1
|
Grant A, Kontak J, Jeffers E, Lawson B, MacKenzie A, Burge F, Boulos L, Lackie K, Marshall EG, Mireault A, Philpott S, Sampalli T, Sheppard-LeMoine D, Martin-Misener R. Barriers and enablers to implementing interprofessional primary care teams: a narrative review of the literature using the consolidated framework for implementation research. BMC PRIMARY CARE 2024; 25:25. [PMID: 38216867 PMCID: PMC10785376 DOI: 10.1186/s12875-023-02240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 12/11/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Interprofessional primary care teams have been introduced across Canada to improve access (e.g., a regular primary care provider, timely access to care when needed) to and quality of primary care. However, the quality and speed of team implementation has not kept pace with increasing access issues. The aim of this research was to use an implementation framework to categorize and describe barriers and enablers to team implementation in primary care. METHODS A narrative review that prioritized systematic reviews and evidence syntheses was conducted. A search using pre-defined terms was conducted using Ovid MEDLINE, and potentially relevant grey literature was identified through ad hoc Google searches and hand searching of health organization websites. The Consolidated Framework for Implementation Research (CFIR) was used to categorize barriers and enablers into five domains: (1) Features of Team Implementation; (2) Government, Health Authorities and Health Organizations; (3) Characteristics of the Team; (4) Characteristics of Team Members; and (5) Process of Implementation. RESULTS Data were extracted from 19 of 435 articles that met inclusion/exclusion criteria. Most barriers and enablers were categorized into two domains of the CFIR: Characteristics of the Team and Government, Health Authorities, and Health Organizations. Key themes identified within the Characteristics of the Team domain were team-leadership, including designating a manager responsible for day-to-day activities and facilitating collaboration; clear governance structures, and technology supports and tools that facilitate information sharing and communication. Key themes within the Government, Health Authorities, and Health Organizations domain were professional remuneration plans, regulatory policy, and interprofessional education. Other key themes identified in the Features of Team Implementation included the importance of good data and research on the status of teams, as well as sufficient and stable funding models. Positive perspectives, flexibility, and feeling supported were identified in the Characteristics of Team Members domain. Within the Process of Implementation domain, shared leadership and human resources planning were discussed. CONCLUSIONS Barriers and enablers to implementing interprofessional primary care teams using the CFIR were identified, which enables stakeholders and teams to tailor implementation of teams at the local level to impact the accessibility and quality of primary care.
Collapse
Affiliation(s)
- Amy Grant
- Maritime SPOR Support Unit, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Julia Kontak
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Elizabeth Jeffers
- Maritime SPOR Support Unit, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Building Research for Integrated Primary Care, Halifax, Nova Scotia, Canada
| | - Adrian MacKenzie
- Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Building Research for Integrated Primary Care, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR Support Unit, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Kelly Lackie
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emily Gard Marshall
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Building Research for Integrated Primary Care, Halifax, Nova Scotia, Canada
| | - Amy Mireault
- Maritime SPOR Support Unit, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Susan Philpott
- Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | | | | | - Ruth Martin-Misener
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.
| |
Collapse
|
2
|
Kokorelias KM, Grosse A, Zhabokritsky A, Walmsley SL, Sirisegaram L. Exploring implementation considerations for geriatric-HIV clinics: A secondary analysis from a scoping review on HIV models of geriatric care. HIV Med 2024; 25:38-59. [PMID: 37794607 DOI: 10.1111/hiv.13549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES This review aimed to map the current state of knowledge regarding the implementation considerations of existing geriatric-HIV models of care, to identify areas of further research and to inform the implementation of future geriatric-HIV interventions that support older adults living with HIV. METHODS We conducted a scoping review that was methodologically informed by the Arskey and O'Malley's 5 step framework and theoretically informed by the Consolidated Framework for Implementation Research (CFIR). A systematic search of six databases was conducted for peer-reviewed literature. The grey literature was also searched. Article screening was performed in duplicate. Data was extracted for the purpose of this secondary analysis using a data extraction template informed by the CFIR. Data was inductively and deductively analyzed. RESULTS In total, 11 articles met the inclusion criteria. The models of care described varied in terms of their location and setting, the number and type of care providers involved, the mechanism of patient referral, the type of assessments and interventions performed and the methods of longitudinal patient follow-up. Four key categories emerged to describe factors that influenced their implementation: care provider buy-in, patient engagement, mechanisms of communication and collaboration, and available resources. CONCLUSIONS The findings from this scoping review provide an initial understanding of the key factors to consider when implementing geriatric-HIV models of care. We recommend health system planners consider mechanisms of communication and collaboration, opportunities for care provider buy-in, patient engagement and available resources. Future research should explore implementation in more diverse settings to understand the nuances that influence implementation and care delivery.
