An Overview of Reviews on Interprofessional Collaboration in Primary Care: Barriers and Facilitators

Piloting a Telehealth Interprofessional Diabetes Clinic During Covid 19: Continuing patient care and student learning

Due to the COVID-19 pandemic, a team of faculty from dietetics, nursing, pharmacy, and social work converted a long-standing effective Interprofessional Team Care Clinic (IPTCC) at two outpatient health centers to a telehealth clinic during 2020 and 2021. Preliminary data suggest that this pilot telehealth clinic for patients with diabetes or prediabetes was effective in significantly lowering average hemoglobin A1C levels and increasing students' perceived interprofessional skills. This article describes the pilot telehealth interprofessional model used to educate students and provide patient care, outlines preliminary data about its effectiveness, and makes recommendations for future research and practice.

Innovative Non-Pharmacological Management of Delirium in Persons with Dementia: New Frontiers for Physiotherapy and Occupational Therapy?

BACKGROUND

Delirium and dementia are two of the most common geriatric syndromes, which requires innovative rehabilitation approaches.

AIM

We aimed at determining which occupational therapy and physiotherapy interventions are applied with older people with delirium and dementia in different care settings. We also identified the assessment tools that were used.

MATERIALS AND METHODS

We conducted a literature search for scientific articles published from 2012 to 2022 (PubMed, MEDLINE, AMED and CINAHL) with adults aged >65 years including experimental study designs with randomized or non-randomized intervention, exploratory studies, pilot studies, quasi-experimental studies, case series and/or clinical cases. Studies that did not use interventions that could be classified as occupational therapy or physiotherapy were excluded.

RESULTS

After applying the exclusion criteria, 9 articles were selected. The most widely used assessment to define dementia was the MMSE (N = 5; 55.5%), whereas the CAM (N = 2; 22.2%), CAM-ICU (N = 2; 22.2%) and RASS (N = 3; 33.3%) were the most widely used to define delirium. The rehabilitation interventions that were most frequently performed were early mobilization, inclusion of the caregiver during treatment, modification of the environment to encourage orientation and autonomy, the interprofessional systemic approach and engaging persons in meaningful activities.

CONCLUSIONS

Despite the growing evidence on its effectiveness, the role of physiotherapy and occupational therapy interventions in the prevention and treatment of people with dementia and delirium is still emerging. More research is needed to investigate if effective occupational therapy programs known to reduce the behavioral and psychological symptoms in people with dementia are also useful for treating delirium and specifically delirium superimposed on dementia. Regarding physiotherapy, it is crucial to know about the amount and timing of intervention required. Further studies are needed including older adults with delirium superimposed on dementia to define the role of the interprofessional geriatric rehabilitation team.

Family physicians collaborating for health system integration: a scoping review

BACKGROUND

In Canada, Ontario Health Teams (OHTs) are a new model for integrated healthcare. Core to OHTs are family physicians (FPs) and their ability to collaborate with other FPs and healthcare providers. Whereas the factors for intra-organizational collaboration have been well-studied, inter-organizational collaboration between FPs and other healthcare organizations as an integrated care network, are less understood. This paper aims to explore the structural factors, processes, and theoretical frameworks that support FPs' collaboration for integrated healthcare.

METHODS

A scoping review was undertaken based on Joanna Briggs Institute (JBI) methodology for scoping review and using the Preferred Reporting Items for Systematic Review and Meta-Analysis for Scoping Review (PRISMA_ScR) checklist. A search for academic and relevant grey literature published between 2000-2021 was conducted across databases (MEDLINE, EMBASE, EBSCOhost).Thematic analysis was used to identify the key findings of the selected studies.

RESULTS

Thirty-two studies were included as eligible for this review. Three structural components were identified as critical to FPs' successful participation in inter-organizational partnerships: (1) shared vision/values, (2) leadership by FPs, and (3) defined decision-making procedures. Also, three processes were identified: (1) effective communication, (2) a collective sense of motivation for change, and (3) relationships built on trust. Three theoretical frameworks provided insight into collaborative initiatives: (1) Social Identity Approach, (2) framework of interprofessional collaboration, and (3) competing values framework.

CONCLUSION

FPs hold unique positions in healthcare and this review is the first to synthesize the best evidence for building collaborations between FPs and other healthcare sectors. These findings will inform collaboration strategies for healthcare integration, including with OHTs.

