CROSSDISCIPLINARY HEALTHCARE DELIVERY MODEL FOR A HEALTH PROTECTION PROGRAM

Purposes/Aims:  With shortages of primary care providers in both rural and urban areas, access to care is often limited.  The Circle of Caring advanced practice model by Dunphy and Winland-Brown was modified to transcend disciplines and clinical settings to reduce access inequities and foster provider collaboration.  Using this model, health education and screenings were delivered efficiently and cost effectively to promote healthy behaviors and subsequent health outcomes in groups of families. Theory Description:  Attributes of caring in this model include courage, authentic presence, advocacy, knowing, commitment, and patience.   In primary care settings, medical model components include formulation of a medical diagnosis and identification of patient responses to illness. In community-based settings, providers identify population health risks, susceptibilities, and community strengths and focus on chronic disease prevention to protect the health of groups. Providers in each setting envelope patients in caring throughout healthcare encounters and create plans to respond to pertinent findings.   Internal Consistency:  Setting-specific primary care and community-based Circle of Caring models were combined to demonstrate how interdisciplinary screenings and education can be delivered in a caring, socially supported manner.  Primary care clinical and therapeutic decision making were integrated with community-based proactive problem solving and prevention methodologies.  Intended whole person outcomes include the achievement of long-term, subjective indicators of well-being including functional outcomes as well as improved objective indicators or health.  Linkage to Practice: Using this approach, contextual and environmental influences on health behaviors, population health risks, and biopsychosocial responses to health status can be rapidly addressed by interdisciplinary providers. Providers can maintain regular contact with groups through shared use facilities combined with online technologies versus individual-based episodic care at an off-site clinical setting where it is often difficult to obtain appointments for education required to protect patients from developing chronic illnesses.  By combining the conceptual focus of both settings, interdisciplinary care can be brought to families and communities for health screenings and education to prevent chronic illness before one develops a diagnosis.  Additionally, providers can use complimentary clinical strategies as well as family and group social support to foster a trusting, caring relationship which mediates patient engagement to improve long-term subjective and objective indicators of wellbeing. Conclusions: Contextual and environmental antecedents heavily influence the long-term health behaviors of families and groups.  Annual or episodic illness care in primary care settings may not produce long-term changes when certain complex health issues such as diabetes, hypertension and obesity require ongoing assessment, education, engagement and support.   Efficient and cost-effective health protection is possible when primary care planning is combined with community-based partnership elements to address chronic health risks in families and groups.   For long-term changes, a transformation in engagement, knowledge, skills, beliefs, and behaviors must occur in a caring atmosphere to maximize provider time, health care equity, utilization and whole person patient outcomes.