Multidisciplinary vs Interdisciplinary Models of Healthcare Delivery: Challenging the status quo on HIPAA privacy rules

The word multi indicates more than one. Multidisciplinary is a term given to a collection of two or more disciplines or specialties coming together to manage a health condition. In this approach, each discipline will focus on its role and take accountability for managing its particular piece of the problem. These specialties, although they work together, are determined solely by their areas of expertise and operate only in their expert roles. There is no overlapping or integration between the two disciplines.

Example: Early in my NP career, I worked in the Physical Medicine and Rehabilitation (PM&R) department at Texas Children's Hospital. One of my clinic's roles was to refill the intrathecal baclofen pump in children who had undergone baclofen pump implantation for the treatment of spasticity. Once a week, we used to have a multidisciplinary clinic. This clinic was exclusively meant for children who may need this implant surgery. There were three disciplines in this clinic. We, PM&R, along with Neurosurgery and Orthopedics. Each of the specialties had a different role, but it was a collective approach. Three specialties would discuss and decide if the patient is the correct candidate for such implant surgery. In brief, each discipline had a different role; one did not interfere with the other, but worked collectively and served a different purpose.  

On the other hand, an interdisciplinary approach refers to working together, where each specialty integrates its care towards one common goal.

Example: My second NP position was in inpatient surgical cardiology at Texas Children’s Hospital, where I have seen many interdisciplinary teams working together. For each infant who underwent cardiac surgery, there was occupational therapy, physical therapy, and a diet plan in place. OT helped in developing swallowing skills in these infants. PT helped build muscle strength, and the dietitian helped monitor intake and calories in infant feedings. Everything would fall apart, and there is no way an infant would survive post-major cardiac surgery if we did not have input from the interdisciplinary teams.

I chose these two examples to present the background on how these two healthcare delivery models function in healthcare.

My main intention in writing this column is to shed light on the mental health aspect in primary care practice. Working as an NP in a community-based primary care clinic, I have seen the gaps where changes/ modifications are needed in our healthcare infrastructure.  

Primary care is the home clinic of the patients. Primary care provider (PCP) can provide better care to their patients when they are included in health communication. Usually, when a PCP refers a patient to a specialist, they receive a consultation report about the patient. That is how the PCP knows what's going on with their patients on the specialist side and provides help to them if needed. All the specialties send consultation reports to the PCP, except the mental health specialty. PCPs do not receive a consultation report from a child psychiatrist or a child psychologist. Under the regulations of HIPAA (Health Insurance Portability and Accountability Act), the notes from psychiatrists and psychologists are considered sensitive notes and need to be protected. Therefore, to maintain the confidentiality of patient information, the notes are not shared or sent to the PCP.

Now, let's think of the pros and cons of this Act. Yes, information is sensitive, and protecting the data is for patient safety. But on the flip side, mental health is directly connected to physical health, where the PCP comes into play.

Let us say a patient named Audrea has a clinical depression, a high level of anxiety, and an eating disorder. She has been compromising on her eating & drinking for a few weeks. Mom brought her in to her PCP’s office. Her presentation is: lethargy, dehydration, electrolyte imbalance, tachycardia, palpitations, and hypoglycemia. The PCP immediately orders a bunch of tests and starts addressing all the problems. In the meantime, mom tells the PCP that Audrea's eating disorder has been worse lately, she refuses to eat, and she has been very depressed, missing school and isolating herself. Here, PCP is taking all the required actions to address the patient’s problem, but has no idea about the patient’s status of depression and eating disorder. If the PCP were aware of his patients’ mental health status, he would have, perhaps, scheduled a close follow-up, not only on Audrea but on those patients who are at high risk of going into medical problems. In such cases, a periodic communication between PCP and mental health provider would help these vulnerable and high-risk patients avoid falling into the trap of medical complications.

Secondly, there are some medications such as Diazepam and Ativan, which are used in epilepsy and anxiety. Although neurologists and psychiatrists may be prescribing these medications, PCP plays an essential role as a middleman in the coordination of care. The patient can be at risk of overdosing or underdosing on these medications without the timely interdisciplinary approach.    

Thus, this integration of mental health and primary care utilizes both multidisciplinary & interdisciplinary models of healthcare delivery.

This brief scenario is to initiate brainstorming the benefits of integrating mental health specialty and primary care:

1.     Provides clarity in decision-making for PCP to identify the need for a referral to mental health.

2.     Facilitates understanding of the pathophysiology of mental illness in patients and how it could affect the current medical problem.

3.     Helps make better diagnoses of existing health problems in patients.

4.     Creates better treatment plans and home care methods for patients.

5.     Guides to schedule necessary follow-up visits to monitor the progression of medical problems that could be affected by mental health status.

6.     Lastly, it helps tailor treatment and management according to the needs based on the patient’s mental and psychological needs, for example, a patient with anxiety may cooperate better with nebulizer treatment for asthma as compared to an inhaler, etc.

 With this, I will let my readers make their own interpretations as to why multidisciplinary and interdisciplinary health care models are essential. What do you think about existing HIPAA privacy rules? Do you think it needs modifications?

I encourage alternative thoughts and perspectives.