Shared care & MDT Flashcards
Define shared care & why it’s important?
Shared care:
- Refers to the management of a patient w/ a chronic condition in an integrated manner, involving joint participation of GP & hospital specialists.
- Reflects a transfer of clinical responsibility
Importance of shared care:
- Ensure patients receive high quality care btw the handover of responsibility for management of their condition.
- Easier for patients to get their prescriptions close to home.
- Easier for blood monitoring & accessing appointments.
- Provides GPs w/ support for medication they may not be familiar with.
- When a patient is discharged from hospital, the specialist need to provide enough medicine, so the GP has time to generate a prescription
Explain the concept of shared care for people w/ chronic illness?
Involves the collaboration of both primary & secondary care physicians in the delivery of care.
Enhances information exchange through discharge letters & emails e.g. dosage of medication to be prescribed by GP from the hospital specialist.
Aim: To improve the coordination of care delivery i.e. provide seamless transition of prescribing & monitoring from secondary care to primary care.
The patient remains under specialist care but seen less often once stable.
What is treat to target?
- Promotes & provides guidance to achieve optimum control in RA
Aims for remission or low disease activity improves patient outcomes in RA significantly.
Aims for effectively controlling symptoms, preventing joint damage & normalising physical functioning & social interaction.
- Treatment requires a multi-disciplinary approach, based on a shared decision between patient / doctor or nurse.
What principles should you follow when prescribing on the recommendation of someone else?
- check the prescription is needed
- Check it is appropriate for the patient i.e. no contraindications, correct dose, no allergies to ingredients…
- Check it is w/in the limits of your competence - do you know what it is, how to prescribe it and the side effects?
- You are responsible for any prescription that you sign
- Keep yourself up-to-date on relevant guidance
What medicine have shared care?
- Methotrexate
- Sulphasalazine
- Leflunomide
- Ciclosporin
- Denosumab
Role of primary care professionals
provide the first point of contact in the healthcare system, acting as the ‘front door’ of the NHS.
- Includes general practice, community pharmacy, dental & optometry (eye health) services.
Role of secondary care providers
- Provide specialist treatment
- Patients are referred from primary care
- can either be planned (elective) care such as a cataract operation, or emergency care such as treatment for a fracture.
Role of intermediate care professionals
care services areprovided to patients, usually older, after leaving hospital or when they are at risk of being sent to hospitals
There are 4 types that are usually called: reablement, crisis response, home based & bed based.
Free-short term service
receive support from a range of professionals- occupational therapist, physio, speech & language therapist
Role of rheumatologist
- Diagnosis
- Coordination of team
- Disease monitoring
- Prescription and monitoring of drug therapy
- Identification and management of complications
Role of specialist nurse
- Key role in implementing T2T principles
- Deliver disease & treatment education
- Drug monitoring
- Physical, psychosocial & emotional support
- Advice Line support to patients, families & HCPS
- Source of referral w/in the MDT
- Escalation clinic- induce clinical remission/ low disease activity or timely referral for further treatments by seeing patients monthly
Patient concerns- beliefs around medication e.g. site effects
- Fears & anxiety around escalation of treatment
- Feat & anxiety around adverse events
- Coping strategies
Patient info:
- benefits they may be entitled to
- managing disease flares & pain management
- disease process & ability to make informed decisions
Self-management:
- know what their responsibilities are
- Know when to seek help
- adherence to treatment= improve QOL & life expectancy
Role of pain management team
- Experts in understanding the mechanisms & management of pain.
- Try to reduce polypharmacy
- Difficult to reduce / stop analgesia
- Poor communication, psychosocial & psychological factors need to be recognised & addressed to minimise impact
Role of occupational therapist
- Help find alternative ways of doing tasks to make activities easier & less painful.
- Home visits: possible adaptations and aids to support self-management and improve independence.
- Advice on conserving energy
- relaxation & stress
- Splints & insoles
Role of physiotherapist
- Joint examination & joint count
- Range of movement, muscle wasting
- Exercise programme
- Treatment: wax therapy, exercises, hydrotherapy, ultrasound, acupuncture.
- Joint education
- Promote Self-Management- promotes better understanding of benefits of setting meaningful, achievable goals
Role of clinical & health psychologist
- Mental Health: anxiety, depression, poor coping strategies
- Behaviour & Psychological influences interactions w/ health, symptoms & daily functioning.
- Lifestyle impact
- CBT
- Counselling
- Anxiety & depression common symptoms in RA
- Anxiety & depression can lower pain threshold resulting in chronic pain- in turn exacerbates mental health problems
- Treatment compliance can be impaired resulting in worsening of symptoms
Role of podiatry
- Foot pain is common & impacts on activity.
- Provide insoles & supports to correct deformities
- Make special shoes & can analyse gait.
- Provide education
- Common foot deformities- subluxation of MTPs, hammer & claw toes, widening of forefoot, loss of fat pads resulting In callouses
