Processes of patient-centred care in Family Health Teams: a qualitative study

Strengthening Primary Healthcare in Jordan for Achieving Universal Health Coverage: A Need for Family Health Team Approach

Achieving Universal Health Coverage (UHC) is a strategic objective of the Jordanian government and has been prioritized in its strategies and plans. However, there are several challenges affecting primary healthcare in Jordan and the health system in general that prevent Jordan from achieving UHC. This paper highlights the importance of team-based care in the form of Family Health Teams (FHTs) to realize Jordan's goal of achieving UHC. FHTs are a team-based approach that brings together diverse professionals to provide a comprehensive, efficient, patient-centered primary care system that meets the changing needs of Jordan's population and refugees. However, the implementation of FHT may encounter obstacles, including individual, organizational, institutional, and external barriers. To overcome such obstacles, several actions and processes need to be taken, including political commitment and leadership, implementing good governance and policy frameworks, allocating resources and funding, multisectoral collaboration, and engagement of communities and stakeholders. The successful implementation of FHTs requires participation from government officials, parliamentarians, civil society, and influential community, religious, and business leaders. A strategic policy framework, effective oversight, coalition building, regulation, attention to system design, and accountability are also essential. In conclusion, adopting the FHT approach in Jordan's Primary Healthcare system offers a promising path towards achieving UHC, improving healthcare access, quality, and efficiency while addressing the unique challenges faced by the country's healthcare system.

People-centred primary health care: a scoping review

BACKGROUND

Integrated people-centred health services (IPCHS) are vital for ensuring comprehensive care towards achieving universal health coverage (UHC). The World Health Organisation (WHO) envisions IPCHS in delivery and access to health services. This scoping review aimed to synthesize available evidence on people-centred primary health care (PHC) and primary care.

METHODS

We conducted a scoping review of published literature on people-centred PHC. We searched eight databases (PubMed, Scopus, Embase, CINAHL, Cochrane, PsycINFO, Web of Science, and Google Scholar) using search terms related to people-centred and integrated PHC/primary care services. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist to select studies. We analyzed data and generated themes using Gale's framework thematic analysis method. Themes were explained under five components of the WHO IPCHS framework.

RESULTS

A total of fifty-two studies were included in the review; most were from high-income countries (HICs), primarily focusing on patient-centred primary care. Themes under each component of the framework included: engaging and empowering people and communities (engagement of community, empowerment and empathy); strengthening governance and accountability (organizational leadership, and mutual accountability); reorienting the model of care (residential care, care for multimorbidity, participatory care); coordinating services within and across sectors (partnership with stakeholders and sectors, and coordination of care); creating an enabling environment and funding support (flexible management for change; and enabling environment).

CONCLUSIONS

Several people-centred PHC and primary care approaches are implemented in HICs but have little priority in low-income countries. Potential strategies for people-centred PHC could be engaging end users in delivering integrated care, ensuring accountability, and implementing a residential model of care in coordination with communities. Flexible management options could create an enabling environment for strengthening health systems to deliver people-centred PHC services.

Coordination between Primary Care Teams and Family Health Support Units and influence on Primary Care delivery

This article aims to compare the implementation of coordinated actions by family health/primary care (FH/PC) teams and extended family health and primary care units (NASF-ABs) in the Northeast and rest of Brazil, and the influence of implementation on collaborative working. The independent variables were 19 coordinated actions assessed by Module II of the 3rd Cycle of the National Program for Improving Primary Care Access and Quality (PMAQ-AB). The three collaborative working outcomes were "FH/PC team readiness to work jointly with the NASF-AB", "support received by the FH/PC team from the NASF-AB", and "The NASF-AB's contribution to resolving patients" needs. The implementation of coordinated actions by the Northeast and at national level was compared using the two-proportions z-test and the influence of these actions on the outcomes was assessed using hierarchical linear regression models: The Northeast implemented more actions that at national level (p<0.05). The implemented actions that had the most positive influence on the three outcomes were "Case conferences", "Joint development of singular therapy plans for complex cases", "Shared appointments" and "Results monitoring". The Northeast implemented more actions and the implemented actions had a positive influence on collaborative working.

Team-based care Evaluation and Adoption Model (TEAM) Framework: Supporting the comprehensive evaluation of primary care transformation over time

OBJECTIVE

To introduce the new Team-based care Evaluation and Adoption Model (TEAM) Framework.

QUALITY OF EVIDENCE

The initial TEAM Framework was derived from a series of reviews and consultations with academic and clinical experts. In a parallel process, team-based primary and community care evaluation in Canada was assessed through a structured review of academic literature, followed by a review of policy literature of existing primary care evaluation frameworks.

