Feature Report

Implementing multidisciplinary care in heart failure – key considerations

What is multidisciplinary care?

Multidisciplinary care is the close collaboration of care professionals who provide joint and coordinated care and management of a given or multiple conditions.

In HF as in many other chronic conditions, multidisciplinary care is an essential part of delivering person-centred care to patients and addressing all of their medical and other needs.

Who should be involved in the multidisciplinary care team?

Multidisciplinary care teams should involve all health and allied professionals involved in the care of a given patient. This may include: general practitioners/family physicians, nurses, cardiologists, dieticians, pharmacists, social workers, physiotherapists and palliative care professionals if appropriate.

What are some of barriers to implementing multidisciplinary care?

The barriers to multidisciplinary working will depend in great part on the organisation of a given health care system.

Resource constraints: Healthcare systems are often under resourced to support multidisciplinary care working, for example by creating new, non-clinical roles, such as care coordination and therapeutic patient education for self-management.

Cultural barriers: Existing professional hierarchies may be challenged by multidisciplinary working, and some health care professionals may be suspicious of multidisciplinary care and reluctant to work with others.

Structural and legal barriers: may also make implementation of multidisciplinary working difficult. For example, care systems where health and social care services are well integrated may be more amenable to multidisciplinary care.

Workforce challenges: Appropriate remuneration is also key to encourage multidisciplinary working – often health professionals do not receive any additional remuneration for care coordination roles, for example.

What is needed to make multidisciplinary care work?

  • Clear commitment across different organisations to integrated HF team working
  • Training of all relevant healthcare professionals to challenge any cultural or professional barriers and align them to common goals.
  • Clear governance and accountability within the team, and designation of coordination and leadership roles
  • Shared decision-making among health professionals, facilitated by practical information sharing tools
  • Efficient information systems that allow the sharing of patient records and monitoring of patient outcome over the entire chain of care
  • Remuneration and incentive schemes that explicitly reward multidisciplinary working.