Facilitators and barriers regarding the implementation and interprofessional collaboration of a first contact physiotherapy service in primary care in Wales: a qualitative study

Background/Aims

Future primary care services in Wales are likely to face higher demand for musculoskeletal ailments because of an ageing population and difficulties retaining and recruiting general practitioners. First contact physiotherapists provide specialist musculoskeletal management within primary care and offer a solution to this issue; however, no studies have yet explored first contact physiotherapist services in Wales. Consequently, little is known about the experience of working as a first contact physiotherapist in Wales. The aim of this study was to explore the experiences of first contact physiotherapists in primary care in south east Wales regarding the implementation, interprofessional collaboration and the facilitators and barriers to providing the service.

Methods

A qualitative, Heideggerian hermeneutical phenomenological study was performed. A purposive sample of eleven physiotherapists were recruited for the study from an NHS health board in south east Wales, comprising three different first contact physiotherapist models. Data were collected through individual semi-structured interviews. Data analysis was conducted via a three-step format.

Results

Participants viewed the first contact physiotherapist role as positive as it represented role and career advancement. Adequate training and mentorship were not provided to support the role. Participants perceived that patients and the wider multidisciplinary team did not fully understand the role of the first contact physiotherapist. Inappropriate use of services was common, with first contact physiotherapists often acting as the second contact practitioner, leading to duplication of effort and the development of unnecessary waiting lists. The degree of interprofessional collaboration appeared to influence the clarity of the role of the first contact physiotherapist, with a reduced clarity of role in models where first contact physiotherapists were not often present. Burnout was perceived as a risk for participants with low levels of experience in advanced practice and was dependent on the model worked in. Participants perceived a lack of specific aims for the first contact physiotherapy service and ambiguity over who was responsible for service leadership, leading to inappropriate use of services.

Conclusions

Clear operational leadership and strategies to increase interprofessional collaboration are required to increase the clarity about the roled of the first contact physiotherapist and ensure service efficacy. There is a need in Wales for a professional development, mentorship and governance framework to ensure sustainability and efficacy of first contact physiotherapy services.

A Cross-Sectional Study on Attitude and Barriers to Interprofessional Collaboration in Hospitals Among Health Care Professionals

The need for an effective health personnel team is important due to the increasing complexity of patient care and increasing co-morbidities. Interprofessional collaboration (IPC) among healthcare professionals offers appropriate collaborative management for humans. This study aimed to assess the attitude and barriers to IPC in hospitals among healthcare professionals in Lahore, Pakistan. A cross-sectional study was conducted using a convenience sampling technique. Healthcare professionals (speech-language pathologists, audiologists, physiotherapists, occupational therapists, psychologists, psychiatrists, neurologists, ENT specialists, pediatricians, dentists, and nursing staff) working at Children Hospital, Shaikh Zayed Hospital, Pakistan Society for the Rehabilitation of the Disabled (PSRD), Lahore, Pakistan were included. The paper and online survey questionnaire composed in the google form and attitudes toward healthcare teams scale (ATHCT) and barriers scale toward interprofessional collaboration were used. Statistical package for the social sciences (SPSS) version 21 was used to analyze the survey data through frequency analyses and percentage distributions. Most of the respondents (response rate = 88.1%) had positive attitudes toward IPC and strongly agreed on 9 positive statements in ATHCT. Statistically, Major barriers were role and leadership ambiguity 68.6%, different goals of individual team members 68.1%, and 53.3% strongly agreed on the difference in levels of authority, power, expertise, and income. Although healthcare professionals have an optimistic attitude toward IPC, several healthcare professionals come across challenges during the practice of IPC. To overcome the analyzed barriers, the higher healthcare authorities must encourage interprofessional collaborative strategies and models.

