The Benefits and Challenges of Interprofessional Training Programs Implemented to Increase Access to Primary Care for Medicaid Enrollees

Main Article Content

Cynthia J. Sieck, PhD, MPH Megan E. Gregory, PhD Sarah R. MacEwan, PhD Lindsey N. Sova, MPH Jaclyn Volney, MPH Kristen Rundell, MD Ann Scheck McAlearney, ScD, MS

Abstract

Background: Interprofessional (IP) care teams that bring together health care providers from multiple disciplines can provide a broader scope of services and enhance efficiency so as to increase availability of providers. The use of IP teams may be of particular benefit for Medicaid enrollees who experience difficulty accessing care given socioeconomic barriers and limited provider availability. However, IP training is critical to ensure that health and social service providers understand their roles on these teams. Our study sought to understand the benefits and challenges of IP training programs, including how such programs could help improve access to health care for underserved populations.


 


Methods: We conducted a qualitative study across 10 health care organizations where IP training programs had been implemented. Learners, preceptors, and program staff were interviewed and asked about the structure of the programs, individual roles within the programs, and satisfaction with the programs. Interviews were transcribed and analyzed using rigorous qualitative methods.


 


Results: Two types of IP training programs were identified: those offering a specific program that integrated behavioral health and primary care, and those offering a general program that included multiple types of providers. Benefits of IP training included expanded access to primary care providers, increased ability to deliver ‘whole person care’ that addressed social determinants of health, and improved support across disciplines. Challenges included navigating logistics of integrating IP trainees into a program, changing expectations about approaches to IP care delivery, technology issues, and funding.


 


Conclusions: IP training programs can increase access to care for Medicaid enrollees and improve primary care delivery by increasing the number of trained providers and improving the capacity of organizations to deliver care that addresses social determinants of health. Addressing challenges around logistics, technology, and funding can help IP training programs succeed and sustain their efforts to improve care for Medicaid enrollees. 

Article Details

How to Cite
SIECK, Cynthia J. et al. The Benefits and Challenges of Interprofessional Training Programs Implemented to Increase Access to Primary Care for Medicaid Enrollees. Medical Research Archives, [S.l.], v. 8, n. 8, aug. 2020. ISSN 2375-1924. Available at: <https://journals.ke-i.org/mra/article/view/2168>. Date accessed: 30 sep. 2020. doi: https://doi.org/10.18103/mra.v8i8.2168.
Section
Research Articles