MAIN MESSAGE

The review of academic articles alongside an analysis of policy documents and existing evaluation frameworks in primary care resulted in the development of the 10-dimension TEAM Framework.

CONCLUSION

Primary care transformation requires evaluation over time. The TEAM Framework provides a comprehensive framework for assessing evidence needed to support short- and long-term actionable improvements for team-based primary and community care in Canada. This framework will inform the development of an evaluation tool kit for primary care teams.

Patient perspectives on quality of care for depression and anxiety in primary health care teams: A qualitative study

BACKGROUND

Widespread policy reforms in Canada, the United States and elsewhere over the last two decades strengthened team models of primary care by bringing together family physicians and nurse practitioners with a range of mental health and other interdisciplinary providers. Understanding how patients with depression and anxiety experience newer team-based models of care delivery is essential to explore whether the intended impact of these reforms is achieved, identify gaps that remain and provide direction on strengthening the quality of mental health care.

OBJECTIVE

The main study objective was to understand patients' perspectives on the quality of care that they received for anxiety and depression in primary care teams.

METHODS

This was a qualitative study, informed by constructivist grounded theory. We conducted focus groups and individual interviews with primary care patients about their experiences with mental health care. Focus groups and individual interviews were recorded and transcribed verbatim. Grounded theory guided an inductive analysis of the data.

RESULTS

Forty patients participated in the study: 31 participated in one of four focus groups, and nine completed an individual interview. Participants in our study described their experiences with mental health care across four themes: accessibility, technical care, trusting relationships and meeting diverse needs.

CONCLUSION

Greater attention by policymakers is needed to strengthen integrated collaborative practices in primary care so that patients have similar access to mental health services across different primary care practices, and smoother continuity of care across sectors. The research team is comprised of individuals with lived experience of mental health who have participated in all aspects of the research process.

How is the medical assistance in dying (MAID) process carried out in Nova Scotia, Canada? A qualitative process model flowchart study

OBJECTIVES

The aims of this study are: (1) to create a flowchart process model of how medical assistance in dying (MAID) occurs in Nova Scotia (NS), Canada and (2) to detail how NS healthcare professionals are involved in each stage of MAID. The research questions are: how is the MAID process carried out and which professionals are involved at which points? and which roles and activities do professionals carry out during MAID?

DESIGN

Qualitative process model flowchart study with semistructured interviews.

SETTING

Primary and secondary care in NS, Canada.

PARTICIPANTS

Thirty-two interviewees self-selected to participate (12 physicians, 3 nurse practitioners (NP), 6 nurses, 6 pharmacists and 5 healthcare administrators and advocates). Participants were included if they conduct assessments, provide MAID, fill prescriptions, insert the intravenous lines, organise care and so on.

RESULTS

The flowchart process model details five stages of how MAID occurs in NS: (1) starting the MAID process, (2) MAID assessments, (3) MAID preparation (hospital in-patient, hospital outpatient, non-hospital), (4) day of MAID and (5) post-MAID (hospital in-patient and outpatient, non-hospital, after leaving setting). Nineteen points where the process could stop or be delayed were identified. MAID differs slightly by location and multiple professionals from different organisations are involved at different points. Some physicians and NP provide MAID for free as they cannot be reimbursed or find it too difficult to be reimbursed.

CONCLUSIONS

Our study adds knowledge about the MAID activities and roles of NS professionals, which are not documented in the international literature. Clinicians and pharmacists spend significant additional time to participate, raising questions about MAID's sustainability and uncompensated costs. The process model flowchart identifies where MAID can stop or be delayed, signalling where resources, training and relationship-building may need to occur. Knowing where potential delays can occur can help clinicians, administrators and policymakers in other jurisdictions improve MAID.

Primary care teams' experiences of delivering mental health care during the COVID-19 pandemic: a qualitative study

Background

Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams’ delivery of mental health care.

Methods

A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis.

Results

We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers.

Conclusions

From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care’s capacity for mental health care for the duration of the pandemic and beyond.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01496-8.

It starts with a strong foundation: constructing collaborative interprofessional teams in primary health care

The purpose of this qualitative study was to explore how team members experience and enact interprofessional teamwork in primary health care (PHC). Fifty-three participants (from eight teams), members of the Association of Family Health Teams of Ontario (AFHTO), were interviewed; interviews were audiotaped and transcribed verbatim. The data analyses used an iterative process with individual and team analysis. Findings revealed components that comprise the foundation and pillars of collaborative interprofessional teamwork in PHC. First, participants described a shared philosophsy of teamwork with six elements: values, vision, and mission; collaboration; communication; trust; respect and team members that 'fit.' Second, findings revealed three 'pillars.' The first pillar, leadership, included the elements of specific leadership attributes, such as leaders encouraging teamwork, mitigating conflict, and facilitating change. In the second pillar, participants described three elements of team building: formal and informal team building activities plus how these activities benefited both the team and patient care. The last pillar, optimizing scope of practice, included the elements of recognizing, appreciating, utilizing, and expanding team members' scope of practice. While each component and their concomitant elements can be enacted individually, collectively applying all elements produces collaborative interprofessional teamwork in primary health care.