Collapse
Affiliation(s)
- Kristina Marie Kokorelias
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anna Grosse
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alice Zhabokritsky
- Department of Medicine, The University of Toronto, Toronto, Ontario, Canada
- Infectious Diseases, Department of Medicine, University Health Network, Toronto, Ontario, Canada
- CIHR Canadian HIV Trails Network, Vancouver, British Columbia, Canada
| | - Sharon L Walmsley
- Department of Medicine, The University of Toronto, Toronto, Ontario, Canada
- Infectious Diseases, Department of Medicine, University Health Network, Toronto, Ontario, Canada
- CIHR Canadian HIV Trails Network, Vancouver, British Columbia, Canada
| | - Luxey Sirisegaram
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Carter C, Mohammed S, Upshur R, Kontos P. "I don't see the whole picture of their health": a critical ethnography of constraints to interprofessional collaboration in end-of-life conversations in primary care. BMC PRIMARY CARE 2023; 24:225. [PMID: 37898764 PMCID: PMC10612350 DOI: 10.1186/s12875-023-02171-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/04/2023] [Indexed: 10/30/2023]
Abstract
CONTEXT Interprofessional collaboration is recommended in caring for frail older adults in primary care, yet little is known about how interprofessional teams approach end-of-life (EOL) conversations with these patients. OBJECTIVE To understand the factors shaping nurses' and allied health clinicians' involvement, or lack of involvement in EOL conversations in the primary care of frail older adults. METHODS/SETTING A critical ethnography of a large interprofessional urban Family Health Team in Ontario, Canada. Data production included observations of clinicians in their day-to-day activities excluding direct patient care; one-to-one semi-structured interviews with clinicians; and document review. Analysis involved coding data using an interprofessional collaboration framework as well as an analysis of the normative logics influencing practice. PARTICIPANTS Interprofessional clinicians (n = 20) who cared for mildly to severely frail patients (Clinical Frailty Scale) at the Family Health Team. RESULTS Findings suggest primary care nurses and allied health clinicians have the knowledge, skills, and inclination to engage frail older adults in EOL conversations. However, the culture of the clinic prioritizes biomedical care, and normalizes nurses and allied health clinicians providing episodic task-based care, which limits the possibility for these clinicians' engagement in EOL conversations. The barriers to nurses' and allied health clinicians' involvement in EOL conversations are rooted in neoliberal-biomedical ideologies that shapes the way primary care is governed and practiced. CONCLUSIONS Our findings help to explain why taking an individual-level approach to addressing the challenge of delayed or avoided EOL conversations, is unlikely to result in practice change. Instead, primary care teams can work to critique and redevelop quality indicators and funding models in ways that promote meaningful interprofessional practice that recognize the expertise of nursing and allied health clinicians in providing high quality primary care to frail older patients, including EOL conversations.
Collapse
Affiliation(s)
- Celina Carter
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Shan Mohammed
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Ross Upshur
- Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Pia Kontos
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| |
Collapse
|
4
|
Aggarwal M, Hutchison B, Kokorelias KM, Mehta K, Greenberg L, Moran K, Barber D, Samson K. Impact of remuneration, extrinsic and intrinsic incentives on interprofessional primary care teams: protocol for a rapid scoping review. BMJ Open 2023; 13:e072076. [PMID: 37336539 DOI: 10.1136/bmjopen-2023-072076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
INTRODUCTION Interprofessional teams and funding and payment provider arrangements are key attributes of high-performing primary care. Several Canadian jurisdictions have introduced team-based models with different payment models. Despite these investments, the evidence of impact is mixed. This has raised questions about whether team-based primary care models are being implemented to facilitate team collaboration and effectiveness. Thus, we present a protocol for a rapid scoping review to systematically map, synthesise and summarise the existing literature on the impact of provider remuneration mechanisms and extrinsic and intrinsic incentives in team-based primary care. This review will answer three research questions: (1) What is the impact of provider remuneration models on team, patient, provider and system outcomes in primary care?; (2) What extrinsic and intrinsic incentives have been used in interprofessional primary care teams?; and (3) What is the impact of extrinsic and intrinsic team-based incentives on team, patient, provider and system outcomes? METHODS AND ANALYSIS We will conduct a rapid scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. We will search electronic databases (Medline, Embase, CINAHL, PsycINFO, EconLit) and grey literature sources (Google Scholar, Google). This review will consider all empirical studies and full-text English-language articles published between 2000 and 2022. Reviewers will independently perform the literature search, data extraction and synthesis of included studies. The Mixed Methods Appraisal Tool will be used to appraise the quality of evidence. The literature will be synthesised, summarised and mapped to themes that answer the research question of this review. ETHICS AND DISSEMINATION Ethics approval is not required. Findings from this study will be written for publication in an open-access peer-review journal and presented at national and international conferences. Knowledge users are part of the research team and will assist with disseminating findings to the public, clinicians, funders and professional associations.
