Editor’s note: Originally published on Oct. 12, 2023. Updated Feb. 28, 2024, to add fact sheets.
According to the Agency for Healthcare Research and Quality (AHRQ), a leading cause of medical errors and poor care is a lack of communication between healthcare providers.1 As healthcare has evolved, the importance of holistic care has become more and more evident, particularly in the realm of chronic disease.
The World Health Organization defines interprofessional (IP) collaborative practice as “multiple healthcare workers from different professional backgrounds working together with patients, families and communities to deliver the highest quality of care.”2
Shirey et al. developed an interprofessional collaborative practice using a deference to expertise model, which is not based on a fixed hierarchy, but on a shifting one in which the profession with the needed skills takes the lead, depending on the needs of the patient at any given period of time.3,4
Patients with rheumatic disease benefit from IP team care because their needs shift in response to disease progression, life changes, workload, emotional burden, financial crisis, injuries, functional decline and response to medication. One patient may need emotional support from a counselor or psychologist as a priority. Another may need a physical therapist (PT) or occupational therapist (OT) to address functional decline and disease self-management. The next patient may need help managing medications from a pharmacist or rheumatologist, and another may need dietary counseling for weight loss. Six months later, all of these patients’ needs will have likely shifted, requiring a different combination of interventions. The bottom line is that it truly does take a village to manage rheumatic diseases.
Taking into account the results of the 2022 ARP Practice Committee focus groups, as well as the ACR/ARP member survey, the ARP Practice Committee is developing IP Fact Sheets targeted toward healthcare providers to assist them in determining the needs of their practices and the benefits of partnerships with a network of providers in their communities.
Each sheet covers a different profession, providing information on their role and skill set, what they can do for a patient with rheumatic disease, education and licensing requirements, and links to their professional organizations where more information can be found on their professional values and ethics.
As these fact sheets are developed, they will be published in The Rheumatologist, as well as on the ACR/ARP website as provider resources. All will follow the template outlined below. In conjunction with ACR’s Workforce Solutions Committee, we hope the IP Fact Sheet, along with a case study, showcases how professions can work together to provide the highest quality of care for patients.
Interprofessional Fact Sheet Template
- Profession:
- Training:
- Licensure/certification:
- General description of role:
- Rheumatology skill set:
- How/when to refer:
- Case study:
▶ Rose, a single, 50-year-old woman, was diagnosed with rheumatoid arthritis one month ago and was prescribed methotrexate and prednisone to control inflammation. She reports a one-year history of general pain and swelling in her hands and feet, morning stiffness lasting two hours, extreme fatigue and malaise, and often drops things held in her hands, particularly if they are heavy. She is having difficulty getting through her morning routine and getting to work. She works in an office and finds it difficult to type, walk or stand for long periods due to pain and fatigue. She has two children in their middle teens. - What can this profession do for Rose?
- Links to the profession’s national organization (APTA, AOTA, etc.):
The 1st 3 Fact Sheets
Profession: Physician Rheumatologist (MD/DO)
Medical School (four years) > Internal Medicine Residency (three years) > Rheumatology Fellowship (two to three years)
License/Certification
American Board of Internal Medicine Rheumatology Certification Exam
General Description
The rheumatologist is a specialized internist who helps with all aspects of patient care, including: 1) making diagnoses, 2) providing recommendations and prescriptions for treatment, 3) medication management and 4) coordination of patient care. Because rheumatic diseases can be complicated and may involve multiple organ systems, the rheumatologist commonly shares patients with other specialists. The rheumatologist can also refer patients to other rheumatology professionals, including physical therapists, occupational therapists and pharmacists. Rheumatologists are often leaders of a practice and may work in both the inpatient and outpatient settings. Of all rheumatology providers, they are generally best suited to manage complex patient cases. Rheumatologists can also engage in clinical, translational or basic research and may oversee a clinical research team or laboratory as a principal investigator.
How/When to Refer
A patient can be referred to a rheumatologist by any provider who believes they would benefit from specialty care. Rheumatologists may also be recognized as clinical experts within specific disease areas and may receive requests from other rheumatologists to provide second opinions on patient cases.