Perspectives of specialists and family physicians in interprofessional teams in caring for patients with multimorbidity: a qualitative study

BACKGROUND

Patients with multimorbidity often require services across different health care settings, yet team processes among settings are rarely implemented. We explored perceptions of specialists and family physicians collaborating in a telemedicine interprofessional consultation for patients with multimorbidity to better understand the value of bringing physicians together across the boundaries of health care settings.

METHODS

This was a descriptive qualitative, interview-based study. Physicians who had previously participated in the Telemedicine Interprofessional Model of Practice for Aging and Complex Treatments (Telemedicine IMPACT Plus [TIP] Program) were invited to participate and asked to describe their experience of being a member of the program. Interviews were conducted from March to May 2016. We conducted an iterative and interpretive process using both individual and team analysis to identify themes.

RESULTS

There were 15 participants, 9 specialists and 6 family physicians. Three themes emerged in the analysis: creating new perspectives on care for patients with multimorbidity by sharing knowledge, skills and attitudes; the shift from a consultant model to an interprofessional team model (allowing a window into the community, extending discussions beyond the medical model and focusing on the patient's health in context); and opportunities for learners, including learning about interprofessional collaboration and gaining exposure to a real-world model for caring for people with multimorbidity in outpatient settings.

INTERPRETATION

Family physicians and specialists participating in a TIP Program believed the program improved their knowledge and skills, while also serving as an effective care delivery strategy. The findings also support that learners require more exposure to nontraditional consultant models in order to care for patients with multimorbidity effectively.

Association between person-centredness and financially driven postponement of care in European primary care: a cross-sectional multicountry study

BACKGROUND

Previous research has shown that person-centred care has beneficial effects on several health-related outcomes. We investigated the association between a general practitioner's person-centred attitude and financially driven postponement of care in European countries.

METHODS

In this cross-sectional study, data were collected within the Quality and Costs of Primary Care in Europe study, which included 69 201 patients and 7183 general practitioners from 31 European countries (all 27 European Union member states, 2 candidate states [former Yugoslav Republic of Macedonia and Turkey], Norway and Switzerland). Financially driven postponement of care was measured by asking patients whether they had postponed care for financial reasons in the previous 12 months. We constructed a variable for person-centredness using a previously published conceptual framework: 1) exploring both the disease and the illness experience, 2) understanding the whole person, 3) finding common ground and 4) enhancing the patient-physician relationship. We analyzed the data using multilevel logistic regression modelling, adjusting for the strength of a country's primary care system.

RESULTS

Having a low income was associated with higher financially driven postponement of care. General practitioners with a person-centred attitude were associated with lower rates of financially driven postponement among their patients. An increase in general practitioners' person-centredness with 1 standard deviation was associated with a decreased likelihood of postponement of care for financial reasons (odds ratio 0.923, 95% confidence interval 0.869-0.981).

INTERPRETATION

Person-centred care by general practitioners in Europe was associated with lower financially driven postponement of care, irrespective of the strength of a country's primary care system.

What we know about the purpose, theoretical foundation, scope and dimensionality of existing self-management measurement tools: A scoping review

OBJECTIVES

To identify self-report, self-management measures for adults with chronic conditions, and describe their purpose, theoretical foundation, dimensionality (multi versus uni), and scope (generic versus condition specific).

METHODS

A search of four databases (8479 articles) resulted in a scoping review of 28 self-management measures.

RESULTS

Although authors identified tools as measures of self-management, wide variation in constructs measured, purpose, and theoretical foundations existed. Subscales on 13 multidimensional tools collectively measure domains of self-management relevant to clients, however no one tool's subscales cover all domains.

CONCLUSIONS

Viewing self-management as a complex, multidimensional whole, demonstrated that existing measures assess different, related aspects of self-management. Activities and social roles, though important to patients, are rarely measured. Measures with capacity to quantify and distinguish aspects of self-management may promote tailored patient care.

PRACTICE IMPLICATIONS

In selecting tools for research or assessment, the reason for development, definitions, and theories underpinning the measure should be scrutinized. Our ability to measure self-management must be rigorously mapped to provide comprehensive and system-wide care for clients with chronic conditions. Viewing self-management as a complex whole will help practitioners to understand the patient perspective and their contribution in supporting each individual patient.