenshult Hospital for Rheumatic Diseases, Halmstad, and Department of Clinical Sciences, Lund University, Lund, Sweden. I.F. Petersson, MD, PhD, Assistant Professor. Address reprint requests to I.F. Petersson, Spenshult Hospital, S-313 92 Oskarström, Sweden. E-mail: Ingemar.petersson@spenshult.se
Team care in rheumatology has a long tradition in Europe and a somewhat different and shorter tradition in North America 1,2 . Initially, most team care was based on longterm inpatient care, but following major changes in healthcare systems in Western countries, team care models have also changed 1,3-5 . Traditionally, all teams within rheumatology included a doctor, nurse, physiotherapist, occupational therapist, and sometimes a social worker 1,6 . The patient was "in the midst of the team" but with a passive role as the receiver of proposals and treatment from caregivers. Today, a more appropriate definition of rheumatological team care might be: All interventions and care given by a group of health professionals (at least 3 persons, patient included) with different professional backgrounds. The teamwork is patient centered and interdisciplinary, with common, well defined goals. The structure of teams is also becoming more flexible. In many countries there is a close collaboration with other healthcare providers such as general practice/primary healthcare, orthopedic surgery, chiropody, etc. In Western countries, musculoskeletal disorders are a major threat to health, function, and quality of life, with continuously rising costs for prevention and care, and for dealing with socioeconomic consequences of these diseases (World Health Organization/Bone and Joint Decade, Technical Report) 7 . Inflammatory joint diseases have been the main focus for rheumatologic care for many years, but rheumatologic care, research, and development include other disease groups such as long-standing musculoskeletal pain 8,9 and osteoarthritis 10 . Pharmacological treatment of inflammatory joint diseases in Western countries has undergone major changes in the past 5 years 11,12 . However, as the majority of patients with rheumatic disorders will not benefit from these new biological treatments, there is still a major need for team care in the future. Despite the undisputable value of and place for team care and rehabilitation in clinical practice, the scientific basis for many aspects of team care needs to be developed 2,13,14 . Rheumatologic teams for patients with inflammatory diseases are available at healthcare centers, regional hospitals, and at university hospitals in Europe and North America. In parts of Europe teams are also found in specialized hospitals/units. Some examples are Spenshult, Halmstad, Sweden 15,16 ; Diakonhjemmet Hospital, Oslo, Norway 17 ; and Graasten Hospital, Graasten, Denmark. The different settings for team care make for fruitful comparisons of interventions and outcomes to detect components of team care 14 . For patients with osteoarthritis and musculoskeletal pain syndromes, primary healthcare, orthopedic surgery/specialized units, or other rehabilitation units are the main alternative. However, rheumatology still has the longest experience and the best strategies for research and development in musculoskeletal disorders and thus the major development and evaluation of team care and rehabilitation should take place within rheumatology. The effectiveness of team care has been shown both in clinical followup studies 16,18 and in controlled trials 3,5,19 . Some studies have also included comparisons between different types of team interventions 3,5,19 , but to date no projects have performed detailed studies on the components and individual features of team care in patients with rheumatic diseases 14 . In order to fill this gap in knowledge, some units in Northern Europe have created a research network. As a part of this effort, we are also planning a common standard for reporting the structure of different teams, as well as different steps in and parts of the team care process. Moreover, we will propose a common core set for sampling and reporting different aspects of outcomes of team care according to the International Classification of Functioning 20-22 . To summarize, new trends in team care include a more patient centered approach, a higher degree of flexibility, and facilitation of true interdisciplinary interaction. For decision makers, healthcare providers, and patients, benchmarking and quality improvement are standard approaches to be applied in all areas of healthcare including team care.