Interprofessional Collaboration and Team Effectiveness of Pharmacists in General Practice: A Cross-National Survey

As team-based care continues to evolve, pharmacists have been included in general practice teams in many countries, to varying extents, to improve medication use and patient safety. However, evidence on interprofessional collaboration and team effectiveness of pharmacists in general practice is sparse. This study aimed to compare the extent of interprofessional collaboration and team effectiveness of general practice pharmacists in Australia with international sites (Canada and the UK), and identify the factors associated with interprofessional collaboration and team effectiveness. General practice pharmacists from Australia, Canada, and the UK were identified through professional organisations and networks, and invited to participate in an online survey, adapted from existing validated tools. The survey explored interprofessional collaboration through four sub-domains (professional interactions, relationship initiation, trust and role clarity, and commitment to collaboration) and team effectiveness of general practice pharmacists. Of the 101 respondents (26 from Australia, 44 from Canada and 31 from the UK), 79% were female and 78% were aged below 50 years. Interprofessional collaboration and team effectiveness appeared to be high and similar between countries. Total scores for collaboration of pharmacists were 86.1 ± 7.4 in Australia, 88.5 ± 7.5 in the UK, and 89.1 ± 7.3 in Canada (mean ± SD, where higher scores represent more advanced collaboration), while the team effectiveness scores of the pharmacists were 88.6 ± 14.6 in Canada, 91.8 ± 14.6 in Australia and 97.5 ± 14.0 in the UK. Pharmacists who had worked in general practice for a longer time showed advanced interprofessional collaboration while those who worked exclusively in general practice had higher scores for team effectiveness. Overall, general practice pharmacists in the three countries were highly collaborative with general practitioners. Long-term employment and longer work hours could enhance interprofessional collaboration and team effectiveness in general practice pharmacists by improving trust and working relationships over time.

Perspectives on Coordinating Health Services for Individuals with Serious Mental Illness - A Qualitative Study

PURPOSE

Individuals with serious mental illness (SMI) might require coordinated health services to meet their healthcare needs. The overall aim of this study was to describe the perspectives of professionals (registered nurses, medical doctors, social educators, and social workers) on care coordination and measures to ensure proper and coordinated follow-up of the healthcare needs of individuals with SMI. More specifically, we investigated which measures are taken by employees in municipal health and care services to prevent the deterioration of health conditions and which measures are taken in cases where deterioration occurs despite preventive efforts.

METHOD

The study comprised individual qualitative interviews with professionals employed in municipal health and care services in two Norwegian municipalities. The interview material was analyzed using systematic text condensation.

RESULTS

Three categories and seven subcategories were created in the data analysis: 1) Maintain a stable and meaningful home life, including ensuring proper housing and access to services and assistance in receiving healthcare; 2) Measures to prevent deterioration of the health condition, including close monitoring of symptoms, emergency psychiatric care plans and emergency room calls and visits; and 3) Inpatient care to stabilize acute and severe symptoms, including municipal inpatient care, returning home after inpatient care and a need for shared responsibility for treatment and care.

CONCLUSION

Professionals employed in municipal health and care services coordinate health services to ensure proper and coordinated follow-up of the healthcare needs of individuals with SMI by ensuring housing services and access to the required healthcare. Measures taken when deterioration occurs include monitoring symptoms, use of emergency psychiatric care plans, emergency room contacts, or inpatient care.

Interprofessional Identity in Health and Social Care: Analysis and Synthesis of the Assumptions and Conceptions in the Literature

Interprofessional identity (IPI) development is considered essential in reducing incongruency and improving interprofessional collaboration. However, noticeable differences in conceptualizations are being put forward in the literature, hindering interpretation of research findings and translation into practice. Therefore, a Concept Analysis and Critical Interpretative Synthesis of empirical research articles were conducted to explore the assumptions and conceptions of IPI. Independent literature screening by two researchers led to the inclusion and extraction of 39 out of 1334 articles. Through critical analysis, higher order themes were constructed and translated to a synthesizing argument and a conceptual framework depicting what constitutes IPI (attributes), the boundary conditions (antecedents) and the outcomes (consequences) of its development. The attributes refer to both IPI's structural properties and the core beliefs indicative of an interprofessional orientation. The antecedents inform us on the importance of IPI-fitting constructivist learning environments and intergroup leadership in enabling its development. This development may lead to several consequences with regard to professional wellbeing, team effectiveness and the quintuple aim. Given the educational orientation of this study, ways for facilitating and assessing the development of IPI among learners across the professional continuum have been proposed, although empirical research is needed to further validate links and mediating and moderating variables.

Can We Realize Our Collaborative Potential? A Critical Review of Faculty Roles and Experiences in Interprofessional Education

PURPOSE

Faculty within interprofessional education (IPE) are essential contributors to IPE implementation efforts. Although the majority of existing IPE literature consists of reports on IPE innovations, few insights are available into the experiences of the faculty members who deliver IPE. This critical narrative review was designed to synthesize the knowledge available about (1) roles assigned to IPE educators and (2) IPE faculty members' experiences of fulfilling these roles.