References

1. Abdus S, Mistry KB, Selden TM. Racial and ethnic disparities in services and the patient protection and affordable care act. Am J Public Health. 2015;105(S5):S668-675. doi: 10.2105/AJPH.2015.302892.
2. 2016 National healthcare quality and disparities report. Rockville, MD: Agency for Healthcare Research and Quality. 2016. Available from: http://www.ahrq.gov/research/findings/nhqrdr/nhqdr16/index.html.
3. Alcala HE, Roby DH, Grande DT, McKenna RM, Ortega AN. Insurance type and access to health care providers and appointments under the Affordable Care Act. Med Care. 2018;56(2):186-192. doi: 10.1097/MLR.0000000000000855.
4. Sharma R, Tinkler S, Mitra A, Pal S, Susu-Mago R, Stano M. State Medicaid fees and access to primary care physicians. Health Econ. 2018;27(3):629-636. doi: 10.1002/hec.3591.
5. Decker SL. In 2011 nearly one-third of physicians said they would not accept new Medicaid patients, but rising fees may help. Health Aff (Millwood). 2012;31(8):1673-1679. doi: 10.1377/hlthaff.2012.0294.
6. Golberstein E, Gonzales G, Sommers BD. California's early ACA expansion increased coverage and reduced out-of-pocket spending for the state's low-income population. Health Aff (Millwood). 2015;34(10):1688-1694. doi: 10.1377/hlthaff.2015.0290.
7. Neprash HT, Zink A, Gray J, Hempstead K. Physicians' participation in Medicaid increased only slightly following expansion. Health Aff (Millwood). 2018;37(7):1087-1091. doi: 10.1377/hlthaff.2017.1085.
8. Morgan S, Pullon S, McKinlay E. Observation of interprofessional collaborative practice in primary care teams: an integrative literature review. Int J Nurs Stud. 2015;52(7):1217-1230. doi: 10.1016/j.ijnurstu.2015.03.008.
9. Franklin CM, Bernhardt JM, Lopez RP, Long-Middleton ER, Davis S. Interprofessional teamwork and collaboration between community health workers and healthcare teams: an integrative review. Health Serv Res Manag Epidemiol. 2015;2:2333392815573312. doi:10.1177/2333392815573312.
10. Supper I, Catala O, Lustman M, Chemla C, Bourgueil Y, Letrilliart L. Interprofessional collaboration in primary health care: a review of facilitators and barriers perceived by involved actors. J Public Health. 2015;37(4):716-727. doi: 10.1093/pubmed/fdu102.
11. Rasin-Waters D, Abel V, Kearney LK, Zeiss A. The integrated care team approach of the department of Veterans Affairs (VA): geriatric primary care. Arch Clin Neuropsychol. 2018;33(3):280-289. doi: 10.1093/arclin/acx129.
12. Altschuler J, Margolius D, Bodenheimer T, Grumbach K. Estimating a reasonable patient panel size for primary care physicians with team-based task delegation. Ann Fam Med. 2012;10(5):396-400. doi: 10.1370/afm.1400.
13. Institute of Medicine Committee on the Health Professions Education Summit. Health professions education: a bridge to quality. Washington DC: National Academies Press. 2003. Available from: https://www.ncbi.nlm.nih.gov/books/NBK221525/.
14. West C, Graham L, Palmer RT, Miller MF, Thayer EK, Stuber ML, et al. Implementation of interprofessional education (IPE) in 16 U.S. medical schools: common practices, barriers and facilitators. J Interprof Educ Pract. 2016;4:41-49. doi: 10.1016/j.xjep.2016.05.002.
15. Harada ND, Traylor L, Rugen KW, Bowen JL, Smith CS, Felker B, et al. Interprofessional transformation of clinical education: the first six years of the Veterans Affairs Centers of Excellence in Primary Care Education. J Interprof Care. Feb 2018:1-9. doi: 10.1080/13561820.2018.1433642.
16. Bridges DR, Davidson RA, Odegard PS, Maki IV, Tomkowiak J. Interprofessional collaboration: three best practice models of interprofessional education. Med Educ Online. 2011;16:6035. doi: 10.3402/meo.v16i0.6035.
17. Pecukonis E, Doyle O, Bliss DL. Reducing barriers to interprofessional training: promoting interprofessional cultural competence. J Interprof Care. 2008;22(4):417-428. doi: 10.1080/13561820802190442.
18. Glaser BG. The constant comparative method of qualitative analysis. Soc Probl. 1965;12(4):436-445. doi: 10.1525/sp.1965.12.4.03a00070.
19. Constas MA. Qualitative analysis as a public event: the documentation of category development procedures. Am Educ Res J. 1992;29(2):253-266. doi: 10.2307/1163368.
20. Corbin JM, Strauss A. Grounded theory research: procedures, canons, and evaluative criteria. Qual Sociol. 1990;13(1):3-21. doi: 10.1007/BF00988593.
21. ATLAS.ti (version 6). Berlin, Germany: Scientific Software Development.
22. Green BN, Johnson CD. Interprofessional collaboration in research, education, and clinical practice: working together for a better future. J Chiropr Educ. 2015;29(1):1-10. doi: 10.7899/JCE-14-36.
23. Levinson DR. Access to care: provider availability in Medicaid managed care: Department of Health and Human Services, Office of Inspector General. 2014. Available from: https://oig.hhs.gov/oei/reports/oei-02-13-00670.pdf.
24. Baker A, Cronin K, Conway PH, DeSalvo KB, Rajkumar R, Press MJ. Making the comprehensive shared care plan a reality. NEJM Catalyst. 2016. doi: 10.1056/CAT.16.0838.
25. Hewner S, Casucci S, Sullivan S, Mistretta F, Xue Y, Johnson B, et al. Integrating social determinants of health into primary care clinical and informational workflow during care transitions. eGEMs. 2017;5(2):2. doi: 10.13063/2327-9214.1282.
26. Sullivan SS, Mistretta F, Casucci S, Hewner S. Integrating social context into comprehensive shared care plans: a scoping review. Nurs Outlook. 2017;65(5):597-606. doi: 10.1016/j.outlook.2017.01.014.
27. Holmqvist M, Courtney C, Meili R, Dick A. Student-run clinics: opportunities for interprofessional education and increasing social accountability. J Res Interprof Pract Educ. 2012;2(3):264-277. doi: 10.22230/jripe.2012v2n3a80.
28. Tong STC, Phillips RL, Berman R. Is exposure to a student-run clinic associated with future primary care practice? Fam Med. 2012;44(8):579-581.
29. Feldman CT, Morici B, Goodrich S. Early exposure to underserved patients and its impact on initial employment decisions regarding physician assistants. J Physician Assist Educ. 2018;29(3):144-149. doi: 10.1097/JPA.0000000000000213.
30. Jones MD, Jr., McGuinness GA, First LR, Leslie LK. Linking process to outcome: are we training pediatricians to meet evolving health care needs? Pediatrics. 2009;123(Suppl 1):S1-7. doi: 10.1542/peds.2008-1578C.
31. Vickery KD, Rindfleisch K, Benson J, Furlong J, Martinez-Bianchi V, Richardson CR. Preparing the next generation of family physicians to improve population health: a CERA study. Fam Med. 2015;47(10):782-788.
32. Lochner J, Lankton R, Rindfleish K, Arndt B, Edgoose J. Transforming a family medicine residency into a community-oriented learning environment. Fam Med. 2018;50(7):518-525. doi: 10.22454/FamMed.2018.118276.
33. Janamian T, Jackson CL, Glasson N, Nicholson C. A systematic review of the challenges to implementation of the patient-centred medical home: lessons for Australia. Med J Aust. 2014;201(3 Suppl):S69-73. doi: 10.5694/mja14.00295
34. Doolittle B, Tobin D, Genao I, Ellman M, Ruser C, Brienza R. Implementing the patient-centered medical home in residency education. Educ Health (Abingdon). 2015;28(1):74-78. doi: 10.4103/1357-6283.161916.

Most read articles by the same author(s)

Obs.: This plugin requires at least one statistics/report plugin to be enabled. If your statistics plugins provide more than one metric then please also select a main metric on the admin's site settings page and/or on the journal manager's settings pages.