Case Study
Rose, a single, 50-year-old woman, was diagnosed with rheumatoid arthritis one month ago. She just started methotrexate and prednisone to control inflammation. She reports a one-year history of general pain and swelling in her hands and feet, as well as morning stiffness lasting two hours, extreme fatigue and malaise. She says she often drops things held in her hands, particularly if they are heavy. She is having difficulty getting through her morning routine and getting to work. She does office work and finds it difficult to type, walk or stand for long periods due to pain and fatigue. She has two children in their middle teens.
What Can This Professional Do for Rose?
- Confirm the diagnosis of rheumatoid arthritis, provide additional or alternative diagnoses and consider individual aspects of the diagnosis in relation to Rose’s comorbidities, risk factors and personal circumstances;
- Equip Rose and her family with education and resources regarding the diagnosis and her treatment options;
- Monitor medication safety and adjust doses according to Rose’s treatment response;
- Monitor efficacy of the treatment plan and provide alternative recommendations if Rose’s response to therapy fails or is incomplete;
- Place referrals to other rheumatology professionals, including physical and occupational therapists, who can help Rose stay functional in performing her daily activities;
- Provide resources for pain and stress management, and offer corticosteroid injections for joint inflammation when appropriate;
- Offer support for any accommodations required during the course of Rose’s treatment, including completion of FMLA paperwork; and
- Stay up to date on the latest clinical and research advances within the field of rheumatoid arthritis that could be of benefit to Rose during the course of the patient-physician relationship.
Links to the Profession’s National Organizations
Profession: Clinical Research Coordinator/Nurse
Training
Not mandatory but usually a bachelor’s degree, master’s degree and/or a doctorate (PhD) is preferred.
License/Certification
Certified Clinical Research Coordinator (CCRC)/Certified Clinical Research Professional (CCRP)
General Description
A clinical research coordinator (CRC) and/or clinical research nurse (CRN) will be the main point of contact for any possible research studies. These individuals are well versed in study activities, and the personalized care patients will be given while in a particular study. The CRC/CRN will work/coordinate with multiple medical teams, as well as with the patient, to ensure the best possible outcome for the study, but more importantly, the patient. Because each research study is unique, the types of skillsets, education, experience and certifications/licenses the particular researcher will need can vary.
How/When to Refer
Often, the CRC/CRN educates clinical staff about current studies and what patients may qualify and/or notify clinical staff of a potential patient who may qualify for a study. Usually the CRC/CRN will meet directly with the patient to determine their research eligibility and coordinate all study activities/visits moving forward if they do qualify and participate.
Case Study
Rose, a 50-year-old single female, was diagnosed with rheumatoid arthritis one month ago. She just started methotrexate and prednisone to control inflammation. She reports a one-year history of general pain and swelling in her hands and feet, morning stiffness lasting two hours, extreme fatigue and malaise, and often drops things held in her hands, particularly if they are heavy. She is having difficulty getting through her morning routine and getting to work. She does office work and finds it difficult to type, walk or stand for long periods due to pain and fatigue. She has two children in their middle teens.
What Can This Professional Do for Rose?
The CRC/CRN can determine if Rose may qualify for a research study. If Rose does qualify, the CRC/CRN will help guide her from study beginning to end. Depending on the study, research staff can assist with study medication or devices, if applicable.
Links to the Profession’s National Organization
- CRC Certification: ACRP (acrpnet.org)
- CCRP Certification Program: Society of Clinical Research Associates (SOCRA)
Profession: Physical Therapist
Training
As a prerequisite to completing earning a Doctor of Physical Therapy (DPT) from a program accredited by the Commission on Accreditation in Physical Therapy Education, physical therapists (PT) must have earned a bachelor’s degree. The length of professional DPT programs is typically two to three years, with most of the programs extending approximately three years.
The PT curriculum includes courses and contents across the continuum of care and across the lifespan. The didactic coursework consists of basic sciences, foundational sciences, behavioral sciences, patient/client management courses, behavioral sciences, differential diagnosis, clinical decision making and research. PT students are required to complete at least 30 weeks of full-time clinical experience (internship).
PTs are trained to be first-line, primary care providers. Patients have some sort of direct access to physical therapy in every state, the particulars of which are governed by the state. In many states, patients don’t need a physician’s referral in order to see a PT. However, patients and providers should check their insurance coverage requirements.
License/Certification
To practice as a PT in the U.S., a DPT student must pass the National Physical Therapy Exam (NPTE). Each state regulates physical therapy licenses independently, so precise requirements for licensing and renewal on top of this exam vary by state.