METHOD

Six databases for English-language studies published between 2000 and March 2021 were searched: PubMed, Embase, Web of Science, MEDLINE, CINAHL, PsycINFO, ERIC, and MedEdPortal. A total of 1,717 manuscripts were identified for possible inclusion. After applying inclusion/exclusion criteria, 214 articles constituted the final literature corpus. Harden and Crosby's original framework of 6 roles of medical educators augmented with the manager role introduced in Harden and Lilley's 2018 framework informed the analysis.

RESULTS

IPE faculty take on all 6 roles identified by Harden and Crosby: facilitator, planner, information provider, examiner, role model, and resource developer, as well as the manager role. Faculty were most commonly identified as facilitator and planner, and rarely as role models. The authors identified 3 main struggles experienced by IPE faculty: personal (e.g., confidence as a cross-professions educator), interpersonal (e.g., co-teaching IPE), and institutional (e.g., supporting IPE logistics).

CONCLUSIONS

This review highlights the complexity of the roles taken on by IPE faculty and the struggles they experience in the process. The results suggest that attention to the different roles that IPE faculty play in educational interventions and to equipping faculty with the necessary competencies, tools, and support, is fundamental to the success of IPE. Future research should harness the explanatory power of theories to help explain dynamics at play between personal, interpersonal, and institutional barriers to identify interventions that can aid IPE faculty in delivering collaboration-ready professionals.

Enacting primary healthcare interprofessional collaboration: a multisite ethnography of nurse practitioner integration in Ontario, Canada

Interprofessional collaboration (IPC) is known to enhance patient outcomes and satisfaction. In primary healthcare (PHC), IPC aims to transform care provision and team functioning, but its implementation is challenging and has yielded mixed results. We aimed to describe the enactment of IPC in PHC settings, particularly as it relates to nurse practitioner (NP) integration. A multisite ethnography involving 6 Canadian PHC clinics was carried out. We conducted 330 hours of direct observation, 23 semi-structured interviews with PHC NPs, informal interviews with key PHC partners, and document analysis. IPC in PHC was found to rest on human and non-human actors that interact in complex ways. Organizational mandates and remuneration models, physical spaces and schedules played a decisive role in the enactment of IPC. Power structures embedded in certain designations (i.e., most responsible provider) or NPs' commitments to physicians' practices stood in contrast with the principles of IPC. NPs enacted various role to develop, enhance, and maintain IPC. Despite shifts in PHC provision, IPC remains poorly defined and precariously sustained.

When worlds collide: Experiences of physiotherapists, chiropractors, and osteopaths working together

BACKGROUND

In Australia, people with musculoskeletal conditions frequently seek care from chiropractors, osteopaths, and physiotherapists. Intertwined histories, distinct philosophies and practical tensions characterise relationships between these three professions, yet little is known about contact or collaboration between individual clinicians.

OBJECTIVES

To explore the experiences of osteopaths, physiotherapists and chiropractors who work together in the same clinic location and explore their attitudes towards each other.

METHODS

Utilising a predominantly inductive qualitative research design, semi-structured interviews were undertaken with a total of 13 clinicians (physiotherapists [n=6], chiropractors [n=2], osteopaths [n=4], dual-qualified chiropractor and physiotherapist [n=1]) who work with at least one clinician from the other two professions. Interviews were analysed using reflexive thematic analysis.

RESULTS

Data analysis produced two main themes and five sub-themes that characterised clinicians' experiences and attitudes: collaboration (collaborative practices; benefits of collaboration) and resisting tension (accepting similarities and differences to work towards shared goals; clinic culture; alignment with evidence-based practice). These findings can be understood in the context of the concepts of professional boundary-work and intergroup contact theory.

CONCLUSIONS

The findings from this study suggest that physiotherapists, chiropractors and osteopaths that work together in the same clinic may collaborate while simultaneously navigating blurred professional lines. These results suggest that working together in the same clinic is a meaningful form of contact, which in turn allows for collaborative practices that may reduce intergroup tension between professions.

A novel perspective of Australian primary care dietetics: Insights from an exploratory study using complex adaptive systems theory

Aims

Effective quality improvement strategies are essential to enhancing outcomes of dietetic care. Interventions informed by complex adaptive systems theory have demonstrated effectiveness in other healthcare settings. This study aimed to explore primary care dietetics practice using complex adaptive systems theory and to identify factors that individuals across the healthcare system can examine and address to improve the quality of dietetic care.