Collapse
Affiliation(s)
- Monica Aggarwal
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Brian Hutchison
- Department of Family Medicine, Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Kristina Marie Kokorelias
- Department of Geriatric Medicine, Sinai Health and University Health Network, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute and Department of Occupational Therapy and Occupational Sciences, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Kavita Mehta
- Association of Family Health Teams of Ontario, Toronto, Ontario, Canada
| | | | - Kimberly Moran
- Ontario College of Family Physicians, Toronto, Ontario, Canada
| | - David Barber
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Kevin Samson
- East Wellington Family Health Team, Erin/Rockwood, Ontario, Canada
| |
Collapse
|
5
|
Rakvaag H, Kjome RLS, Elisabeth Søreide G. Power dynamics and interprofessional collaboration: How do community pharmacists position general practitioners, and how do general practitioners position themselves? J Interprof Care 2023:1-8. [PMID: 36597594 DOI: 10.1080/13561820.2022.2148637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 01/05/2023]
Abstract
Power differentials and medical dominance can negatively affect collaboration between physicians and pharmacists. Norway is recognized as having a relatively egalitarian work sector, which could affect power differentials. In this qualitative study, we used positioning theory as a framework to explore the aspect of power dynamics between Norwegian general practitioners (GPs) and community pharmacists. We used the concepts of reflexive and interactive positioning to identify how GPs positioned themselves and how they were positioned by pharmacists in six focus groups. Data were analyzed using systematic text condensation. We found positioning theory to be a useful lens through which to study power dynamics in relation to collaboration between community pharmacists and GPs. Our findings imply that the presence of medical dominance poses challenges even in an egalitarian Norwegian setting. However, although both GPs and pharmacists draw on a 'medical dominance' storyline, we have also identified how both pharmacists and GPs draw on alternative and promising storylines of collaboration between the two professions.
Collapse
Affiliation(s)
- Hilde Rakvaag
- Department of Global Public Health and Primary care/Centre for Pharmacy, University of Bergen, Bergen, Norway
| | - Reidun Lisbet Skeide Kjome
- Department of Global Public Health and Primary care/Centre for Pharmacy, University of Bergen, Bergen, Norway
| | | |
Collapse
|
6
|
Mathews M, Spencer S, Hedden L, Lukewich J, Poitras ME, Marshall EG, Brown JB, Sibbald S, Norful AA. The impact of funding models on the integration of registered nurses in primary health care teams: protocol for a multi-phase mixed-methods study in Canada. BMC PRIMARY CARE 2022; 23:290. [PMID: 36402965 PMCID: PMC9675973 DOI: 10.1186/s12875-022-01900-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Family practice registered nurses co-managing patient care as healthcare professionals in interdisciplinary primary care teams have been shown to improve access, continuity of care, patient satisfaction, and clinical outcomes for patients with chronic diseases while being cost-effective. Currently, however, it is unclear how different funding models support or hinder the integration of family practice nurses into existing primary health care systems and interdisciplinary practices. This has resulted in the underutilisation of family practice nurses in contributing to high-quality patient care. METHODS This mixed-methods project is comprised of three studies: (1) a funding model analysis; (2) case studies; and (3) an online survey with family practice nurses. The funding model analysis will employ policy scans to identify, describe, and compare the various funding models used in Canada to integrate family practice nurses in primary care. Case studies involving qualitative interviews with clinic teams (family practice nurses, physicians, and administrators) and family practice nurse activity logs will explore the variation of nursing professional practice, training, skill set, and team functioning in British Columbia, Nova Scotia, Ontario, and Quebec. Interview transcripts will be analysed thematically and comparisons will be made across funding models. Activity log responses will be analysed to represent nurses' time spent on independent, dependent, interdependent, or non-nursing work in each funding model. Finally, a cross-sectional online survey of family practice nurses in Canada will examine the relationships between funding models, nursing professional practice, training, skill set, team functioning, and patient care co-management in primary care. We will employ bivariate tests and multivariable regression to examine these relationships in the survey results. DISCUSSION This project aims to address a gap in the literature on funding models for family practice nurses. In particular, findings will support provincial and territorial governments in structuring funding models that optimise the roles of family practice nurses while establishing evidence about the benefits of interdisciplinary team-based care. Overall, the findings may contribute to the integration and optimisation of family practice nursing within primary health care, to the benefit of patients, primary healthcare providers, and health care systems nationally.