1. Petersson IF. Evolution of team care and evaluation of effectiveness. Curr Opin Rheumatol 2005;17:160-3. [MEDLINE] 2. Li LC, Backman C, Bombardier C, et al. Focusing on care research: a challenge and an opportunity. Arthritis Rheum 2004;51:874-6. [MEDLINE] 3. Ahlmen M, Sullivan M, Bjelle A. Team versus non-team outpatient care in rheumatoid arthritis. A comprehensive outcome evaluation including an overall health measure. Arthritis Rheum 1988;31:471-9. [MEDLINE] 4. Ahlmen M, Nordenskiold U, Archenholtz B, et al. Rheumatology outcomes: the patient's perspective. A multicentre focus group interview study of Swedish rheumatoid arthritis patients. Rheumatology Oxford 2005;44:105-10. Epub 2004 Sep 20 [MEDLINE] 5. Vliet Vlieland TP. Multidisciplinary team care and outcomes in rheumatoid arthritis. Curr Opin Rheumatol 2004;16:153-6. [MEDLINE] 6. Ahlmen M, Bjelle A, Sullivan M. Prediction of team care effects in outpatients with rheumatoid arthritis. J Rheumatol 1991;18:1655-61. [MEDLINE] 7. World Health Organization. The burden of musculoskeletal diseases at the start of the new millennium. WHO Technical Report Series No. 919. Geneva: WHO; 2003. 8. Bergman S, Herrstrom P, Hogstrom K, Petersson IF, Svensson B, Jacobsson LT. Chronic musculoskeletal pain prevalence rates and sociodemographic associations in a Swedish population study. J Rheumatol 2001;28:1369-77. [MEDLINE] 9. Bergman S, Herrstrom P, Jacobsson LT, Petersson IF. Chronic widespread pain: a three year followup of pain distribution and risk factors. J Rheumatol 2002;29:818-25. [MEDLINE] 10. Petersson I, Jacobsson T. Osteoarthritis of the peripheral joints. Best Pract Res Clin Rheumatol 2002;16:741-60. [MEDLINE] 11. Geborek P, Crnkic M, Petersson IF, Saxne T. Pharmacovigilance of etanercept and infliximab in clinical practice in southern Sweden [abstract]. Arthritis Rheum 2002;46 Suppl:S529. 12. Geborek P, Crnkic M, Petersson IF, Saxne T. Etanercept infliximab and leflunomide in established rheumatoid arthritis: clinical experience using a structured follow up programme in southern Sweden. Ann Rheum Dis 2002;61:793-8. [MEDLINE] 13. Vliet Vlieland TPM. CARE: International Conference on Multidisciplinary Care in Rheumatoid Arthritis. Noordwiijk, September 13-15, 2002. Int J Adv Rheumatol 2003;1:34-5. 14. Petersson IF, Bremander AB, Klareskog L, Stenstrom C. Who cares about team care? Ann Rheum Dis 2005;64 Suppl:644. 15. Bremander AB, Petersson IF, Roos EM. Validation of the Rheumatoid and Arthritis Outcome Score (RAOS) for the lower extremity. Health Qual Life Outcomes 2003;1:55. [MEDLINE] 16. Bremander AB, Jacobsson LTH, Petersson IF. Team based multiprofessional care improves fatigue pain and function in patients with inflammatory [abstract]. Arthritis Rheum 2004; Suppl 50:S35. 17. Uhlig T, Finset A, Kvien TK. Effectiveness and cost-effectiveness of comprehensive rehabilitation programs. Curr Opin Rheumatol 2003;15:134-40. [MEDLINE] 18. Jacobsson LT, Frithiof M, Olofsson Y, Runesson I, Strombeck B, Wikstrom I. Evaluation of a structured multidisciplinary day care program in rheumatoid arthritis. A similar effect in newly diagnosed and long-standing disease. Scand J Rheumatol 1998;27:117-24. [MEDLINE] 19. Vliet Vlieland TP, Breedveld FC, Hazes JM. The two-year follow-up of a randomized comparison of in-patient multidisciplinary team care and routine out-patient care for active rheumatoid arthritis. Br J Rheumatol 1997;36:82-5. [MEDLINE] 20. Stucki G, Cieza A, Ewert T, Kostanjsek N, Chatterji S, Ustun TB. Application of the International Classification of Functioning Disability and Health (ICF) in clinical practice. Disabil Rehabil 2002;24:281-2. [MEDLINE] 21. Stucki G, Cieza A, Geyh S, et al. ICF Core sets for rheumatoid arthritis. J Rehabil Med 2004;44 Suppl:87-93. 22. Cieza A, Ewert T, Ustun TB, Chatterji S, Kostanjsek N, Stucki G. Development of ICF Core Sets for patients with chronic conditions. J Rehabil Med 2004;44 Suppl:9-11. |
