CCP Interdisciplinary Team Roles 2 — Questions and Answers
Question 1: Which team member is primarily responsible for conducting a comprehensive medication reconciliation for a patient with multiple chronic conditions?
- Social worker
- Clinical pharmacist (Correct answer)
- Dietitian
- Physical therapist
Correct answer: Clinical pharmacist
The clinical pharmacist leads medication reconciliation to identify duplications, interactions, and adherence issues in patients on complex regimens.
Question 2: A care coordinator notices a patient with COPD has missed three consecutive follow-up appointments. The BEST first action is to:
- Discharge the patient from the program
- Notify the billing department
- Conduct an outreach call to identify barriers to attendance (Correct answer)
- Wait for the patient to reschedule independently
Correct answer: Conduct an outreach call to identify barriers to attendance
Proactive outreach to identify and address barriers (transportation, cost, health literacy) is the standard care coordination response to missed visits.
Question 3: In an interdisciplinary team meeting, a social worker's UNIQUE contribution is to:
- Adjust medication dosages
- Assess psychosocial determinants and community resource needs (Correct answer)
- Interpret diagnostic imaging
- Perform physical assessments
Correct answer: Assess psychosocial determinants and community resource needs
Social workers specialize in identifying psychosocial factors, social determinants of health, and linking patients to community resources.
Question 4: Which professional on the chronic care team is best positioned to develop a safe home exercise plan for a patient recovering from a hip fracture with diabetes?
- Registered nurse
- Physical therapist (Correct answer)
- Pharmacist
- Medical social worker
Correct answer: Physical therapist
Physical therapists design individualized therapeutic exercise programs that account for comorbidities such as diabetes to maximize safe functional recovery.
Question 5: A registered dietitian on the chronic care team is asked to support a patient with stage 3 chronic kidney disease (CKD) and type 2 diabetes. The dietitian's PRIORITY intervention is:
- Prescribing insulin adjustments
- Developing a renal-friendly, low-glycemic meal plan (Correct answer)
- Ordering lab tests for renal function
- Performing motivational interviewing for exercise
Correct answer: Developing a renal-friendly, low-glycemic meal plan
The dietitian's core role is medical nutrition therapy, crafting a diet that simultaneously manages blood glucose and limits nephrotoxic nutrients like phosphorus and potassium.
Question 6: When a chronic care patient is transitioning from hospital to home, the team member MOST responsible for ensuring continuity of care instructions is the:
- Hospital administrator
- Discharge planner or transitional care nurse (Correct answer)
- Billing coordinator
- Primary care receptionist
Correct answer: Discharge planner or transitional care nurse
Discharge planners and transitional care nurses coordinate education, follow-up appointments, medications, and community services to prevent readmission.
Question 7: Which statement BEST describes the concept of role clarity within an interdisciplinary chronic care team?
- Each member performs all tasks to ensure coverage
- Team members understand their own scope and defer appropriately to others' expertise (Correct answer)
- Only the physician defines what each member does
- Roles are interchangeable to maximize efficiency
Correct answer: Team members understand their own scope and defer appropriately to others' expertise
Role clarity means each discipline understands its defined scope of practice and recognizes when to collaborate with or defer to other team members.
CCP Interdisciplinary Team Roles 2
Which team member is primarily responsible for conducting a comprehensive medication reconciliation for a patient with multiple chronic conditions?