Collapse
Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, 1465 Richmond Street, Second Floor, Rm 2140, London, ON, Canada, N6G 2M1.
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, BC, Burnaby, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, BC, Burnaby, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, St John's, NL, Canada
| | - Marie-Eve Poitras
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, 1465 Richmond Street, Second Floor, Rm 2140, London, ON, Canada, N6G 2M1
| | - Shannon Sibbald
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, 1465 Richmond Street, Second Floor, Rm 2140, London, ON, Canada, N6G 2M1
| | | |
Collapse
|
7
|
Canny A, Donaghy E, Murray V, Campbell L, Stonham C, Bush A, McKinstry B, Milne H, Pinnock H, Daines L. Patient views on asthma diagnosis and how a clinical decision support system could help: A qualitative study. Health Expect 2022; 26:307-317. [PMID: 36370457 PMCID: PMC9854294 DOI: 10.1111/hex.13657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/22/2022] [Accepted: 10/23/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Making a diagnosis of asthma can be challenging for clinicians and patients. A clinical decision support system (CDSS) for use in primary care including a patient-facing mode, could change how information is shared between patients and healthcare professionals and improve the diagnostic process. METHODS Participants diagnosed with asthma within the last 5 years were recruited from general practices across four UK regions. In-depth interviews were used to explore patient experiences relating to their asthma diagnosis and to understand how a CDSS could be used to improve the diagnostic process for patients. Interviews were audio recorded, transcribed verbatim and analysed using a thematic approach. RESULTS Seventeen participants (12 female) undertook interviews, including 14 individuals and 3 parents of children with asthma. Being diagnosed with asthma was generally considered an uncertain process. Participants felt a lack of consultation time and poor communication affected their understanding of asthma and what to expect. Had the nature of asthma and the steps required to make a diagnosis been explained more clearly, patients felt their understanding and engagement in asthma self-management could have been improved. Participants considered that a CDSS could provide resources to support the diagnostic process, prompt dialogue, aid understanding and support shared decision-making. CONCLUSION Undergoing an asthma diagnosis was uncertain for patients if their ideas and concerns were not addressed by clinicians and were influenced by a lack of consultation time and limitations in communication. An asthma diagnosis CDSS could provide structure and an interface to prompt dialogue, provide visuals about asthma to aid understanding and encourage patient involvement. PATIENT AND PUBLIC CONTRIBUTION Prespecified semistructured interview topic guides (young person and adult versions) were developed by the research team and piloted with members of the Asthma UK Centre for Applied Research Patient and Public Involvement (PPI) group. Findings were regularly discussed within the research group and with PPI colleagues to aid the interpretation of data.
Collapse
Affiliation(s)
- Anne Canny
- Asthma UK Centre for Applied Research, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Eddie Donaghy
- Asthma UK Centre for Applied Research, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Victoria Murray
- Asthma UK Centre for Applied Research, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Leo Campbell
- Asthma UK Centre for Applied Research, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Carol Stonham
- NHS Gloucestershire Clinical Commissioning GroupGloucesterUK,Primary Care Respiratory Society (PCRS)KnowleUK
| | - Andrew Bush
- Imperial Centre for Paediatrics and Child Health and National Heart and Lung InstituteImperial CollegeLondonUK,Department of Paediatric Respiratory MedicineRoyal Brompton HospitalLondonUK
| | - Brian McKinstry
- Centre for Population and Health Sciences, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Heather Milne
- South East GP UnitNHS Education for ScotlandEdinburghUK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Luke Daines
- Asthma UK Centre for Applied Research, Usher InstituteUniversity of EdinburghEdinburghUK
| |
Collapse
|
8
|
Baes S, Horlait M, Dhaene S, Leys M. Physicians’ attitudes and perspectives regarding the uptake of psychosocial aspects and/or patient preferences during multidisciplinary team meetings in oncology. INTERNATIONAL JOURNAL OF CARE COORDINATION 2020. [DOI: 10.1177/2053434520959678] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction Coordinating cancer care is challenging because of its complexity. To partly encounter this complexity, multidisciplinary team meetings (MDTMs) were implemented to evaluate diagnosis, discuss treatment options and collectively decide upon the most optimal patient care and treatment plan. In cancer trajectories, medical professionals have a coordinating role and final decision responsibility. As a consequence patient-centred non-biomedical information are easily overlooked during discussions in MDTMs. This study aims to uncover physicians’ perceived barriers regarding the uptake of psychosocial aspects and/or patient preferences in the cancer treatment decision-making process during Multidisciplinary Oncology Consultations (MOCs), a specific type of MDTM in Belgium. Methods Between March 2019 and May 2019 semi-structured interviews were conducted with twenty medical professionals specialized in oncology. Grounded theory principles were used to detect and classify perceived barriers and patterns emerging regarding the uptake of psychosocial information in the cancer treatment decision-making process. Results Although physicians showed an open attitude towards taking into account psychosocial aspects and patient preferences in treatment decisions, the majority of respondents is not convinced the MOC is the best place to discuss these aspects. Physicians reported organisational, work process, and health system related barriers. Discussion The MOC emerges as a medicalized form of team discussion that, in its current form, does not reach its objective of truly integrated multidisciplinarity as cancer care is demanding. The working practices of the MOC can be optimized to evolve towards a truly interdisciplinary approach.
