• Division of labor—identifying which people on the team perform which tasks

  • Training for the functions each team member routinely performs

  • Effective communication (e.g., minute-to-minute communication through brief verbal interactions among team members)

How these characteristics play out in the care of patients on drug therapy can be illustrated by the example of anticoagulation therapy with warfarin. Such therapy is risky, for example, because of the possibility of bleeding due to drug interactions and suboptimal dosing. Specialized anticoagulation clinics employ a team approach to optimize the treatment (Ansell et al., 1997). Such an approach can help achieve improvements in anticoagulation control (Samsa et al., 2000) and reductions in bleeding and thromboembolic event rates (Chiquette et al., 1998; Hamby et al., 2000). One measurable outcome for patients on warfarin therapy is whether the level of anticoagulation has been maintained within the target therapeutic range at least 80 percent of the time, so as to reduce the risk of bleeding and provide optimal therapeutic benefit. Accordingly, key features of effective warfarin therapy teams are as follows:

  • A clinical system with a set of procedures for informing patients of laboratory results and of any needed changes in the warfarin dose.

  • An administrative system with procedures for scheduling the next laboratory test and notifying the nurse and scheduler when a patient does not present for the test.

  • Adequate training of each team member in the specific functions each must perform. For example, the nurse or pharmacist managing the care of patients on warfarin must be trained in the use of protocols and computer programs for dosing and monitoring of the therapy, as well as in surveillance for important drug interactions.

  • Communication structures for promptly conveying information to the physician when there is a need for decisions regarding response to a warfarin-related bleeding event or complex dosing and monitoring decisions not encompassed by the usual protocols.

It is important to note that despite the potential benefits of multidisciplinary approaches and their increasing use in the care of patients with a variety of medical conditions, such approaches have not always proven to be more effective than conventional care (Matchar et al., 2002; Strom and Hennessy, 2002). Furthermore, multidisciplinary teams are used most commonly in care for a single medical condition or management of a single type of therapy. Care provided by several different multidisciplinary teams may not be the optimum way to care for patients with multiple chronic medical



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