SAN DIEGO—In a session at ACR Convergence 2023, experts addressed the importance of the interprofessional team in caring for rheumatology patients.
Professionals vs. Patient Needs
In 2012, researchers examined the issues rheumatology professionals tended to address for their patients and what issues patients said they wanted addressed.1 Kim Steinbarger, PT, MHS, DHSc, assistant professor of physical therapy at Husson University, Bangor, ME, noted a divergence between the professionals and patients.
Dr. Steinbarger
The professionals favored addressing such issues as swollen joints, labs and global assessments. “We love numbers,” Dr. Steinbarger said.
Meanwhile, patients said they wanted the rheumatology professionals to address their fatigue, emotional distress and ability to self-manage their lives.1
On any given day, a person with a rheumatic disease may experience pain, may not feel like socializing and may struggle with diet, Dr. Steinbarger noted. “Who’s going to address all that?” she asked. “Why aren’t we meeting all these needs for our patients?”
This divergence is not a matter of rheumatology professionals not wanting to care for patients or a matter of competence. Four main barriers stand in the way of meeting such needs, according to Dr. Steinbarger: 1) workforce shortages, 2) inadequate networks, 3) the knowledge of others’ roles and 4) reimbursement—although she noted that reimbursement can be overused as an excuse. Ways around these barriers do exist.
Deference to Expertise
Dr. Steinbarger suggested that rheumatology professionals tap their communities for rehabilitation professionals, pharmacists, social workers and researchers, who can help track patient outcomes. Rheumatologists and rheumatology professionals need to know the roles of healthcare professionals in other fields and follow the principle of deference to expertise—in which the discipline that is most suited to the patient’s needs in that moment takes the lead in their care.
“Who can you bring onto your team?” she asked.
Rheumatologists and rheumatology professionals can hold screening events and invite local practitioners to help conduct screenings, in what is—in addition to the collaboration possibilities—a “referral opportunity for everyone,” Dr. Steinbarger said.
Interprofessional Team
The interprofessional team goes beyond the pediatrician, nurse practitioner and physician assistant. Understanding these roles is an important part of providing the best care.
Looked at in detail, this team can provide a staggering amount of assistance to patients, noted Annelle Reed, MSN, CPNP, a pediatric nurse practitioner in the Division of Pediatric Rheumatology at Children’s of Alabama, the University of Alabama, Birmingham.
According to Ms. Reed, pharmacists can help develop clinical care plans, educate patients about their medications and even help with prior authorizations for insurance carriers. Physical therapists can help patients manage pain and fatigue, boost endurance and provide devices to protect joints. Psychologists can help with anxiety, depression and treatment adherence. Social workers help with referrals to community resources, help arrange family support and financial assistance, and navigation of the healthcare system.
Ms. Rodriguez
Social Work
Giselle Rodriguez, LCSW, a social worker at the Hospital for Special Surgery New York, delved deeper into the role of social work, describing critical gaps that can be left unfilled if no one steps in.
Social workers offer comprehensive support by providing emotional guidance, counseling, education, advocacy, collaborating with healthcare professionals, sharing coping strategies and extending support to caregivers. They also often broker culturally complex dynamics while assessing and addressing social determinants of health issues.
When healthcare professionals label patients as “difficult or non-compliant,” they may be unaware of the negative effect this language can have on patient trust and overall care from the medical team. Ms. Rodriguez emphasized the importance of leading with empathy and asking probing questions to better understand the barriers patients face in accessing and adhering to care.
“Some of the questions I ask [patients] all the time include: What are some of the barriers to completing this treatment plan or for picking up that medication or for coming to the next visit?” Ms. Rodriguez said.
In this interaction, she may find out the patient has no transportation or someone to take care of their child while they go to a doctor’s visit. Or she may discover that the patient may not have access to a pharmacy in their community.
Rheumatology professionals need to recognize the myriad challenges an individual faces. Ms. Rodriguez underscored the critical role that social workers can play to help address psychosocial and concrete needs that impede the success of the treatment plan. “Validating a person’s emotions, can take you a long way,” she said.
Thomas Collins is a freelance medical writer based in Florida.
Reference
- Bartlett, SJ, Hewlett S, Bingham CO, et al. Identifying core domains to assess flare in rheumatoid arthritis: an OMERACT international patient and provider combined Delphi consensus. Ann Rheum Dis. 2012 Nov;71(11):1855–1860.