General Description of the Role
Physical therapists are movement experts who improve quality of life and promote, maintain and/or restore health.
PTs improve health and quality of life through screening, physical examination, diagnosis, prognosis, physical interventions and rehabilitation, patient education, disease prevention, and health promotion and wellness.
PT treatment commonly includes specific exercise, manual therapy, hands-on care, assistive devices (e.g., cane, walker), prostheses, orthoses, physical modalities (e.g., heat, cold, electrical modalities) and patient education.
PTs diagnose and treat individuals across the continuum of care (i.e., acute care to chronic conditions and long-term disability) and across the lifespan (i.e., all ages, from newborns to people at the end of life).
PTs work in a variety of clinical settings, including acute care, hospitals, rehabilitation hospitals, outpatient rehab, outpatient clinics, private-owned physical therapy clinics, sports training facilities, school systems, skilled nursing facilities (i.e., nursing homes), hospices, extended care facilities, private homes, health and wellness clinics/centers, education and research centers.
Rheumatology Skillset
A PT’s education and training include working with individuals with rheumatic disorders. Typically, PT interventions focus on pain relief, maintaining and regaining joint mobility and motion, muscle flexibility, maintaining and increasing strength and endurance, and preventing secondary disorders and complications, such as deformities. PTs work on improving mobility, the ability to perform activities of daily living and independent functioning. PTs work on educating the patient and family/caregiver about the disease process, including the effects of the pathology processes and secondary damage from rheumatic disorders.
How/When to Refer
- After a new rheumatic/musculoskeletal diagnosis, injury or surgery;
- To evaluate fall or other injury risk;
- Upon a decline in mobility;
- For chronic pain conditions;
- To establish a program to increase physical activity;
- For patient education/mobility intervention after any change in status;
- To evaluate and develop ADA recommendation for the workplace; and
- To evaluate adaptive equipment needs.
Case Study
Rose, a 50-year-old single female, was diagnosed with rheumatoid arthritis one month ago. She just started methotrexate and prednisone to control inflammation. She reports a one-year history of general pain and swelling in her hands and feet, morning stiffness lasting two hours, extreme fatigue and malaise, and often drops things held in her hands, particularly if they are heavy. She is having difficulty getting through her morning routine and getting to work. She does office work and finds it difficult to type, walk or stand for long periods due to pain and fatigue. She has two children in their middle teens.
What Can This Professional Do for Rose?
The goals of PT treatment for Rose are to reduce pain, improve mobility and reduce joint stiffness, improve the ability to perform activities of daily living and prevent the development of deformities and complications. Treatment may include physical modalities to reduce pain, such as heat or cold, therapeutic exercise and hands-on/manual therapy to improve joint mobility and muscle strength, and aerobic exercise to address fatigue and improve endurance. PTs will train Rose on the ability to perform activities of daily living, as well as job tasks, to decrease her risk of injury. PTs will educate Rose about the disease process, including the effects of the pathology processes and secondary damage from rheumatic disorders.
Links to the Profession’s National Organization
American Physical Therapy Association (APTA)
Get Involved
If you have questions or would like to contribute to a fact sheet for your profession, contact ARP Practice Committee chair Kimberly Steinbarger.
Kimberly Steinbarger, PT, MHS, DHSc, is an assistant professor at the Husson University College of Health & Pharmacy School of Physical Therapy, Bangor, Maine, and director of the Soaring Eagles Healthcare Pro Bono Clinic. She chairs the ARP Practice Committee and is a member of the ARP Executive Committee.
References
- Diagnostic Safety and Quality. TeamSTEPPS. Agency for Healthcare Research and Quality. 2017. https://www.ahrq.gov/topics/diagnostic-safety-and-quality.html.
- Framework for action on interprofessional education and collaborative practice [WHO/HRH/HPN/10.3]. World Health Organization. 2010 Sep 1. https://www.who.int/publications/i/item/framework-for-action-on-interprofessional-education-collaborative-practice.
- Shirey MR, Selleck CS, White-Williams C, et al. Interprofessional collaborative practice model to advance population health. Popul Health Manag. 2021 Feb;24(1):69–77.
- Godlock GC, Miltner RS, Sullivan DT. Deference to expertise: Making care safer. Creat Nurs. 2017 Feb 1;23(1):7–12.