Collapse
Affiliation(s)
- S Baes
- Vrije Universiteit Brussel, Belgium
| | | | - S Dhaene
- AZ Sint-Elisabeth Ziekenhuis, Belgium
| | - M Leys
- Vrije Universiteit Brussel, Belgium
| |
Collapse
|
9
|
Mathews M, Ryan D, Buote R, Parsons S, Lukewich J. A qualitative study exploring the influence of clinic funding on the integration of family practice nurses in Newfoundland and Labrador. Nurs Open 2020; 7:1067-1073. [PMID: 33346409 PMCID: PMC8262484 DOI: 10.1002/nop2.477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/25/2020] [Indexed: 11/30/2022] Open
Abstract
AIM This study explores the contributions of family practice nurses in primary care across Newfoundland and Labrador funded by fee-for-service and alternate payment plans to examine the influence of funding arrangements on nursing roles/activities. DESIGN A qualitative descriptive design was employed. METHODS Semi-structured telephone interviews were conducted between March-July 2018 with physicians and Registered Nurses working in primary care settings in Newfoundland and Labrador. Interviews were transcribed verbatim, and a content analysis approach was used to identify recurring themes. RESULTS Clinic funding was instrumental in the integration of family practice nurses into primary care settings and influenced roles/activities. In fee-for-service practices, nurses work with physicians and focus on one-on-one patient care in office-based settings, whereas nurses in alternate payment plans practices work more independently, in a wider range of settings and with emphasis on both individual and group-based encounters. Compared with alternate payment plans practices, fee-for-service practices tend to be more restrictive due to physician billing requirements.
Collapse
Affiliation(s)
- Maria Mathews
- Department of Family MedicineSchulich School of Medicine & DentistryWestern UniversityLondonONCanada
| | - Dana Ryan
- Faculty of NursingMemorial UniversitySt. John'sNLCanada
| | - Richard Buote
- Division of Community Health and HumanitiesMemorial UniversitySt. John'sNLCanada
| | - Sandra Parsons
- Department of HealthGovernment of Newfoundland and LabradorSt. John'sNLCanada
| | | |
Collapse
|
10
|
Dellafiore F, Caruso R, Conte G, Grugnetti AM, Bellani S, Arrigoni C. Individual-level determinants of interprofessional team collaboration in healthcare. J Interprof Care 2019; 33:762-767. [PMID: 31006297 DOI: 10.1080/13561820.2019.1594732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Interprofessional team collaboration (ITC) is pivotal for the safety and the quality of healthcare settings, being associated with higher staff and patient satisfaction. However, individual-level determinants (i.e. socio-demographic and working satisfaction) remain currently largely unexplored. This study aimed to describe the overall ITC (i.e. partnership, cooperation, coordination), identifying the individual-level determinants of each ITC domain. This study had a multicentre approach, using cross-sectional data collection. ITC was assessed using the Interprofessional Team Collaboration Scale II, Italian version (I-AITCS II). The determinants of ITC were investigated through multivariable linear regression models. The study results showed significant associations between the same ITC domains, as well as the important role of work satisfaction in determining cooperation and coordination. Physicians reported more inadequate partnership levels than other healthcare professionals. This study provides insights for future research and gives a useful description of the determinants of ITC for multi-stakeholder healthcare organizations.
Collapse
Affiliation(s)
- Federica Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gianluca Conte
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Simona Bellani
- Orthopedics and traumatology Unit, ASST Monza, Monza, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| |
Collapse
|