Methods

Qualitative analysis of semi‐structured interviews of healthcare consumers and professionals involved in the provision of dietetic care. Data collection and analysis was guided by a complexity‐informed conceptual framework. The Framework Method was used to code transcripts and identify themes describing primary care dietetics.

Results

Twenty‐three consumers and 26 primary care professionals participated. Participants described dietetic care as being delivered by individuals organised into formal and informal systems that were influenced by the wider environment, including legal, economic, and socio‐cultural systems. Dietitians described interactions with consumers as a learning opportunity and sought education, mentoring, or supervision to address knowledge and skill gaps. Relationships underpinned transfer of information between individuals.

Conclusion

Complex adaptive systems theory proved to be a useful conceptual framework for primary care dietetics. Factors identified at the macro (e.g., funding), meso (e.g., professional networks), and micro (e.g., consumer education) levels should be examined and addressed to improve the quality of dietetic care.

Interprofessional Collaboration and Diabetes Management in Primary Care: A Systematic Review and Meta-Analysis of Patient-Reported Outcomes

The global spread of diabetes poses serious threats to public health requiring a patient-centered approach based both on interprofessional collaboration (IPC) given by the cooperation of several different health professionals, and patients’ perspective through the assessment of Patient-Reported Outcomes (PROs). The aim of the present study is to evaluate the impact of interprofessional collaboration interventions, for the management of type 2 diabetes in primary care settings, through PROs. A systematic review and meta-analysis was conducted querying the PubMed, Scopus and Embase databases. Out of the 1961 papers initially retrieved, 19 met the inclusion criteria. Interprofessional collaboration is significantly associated with an increase in both patient’s satisfaction (SMD 0.32 95% CI 0.05–0.59) and in the mental well-being component of the HRQoL (SMD 0.18; 95% CI 0.06–0.30), and there was also promising evidence supporting the association between an interprofessional approach and an increase in self-care and in generic and specific quality-of-life. No statistical differences were found, supporting the positive impact on IPC interventions on the physical component of the HRQoL, depression, emotional distress, and self-efficacy. In conclusion, the effect of IPC impacts positively on the few areas assessed by PROMs. Policymakers should promote the widespread adoption of a collaborative approach as well as to endorse an active engagement of patients across the whole process of care.

[Interprofessional Collaboration in Health Care]

Interprofessional Collaboration in Health Care Abstract. Interprofessional collaboration is a hallmark of good and efficient patient care, where several healthcare professionals put their competencies together to care for patients. Interprofessional education is a necessary first step to prepare the different professions for collaborations in their later professional practices. Shared training courses help to empower collaborative healthcare teams so they can respond in an adapted and effective way to individual and local health needs.

Re-evaluation of the interprofessional collaboration scale validation between nurses towards other health care professionals occupied in Italian emergency medical services

BACKGROUND AND AIM

Interprofessional collaboration (IPC) between health professionals is fundamental for the provision of an efficient and effective medical care service. This is especially so in states of emergency, as highlighted by the ongoing coronavirus disease 2019 pandemic. This study aimed to obtain further evidence regarding the validity and reliability of the Italian language IPC scale -an instrument for measuring interprofessional collaboration- in a setting that has yet to be investigated at an in-depth level: the emergency departments in Italian hospitals.

METHODS

The survey tool was a structured questionnaire in the Italian language. It comprised the validated Italian version of the IPC scale plus a question concerning the frequency of collaborations between the nurses interviewed and other health professionals. Confirmatory factor analysis was applied to rate the three factors ("communication", "accommodation" and "isolation") that compose the scale.

RESULTS

Four hundred thirty-six nurses working in an emergency department for at least one year completed the questionnaire, which assessed collaboration with other health professionals working in the same department. The model fit statistics are satisfactory for all the nurse-target group combinations analysed. Regarding the Cronbach's alpha statistic used to compute the reliability of the scale, acceptable values were obtained for all items, except for those related to the isolation factor for each case of interprofessional collaboration considered.

CONCLUSIONS

The results confirm the validity of the IPC scale as an instrument for the assessment of interprofessional collaboration involving nurses and other workers occupied in the provision of healthcare in Italian emergency departments.