1. MULTIDISCIPLINARY (MDT) APPROACH TO CLINICAL CARE MODEL FOR EFFECTIVE AND BEST EVIDENCE PATIENT CARE
DR EZEKIEL ALAWALE
MBBS, FWACS, FRCS(I), JCPTGP, GP PRINCIPAL & PARTNER DERBY ROAD HEALTH CENTRE, CHAIRMAN CMIPD

2. INTRODUCTION
Multidisciplinary care is a collaborative patient management
It involves drawing appropriately from multiple disciplines to redefine problems outside of normal boundaries and reach solutions based on a new understanding of complex situations.

3. WHAT IS MDC?
Multidisciplinary care is an integrated team approach to healthcare.
It involves evaluation of treatment options and planning as a collaborative processes
MDC involves a range of professionals which commonly includes, medical, nursing and allied healthcare professionals in concertation with the patient and the patient’s family.
The individual patient-specific treatment plans are developed making delivery of care a shared responsibility
Regarded as best practice

4. PRINCIPLES OF MDC
A team approach, involving specialists, GP, AHP, social worker, supportive care worker etc
Regular communication among team members is essential
Access to a full range of therapeutic options
Provision of care in line with the national standards and treatment decisions based on adequate information
Patients are involved in their care discussions and management, and should receive timely and appropriate information from the healthcare professionals
Team Approach – the team members will depend on the case that is been managed and also whether its taking place in the hospital or the community.

5. WHAT IS A MULTIDISCIPLINARY TEAM?
A multidisciplinary team is a group of health care workers who are members of different disciplines, which meets together at a given time (whether physically in one place, or by video or teleconferencing) to discuss a given patient and who are each able to contribute independently to the diagnostic and treatment decisions about the patient
MDT model in patient care was introduced and endorsed to ensure that care delivery is consistent with the best available evidence

6. EVIDENCE
Provides consistent, continuous, coordinated and cost effective care to patients (Fleissig et al 2006).
Decisions are likely to conform to evidenced based guidelines than those made by individual clinicians (Vinod et al 2010).
Shorter mean time from diagnosis to treatment (Gabel et al).
Effective in advanced disease
Increased patient satisfaction (Gabel et al 1997).
Higher proportion of patients receiving NACT.

7. Cath Taylor et al BMJ 2010 EVIDENCE IN RELATION TO CANCER
Multidisciplinary team working in cancer: what is the evidence?
Improved Clinical Decision making
More Coordinated Patient Care
Improvement to overall quality of care
More evidence based treatment decisions and
Improved Treatment
England and international evidence for their effectiveness

8. Saini et al 2012, 97%- improved clinical decision making
93%- improved overall quality of treatment
91%- more coordinated patient care
91%- evidenced based treatment decision
and
9%- improved survival rates
Large International surgery from 39 countries

9. BENEFITS OF MDC Multidisciplinary approach to care results in:
Greater patient satisfaction
Improved financial performance
Reduction in mean duration of hospitalisation
A significant reduction in number of unplanned hospital readmissions

10. Benefits
1. International Journal of Breast Cancer Volume 2011:Cancer Multidisciplinary Team Meetings: Evidence, Challenges, and the Role of Clinical Decision Support Technology

11. MDT MEETING (MDTM) Efficient MDTMs that start promptly and discuss:
The right patient
At the right time
With the right clinicians present
With all the relevant information readily available
And with processes in place to collect the required data.
Good team dynamics

12. BARRIERS TO ADOPTION OF MDC
Resistance to change by the clinicians
A lack of funding to support the MDC model
A lack of time on the part of clinicians to attend MDT meetings
Differences between the public and private healthcare sectors
Workforce issues and pressures on disciplines, e.g. pathologists who may need to attend several meetings each week
The unknown cost of MDC
Difficulty of establishing MDC in rural and remote areas because of a lack of team members

13. Summary
MDT are extremely important in providing the best care for our patients
Essential for the right people to be present at the right time with the right resources available
Breast cancer patients managed in an MDT have better care and experiences

14. CONCLUSION Multidisciplinary approach to patient care will lead to:
Improved clinical decision making
Improved clinical outcomes
Improved patient experience and
Improved working lives of team members