Collaborative network

Who needs an interprofessional team?

No one can manage the complex needs of people with a long-term health condition such as dementia alone. Complex needs are best addressed by interprofessional teams. By working in partnership with other professionals doctors can save time and improve health and social outcomes for people with dementia and their carers.

A happy senior, around her, in text, the five types of needs of people with dementia and, in each case, the people from an interprofessional network who help meet each need. For information and symptom control, a physician and a nurse are shown. For social relatedness, a (neuro)psychologist is pictured. For activity and participation, a social worker is depicted. For autonomy and independence, an occupational therapist is pictured.
Meeting the needs of people with dementia requires networking

What are the aims of an interprofessional collaborative network?

The aims of a collaborative network are to:

  • Improve access to care
  • Provide timely diagnosis and treatment
  • Coordinate interventions
  • Capacity building regarding dementia management within the team
  • Enable simple and targeted referrals
  • Ensure smooth transitions of care
  • Reduce clinical errors and adverse outcomes
  • Lowering healthcare costs by decreasing inappropriate use of resources, duplicate efforts, and reducing rates of institutionalisation

How can an interprofessional collaborative network be structured?

An interprofessional team for dementia care usually involves either a physician or trained nurse as care coordinators, and in addition social workers, psychologists, occupational therapists, physical therapists, speech and language therapists and pharmacists. Successful teamwork is characterised by a shared commitment to quality care, strong communication between team members and an appreciation of the contributions of each team member. In a collaborative network a clear definition of responsibilities is essential.

Model of an interprofessional collaborative network

At the center of this model of an interprofessional collaborative network for dementia care is the Team Coordinator. This person is surrounded by and bilaterally connected with professional groups, which are in turn each bilaterally connected. The physician is responsible for team leadership, diagnosis and medical treatment. The social worker is responsible for care coordination, counselling, legal and financial issues and referral to services. The psychologist is responsible for diagnosis, treatment and counselling of carers. The physiotherapist is responsible for improving physical fitness, mobility and enhancing daily activities. The speech and language therapist is responsible for communication and swallowing difficulty. The occupational therapist is responsible for improving daily activities and use of assistive technology. The pharmacist is responsible for pharmacological treatment. The nurse is responsible for care coordination and nursing care.
Model of an interprofessional collaborative network