Abstracts

Abstract

The abstracts service introduces readers to recent articles from a wide range of refereed journals, which may be of interest in respect of interprofessional practice, education and research, from any where in the world. The abstracts highlight the interprofessional nature of the article, within the context of a brief overview. We invite all readers to send us articles, which fit the criteria, and will acknowledge those who send the selected articles, in the Journal. (For address see end of the section.)

Berk, M. L., Gaylin, D. S., & Schur, C. L. (2006). Exploring the public's views on the health care system: A national survey on the issues and options. Health Affairs, 25, 596–606.

(Abstracted by Rochelle Bornett Lee)

Healthcare reform has been debated in the United States for over a decade, especially in regards to access and payment for services. Despite much debate, no clear consensus has ever been reached as to what services should be provided, and how such care should be funded. The authors conducted a telephone survey to explore public opinion on these questions. A random-digit-dialing approach yielded 1,517 respondents across the nation, meeting the criteria of a representative sample of the population. Respondents strongly agreed (805) that the current system is not working well. Fifty-two percent overall believed that basic health insurance should be mandatory. Mandatory coverage was supported by 62% of respondents aged 55–64, 69% of African-Americans, 55% of Hispanics, and 46% of white respondents. Those who were already covered by a private or governmental policy were more likely to support mandatory coverage (76%), than those who were currently uninsured.

Questions about the relationship of insurance premium costs to health status and behaviors yielded mixed results. While 87% stated that premiums should not vary by health status, 60% believed that smokers should pay more for health coverage. Only 29% felt that obesity should raise rates, and no other conditions were considered as indications for higher rates. Ninety-two percent wanted employers to provide some form of insurance, with a choice of options for the employee; 74% stated that government support for employer-based insurance was appropriate.

Considerable variability was found in the respondents' reviews on how to change the US healthcare system. Respondents were asked to comment on six scenarios for change. The strongest support (88%) was for expanded coverage for working people and families, although 55% favored government coverage for low-income, unemployed, and uninsured citizens. Fewer than half (42%) stated that insured should be reserved for catastrophic events, with individuals assuming more of the expense of routine care. The largest source of variance in respondents' views was their political party affiliation, with no significant differences across sociodemographic variables, although support for government-sponsored health care declined with age.

The physicians, nurses, and allied health professionals who constitute the healthcare team have a responsibility to be involved in this change process. The literature has shown that effective interprofessional teams can improve healthcare delivery, efficiency, and quality. Perhaps the climate is favorable to increase professional collaborations and advocate for a healthcare delivery model that better serves all citizens.

Mendenhall, T. J. (2006). Trauma-response teams: Inherent challenges and practical strategies in interdisciplinary fieldwork. Families, Systems, & Health, 24(3), 357–362.

(Abstracted by Anne Thompson)

Trauma response teams, by definition, are always interdisciplinary. Relevant medical and surgical specialties are represented, as well as nurses, respiratory therapists, radiologic technologists, counselors, and other medical and mental health professionals, all necessary to react to the crisis situations for which such teams were invented. The pace, intensity, and chaos of this work clearly distinguish these teams from other practice settings. Trauma team members frequently are cross-trained so that the patient's needs are met immediately. Role flexibility and collaboration result in a patient-focused goal, with blurring of traditional professional boundaries.

The author is a licensed marriage and family therapist who has worked extensively in international disaster relief efforts. He draws on his experience and the literature to address the challenges of professional scopes of practice, “turf battles”, interpersonal team relationships, and the high personal cost of working in trauma care. Team members may be quickly drained of physical and emotional energy, both during the acute phase of a situation and over the duration of long-term disaster work. Team members must also be trained to work with people and families of all cultural, ethnic, racial, and religious backgrounds; this requires a high level of cultural sensitivity, in addition to the strains of the crisis at hand. Mendenhall provides an insightful look into the nature of an interdisciplinary trauma team, with multiple resources that could prove helpful to others in this line of professional service.

Todahl, J. L., Linville, D., Smith, T. E., Barnes, M. F., & Miller, J. K. (2006). A qualitative study of collaborative health care in a primary care setting. Families, Systems, & Health, 24(1), 45–64.

(Abstracted by Anne Thompson)

What are the elements of a successful primary mental health care practice? The authors are part of an interdisciplinary mental health practice including board-certified primary care physicians, psychotherapists, nurses, a physician assistant, and support staff. Using a qualitative approach, the authors attempted to define the elements of collaborative primary mental health care, both from the professional and the users' perspective.

Interviews were conducted with staff members and five patients over an 18-month period. Both open-ended and closed-ended structural questions were used in the first interview, with more focused questions developed for a second round. Six cultural themes emerged from the data: (1) a pleasant, caring environment for both staff and patients; (2) a preference for family therapists; (3) a predominant referral pattern from the physician to the therapist, rather than the reverse; (4) a perceived benefit of both collaboration and co-location of services; (5) increased benefit from coordinated medical and psychological therapy; and (6) placing therapy within the broader social context of race, culture, gender, and socioeconomic class. However, it was noted that fewer than 5% of the patients seen were indigent.

Both staff and patient participants thought that care was improved within an interprofessional model. Two possible barriers to collaboration were cited. First, the lack of assertiveness of younger therapists in challenging physicians might prevent them from advocating effectively for their patients. Second, the therapists were rarely consulted about the appropriateness of referrals; this could result in either inappropriate referrals, or a failure to identify someone for whom therapy is appropriate. The authors recommend an ongoing process of analysis for interprofessional teams in mental health, so that the benefits identified can be strengthened and extended into other practice settings.

Addresses for sending articles for abstracting:

Bryony Lamb

Faculty of Health & Social Care Sciences

Kingston University & St George's

University of London, UK

E-mail: [email protected]

Anne Thompson

Department of Physical Therapy

Armstrong Atlantic State University

Savannah, Georgia, USA

E-mail: [email protected]